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Content provided by the Catalog of Federal Domestic Assistance
93.255 Children's Hospitals Graduate Medical Education Payment

AUTHORIZATION:

Public Health Service Act, Title III Part D, Section 340E, 42 U.S.C. 256E, as amended; The Children's Health Act, 2000, Public Law 106-310, Healthcare Research and Quality Act, 1999, Public Law 106-129; as amended; Public Law 109-307; Social Security Act.
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The Children's Hospitals Graduate Medical Education (CHGME) Payment Program provides funds to children's teaching hospitals to support the training of pediatric and other residents in graduate medical education (GME) programs. Since Federal financial support of graduate medical education is extensively supported by the Medicare system, the CHGME Payment Program compensates for the disparity in the level of Federal funding for Freestanding children’s teaching hospitals versus other types of teaching hospitals. The Secretary of DHHS has delegated the authority for the administration of the CHGME Payment Program to Health Resources and Services Administration (HRSA), which redelegated it to the Bureau of Health Professions (BHP).

TYPES OF ASSISTANCE:

Direct Payments for Specified Use
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USES AND USE RESTRICTIONS:

Funds are restricted to eligible children's hospitals for direct expenses and the other indirect expenses associated with operating approved graduate medical residency programs. See above for additional information.

ELIGIBILITY REQUIREMENTS:

Applicant Eligibility:   Applicants (children's teaching hospitals) must meet the following eligibility requirements in accordance with the Federal Register Notice, Vol. 66, No. 41 published on March 1, 2001: (1) Participate in an approved graduate medical education program; (2) have a Medicare provider agreement; (3) be excluded from the Medicare Inpatient Prospective Payment System (PPS) under Section 1886(d)(1)(B)(iii), of the Social Security Act and its accompanying regulations; and (4) be a "freestanding" children's hospital.

Beneficiary Eligibility:   Any public or private nonprofit and profit children's teaching hospital with an accredited residency training program which meets all eligibility requirements may apply.

Credentials/Documentation:   Applicants should review the individual HRSA funding opportunity announcement issued under this CFDA program for any required proof or certifications which must be submitted prior to or simultaneous with submission of an application package. This program is excluded from coverage under OMB Circular No. A-87.

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APPLICATION AND AWARD PROCESS:
Pre-application Coordination:   Preapplication coordination is required. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.

Application Procedure:   This program is excluded from coverage under OMB Circular No. A-102. OMB Circular No. A-110 applies to this program. Applications are made by submission of application face page (HRSA 99), determination of weighted and unweighted resident FTE count form (HRSA 99-1), indirect medical education data related to the teaching of residents form (HRSA 99-2), assurance/certification attestation form (HRSA 99-3), and the performance data (GPRA) tables (HRSA 99-4). For children's teaching hospitals that file full Medicare Cost Reports, adjudication is conducted by comparing the hospital's application to the Medicare Fiscal Intermediary reports. A comprehensive FTE resident assessment is conducted is each fiscal year for all children’s hospitals applying for funds. This assessment mirrors CMS audits of Medicare Cost Reports. The aforementioned documents are available electronically via the CHGME PP web site at http://www.bhpr.hrsa.gov/childrenshospitalgme/.

All qualified applications will be forwarded to an objective review committee. Based on the advice of the objective review committee, the HRSA program official with delegated authority is responsible for final selection and funding decisions.

Award Procedure:   Notification is made in writing by a Notice of Award. Section 340E(a) requires the Secretary of DHHS to make payments for direct and indirect expenses associated with operating approved graduate medical residency training programs for each fiscal year. The two statutory formulas (direct medical education and indirect medical education) payments to eligible children's teaching hospitals are made as outlined in Federal Register Notice (FRN) Vol. 65, No. 118 published on June 19, 2000; FRN Vol. 66, No. 41 published on March 1, 2001; and FRN Vol. 66, No. 140 published on July 20, 2001 and FRN Vol.67, No. 186, published on September 25, 2002. and FRN Vol 68, No. 208, published October 22, 2003. The formula was updated to incorporate section 422 of the Medicare Modernization Act (MMA) and updates to variables used in the formulas made by CMS through rules and regulations.

Deadlines:   Contact the headquarters or regional office, as appropriate, for application deadlines.

Range of Approval/Disapproval Time:   

Not Applicable.

Appeals:   

Hospitals can appeal the determination of FTE resident counts by CHGME fiscal intermediaries to the Provider Reimbursement Review Board (PRRB) under section 1878 of the Social Security Act.

Renewals:   

Eligible children's hospitals must complete a CHGME Payment Program application for inclusion in the program for each fiscal year that they are applying for funds. They must also submit a reconciliation application that will reflect the “Secretary determination of the Final FTE resident counts” carried out by CHGME fiscal intermediaries led by the Blue Cross and Blue Shield Association (BCBSA). The BCBSA is under contract the BHP to conduct the assessments of residents’ counts reported by children’s hospitals on their initial applications for funds.

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ASSISTANCE CONSIDERATIONS:

Formula and Matching Requirements:   

Statutory formulas are not applicable to this program.
Matching requirements are not applicable to this program.
MOE requirements are not applicable to this program.

Length and Time Phasing of Assistance:   

In accordance with the Healthcare Research and Quality Act, 1999, Public Law 106-129, the Secretary of DHHS shall determine before the beginning of each fiscal year that payments are made for a hospital. The amounts of the payments for direct and indirect medical education are made to each hospital in 12 equal interim installments during the period. The Children's Health Act, Public Law 106-310, amends the length of the CHGME Payment Program through fiscal year 2005. Public Law 109-307 re-authorizes the program, through fiscal year 2011.

In accordance with the Healthcare Research and Quality Act, 1999, Public Law 106-129, the Secretary of DHHS shall determine before the beginning of each fiscal year that payments are made for a hospital. The amounts of the payments for direct and indirect medical education are made to each hospital in 12 equal interim installments during the period. The Children's Health Act, Public Law 106-310, amends the length of the CHGME Payment Program through fiscal year 2005. Public Law 109-307 re-authorizes the program, through fiscal year 2011. . See the following for information on how assistance is awarded/released: Grantees drawdown funds, as necessary, from the Payment Management System (PMS). PMS is the centralized web based payment system for HHS awards. See the following for information on how assistance is awarded/released: Grantees drawdown funds, as necessary, from the Payment Management System (PMS). PMS is the centralized web based payment system for HHS awards.

POST ASSISTANCE REQUIREMENTS:

Reports:   Public Law 109-307 requires children’s hospitals receiving CHGME funds to submit an annual report that focuses on their GME training program. The Department has to submit a report to Congress by 2011. The children’s hospitals comply with the Government Performance Result Act (GPRA) and submit performance data each fiscal year as part of their reconciliation applications for funds. No cash reports are required. No progress reports are required. No expenditure reports are required. No performance monitoring is required.

Audits:   This program is excluded from coverage under OMB Circular No. A-133. DHHS, or any other authorized Federal agency, may conduct an audit to determine whether the applicant has complied with all governing laws and regulations in its application for funding. Any and all information submitted to DHHS by an applicant or participating hospital during or after the award of funds is subject to review in an audit. Eligible hospitals are subjected to the terms of the Full-Time Equivalent Assessment Process Guidance and Assessments which is available electronically via CHGME Payment Program web site noted in Application Procedure above.

Records:   Grantees are required to maintain grant accounting records for 3 years after the date they submit the Federal Financial Report (FFR). If any litigation, claim, negotiation, audit, or other action involving the award has been started before the expiration of the 3-year period, the records shall be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular 3-year period, whichever is later.

FINANCIAL INFORMATION:

Account Identification:  

75-0350-0-1-550.

Obligations:   (Direct Payments for Specified Use) FY 09 $297,000,000; FY 10 est $317,500,000; FY 11 est $317,500,000

Range and Average of Financial Assistance:  

Range: $39,000-$17,786,000; average $4,798,000 in combined DME and IME payments.

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PROGRAM ACCOMPLISHMENTS:
Fiscal Year 2009: The CHGME Payment Program made awards to 57 eligible children's teaching hospitals in FY 01, 59 eligible children's teaching hospitals in FY 02, 61 in FY 03, 61 in FY 04, 60 in FY 05, FY 06, and FY 07, and 56 children’s hospitals in FY 09. Fiscal Year 2010: It is estimated that awards will be made to 56 eligible teaching hospitals. Fiscal Year 2011: No Current Data Available

REGULATIONS, GUIDELINES, AND LITERATURE:

Healthcare Research and Quality Act, 1999 (Public Law 106-129), Section 340E of the Public Health Service Act; The Children's Health Act, 2000 (Public Law 106-310, Title XX); Public Law 108-490; Public Law 109-307; Social Security Act, Section 1886, 42 CFR 412.105; 42 CFR 413.86; FRN Vol. 65, No. 118 published on June 19, 2000; FRN Vol. 66, No. 41 published on March 1, 2001; and FRN Vol. 66, No. 140 published on July 20, 2001, and FRN Vol. 68, No. 204, published on October 22, 2003.

HRSA awards are subject to the requirements of the HHS Grants Policy Statement (HHS GPS) that are applicable based on recipient type and purpose of award. The HHS GPS is available at http://www.hrsa.gov/grants.

INFORMATION CONTACTS:

Regional or Local Office:   See Regional Agency Offices.

Headquarters Office:   Marshala Lee, Children Hospitals Graduate Medical Education Training Branch, Division of Medicine and Dentistry, Bureau of Health Workforce 5600 Fishers Lane, Room 15N142, Rockville , Maryland 20857 Email: Mlee1@hrsa.gov Phone: (301) 443-8681 Fax: (301) 443-8890

Web Site Address:  
http://www.bhpr.hrsa.gov/childrenshospitalgme

EXAMPLES OF FUNDED PROJECTS:

Not Applicable.

CRITERIA FOR SELECTING PROPOSALS:

Children's teaching hospitals must meet all of the eligibility criteria before being considered for program funds and must be training residents during the year for which they are applying for funding. This is a noncompetitive annual award.

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