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Requires the Secretary of HHS to develop a process that provides for the redistribution of residency slots in the case of certain hospitals with an approved medical residency program closing on or after March 23, 2008. Provides that these modifications not be made in a way that would necessitate the reopening of any settled hospital cost report for which there is not an appeal pending as of March 23, 2010 regarding payment of IME or direct GME.
2010
In November 2010, CMS addressed the implementation of this provision in its CY 2011 HOPPS/ASC final rule and provided subsequent clarification in its FY 2013 IPPS/LTCH final rule issued in August 2012 re: notice of closure of teaching hospitals and opportunity to apply for available slots (previous notices issued as well in this regard _ e.g., see here). The final FY 2013 IPPS/LTCH rule also delineated revisions to the application submission time frame, ranking criteria, as well as certain other changes and clarifications. More information on this provision is also available on the CMS website here.
2013
On January 31, 2013, CMS issued instructions to its contractors for incorporating section 5506 resident cap increases that are effective retroactively on applicable hospitals’ cost reports that have already been filed, and for recalculating the hospital’s direct GME and IME payments accordingly on those filed cost reports. The CMS transmittal applied to Round 1 and Round 2 of section 5506.
On August 2, CMS released its FY 2014 Inpatient Prospective Payment System/Long-Term Care Hospital (IPPS/LTCH) final rule in which it announced a sixth round of the redistribution of IME and GME FTE residency slot caps, pursuant to this provision of the ACA, in light of certain teaching hospital closures (Cooper Green Mercy Hospital, in Birmingham, AL, and Sacred Heart Hospital, in Chicago, IL). Applications to receive redistributed resident slots from these two closed teaching hospitals are due by 5pm EST on October 31, 2013. See here for additional details.
2014
On February 12, 2014, HRSA issued a revision of the current CHGME information collection (available here) that was submitted by the agency to OMB to effectuate various policy changes set forth by the ACA, including “changes on counting resident time in non-provider settings, counting resident time for didactic training, and the re-distribution of resident caps” – all of which required subsequent modification of the data collection forms within the CHGME Payment Program application.
On April 18 2014, CMS issued instructions to its contractors regarding implication of this section of the ACA pertaining to the preservation of resident cap positions from closed teaching hospitals.
2015
On Dec. 31, CMS announced its decision regarding ”which teaching hospitals are receiving increases to their Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) full-time equivalent (FTE) resident caps under Round 7” pursuant to this provision of the ACA.
2016
On August 2, 2016 CMS announced Rounds 8, 9, and 10 for redistributing residency cap slots authorized after a participating hospital closed. Details are delineated in the FY 2017 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule. The resident cap slots of the following closed hospitals will be redistributed: Round 8: Pacific Hospital of Long Beach, in Long Beach, CA (CCN 050277); Round 9: Huey P. Long Medical Center, in Pineville, LA (CCN 190009); and Round 10: St. Joseph’s Hospital, in Philadelphia, PA (CCN 390132). First priority is given to hospitals in the same or contiguous core-based statistical areas as the closed hospitals. CMS must receive hard copy applications for these resident cap slots by 5pm ET on Oct. 31. For more information, please also see here.
2019
On November 1, 2019, CMS released the calendar year (CY) 2020 hospital outpatient prospective payment system (OPPS) final rule, in which the agency initiated two 90-day application processes to redistribute the full-time equivalent (FTE) residency slots previously apportioned to Hahnemann University Hospital in Philadelphia, PA and the Ohio Valley Medical Center in Wheeling, WV. The closure of Hahnemann University Hospital constituted the 16th Round of the ACA Sec. 5506 application and selection process, and the closure of Ohio Valley Medical Center initiated the 17th Round.
More information on Section 5506, including the posted results from previous Cap Increase Rounds 1-13, are available here.
SEC. 5506. PRESERVATION OF RESIDENT CAP POSITIONS FROM
CLOSED HOSPITALS.
(a) GME.—Section 1886(h)(4)(H) of the Social Security Act (42
U.S.C. Section 1395ww(h)(4)(H)) is amended by adding at the end
the following new clause:
‘‘(vi) REDISTRIBUTION OF RESIDENCY SLOTS AFTER A
HOSPITAL CLOSES.—
‘‘(I) IN GENERAL.—Subject to the succeeding
provisions of this clause, the Secretary shall, by
regulation, establish a process under which, in the
case where a hospital (other than a hospital described
in clause (v)) with an approved medical
residency program closes on or after a date that is
2 years before the date of enactment of this
clause, the Secretary shall increase the otherwise
applicable resident limit under this paragraph for
other hospitals in accordance with this clause.
‘‘(II) PRIORITY FOR HOSPITALS IN CERTAIN
AREAS.—Subject to the succeeding provisions of
this clause, in determining for which hospitals the
increase in the otherwise applicable resident limit
is provided under such process, the Secretary
shall distribute the increase to hospitals in the following
priority order (with preference given within
each category to hospitals that are members of
the same affiliated group (as defined by the Secretary
under clause (ii)) as the closed hospital):
‘‘(aa) First, to hospitals located in the
same core-based statistical area as, or a corebased
statistical area contiguous to, the hospital
that closed.
‘‘(bb) Second, to hospitals located in the
same State as the hospital that closed.
‘‘(cc) Third, to hospitals located in the
same region of the country as the hospital
that closed.
‘‘(dd) Fourth, only if the Secretary is not
able to distribute the increase to hospitals described
in item (cc), to qualifying hospitals in
accordance with the provisions of paragraph
(8).
‘‘(III) REQUIREMENT HOSPITAL LIKELY TO FILL
POSITION WITHIN CERTAIN TIME PERIOD.—The Secretary
may only increase the otherwise applicable
resident limit of a hospital under such process if
the Secretary determines the hospital has demonstrated
a likelihood of filling the positions made
available under this clause within 3 years.
‘‘(IV) LIMITATION.—The aggregate number of
increases in the otherwise applicable resident limits
for hospitals under this clause shall be equal
to the number of resident positions in the approved
medical residency programs that closed on
or after the date described in subclause (I).
‘‘(V) ADMINISTRATION.—Chapter 35 of title 44,
United States Code, shall not apply to the implementation
of this clause.’’.
(b) IME.—Section 1886(d)(5)(B)(v) of the Social Security Act
(42 U.S.C. 1395ww(d)(5)(B)(v)), in the second sentence, as amended
by section 5503, is amended by striking ‘‘subsections (h)(7) and
(h)(8)’’ and inserting ‘‘subsections (h)(4)(H)(vi), (h)(7), and (h)(8)’’.
(c) APPLICATION.—The amendments made by this section shall
not be applied in a manner that requires reopening of any settled
hospital cost reports as to which there is not a jurisdictionally
proper appeal pending as of the date of the enactment of this Act
on the issue of payment for indirect costs of medical education
under section 1886(d)(5)(B) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(B)) or for direct graduate medical education costs
under section 1886(h) of such Act (42 U.S.C. Section 1395ww(h)).
(d) EFFECT ON TEMPORARY FTE CAP ADJUSTMENTS.—The Secretary
of Health and Human Services shall give consideration to
the effect of the amendments made by this section on any temporary
adjustment to a hospital’s FTE cap under section 413.79(h)
of title 42, Code of Federal Regulations (as in effect on the date of
enactment of this Act) in order to ensure that there is no duplication
of FTE slots. Such amendments shall not affect the application
of section 1886(h)(4)(H)(v) of the Social Security Act (42 U.S.C.
1395ww(h)(4)(H)(v)).
(e) CONFORMING AMENDMENT.—Section 1886(h)(7)(E) of the Social
Security Act (42 U.S.C. 1395ww(h)(7)(E)), as amended by section
5503(a), is amended by striking ‘‘paragraph or paragraph (8)’’
and inserting ‘‘this paragraph, paragraph (8), or paragraph
(4)(H)(vi)’’.
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