Who can apply:
There are two categories of children’s hospitals that may be eligible for CHGME payments in FY 2023, depending on the funding appropriated to the program – “Currently Eligible Hospitals” and “Newly Qualified Hospitals.” Hospitals that are applying for the first time for the CHGME Payment Program may be hospitals that are new to the CHGME Payment Program but qualify under the “Currently Eligible Hospitals” requirements or are eligible as a “Newly Qualified Hospital.” a. Currently Eligible Hospitals: Includes freestanding children’s hospitals that meet the original eligibility requirements for CHGME payments that were established prior to the Children’s Hospital GME Support Reauthorization Act of 2013. These freestanding children’s hospitals must meet the following criteria: 1) Have a Medicare provider agreement; 2) Are excluded from the Medicare Inpatient Prospective Payment System (IPPS) pursuant to section 1886(d)(1)(B)(iii) 4 of the Social Security Act (SSA) and its accompanying regulations; and 3) Participate in an approved GME residency training program as defined in section 1886(h)(5)(A) of the SSA. b. Newly Qualified Hospitals: As per the Children’s Hospital GME Support Reauthorization Act of 2013, a freestanding hospital may be eligible for CHGME payments depending on the level of funding appropriated to the program if it meets the following criteria: 1) Has a Medicare provider agreement; 2) Is excluded from Medicare IPPS pursuant to section 1886(d)(1)(B) of the SSA and its accompanying regulations; 3) Its inpatients are predominantly individuals under 18 years of age; 4) Has an approved medical residency training program as defined in section 1886(h)(5)(A) of the SSA; and 5) Is not otherwise qualified to receive payments as a Currently Eligible Hospital as defined by section 1886(h) of the SSA. For those freestanding children’s hospitals that met the above requirements for Newly Qualified Hospitals as of April 7, 2014, and the Secretary had not previously determined an average number of FTE residents under section 1886(h)(4) of the SSA, the Secretary may establish such number of FTE residents for the purposes of calculating CHGME Payment Program payments. Any public or private nonprofit and for-profit children's teaching hospital with an accredited residency training program (as defined below), that meets all of the above requirements for either category of eligibility may apply, though final eligibility for receiving funds as a “currently eligible hospital” or as a “newly qualified hospital” will depend on appropriated funding levels. Children’s hospitals applying for the CHGME Payment Program must train residents during the fiscal year for which they apply for funds. Residents may be included in a hospital’s FTE resident count for CHGME Payment Program purposes if the residency program (in which the resident is enrolled) meets one of the following criteria:
1. The program must lead toward board certification of its graduates by the American Board of Medical Specialties (ABMS) and also be approved for education and training activities by one of the following accrediting bodies:
- Accreditation Council for Graduate Medical Education
- American Osteopathic Association
- Commission on Dental Accreditation of the American Dental Association
- Council of Podiatric Medicine Education of the American Podiatric Medical Association
2. The program may count towards certification of the resident in a specialty or subspecialty listed in the current edition (at the time of the audit review) of the Directory HRSA-23-012 of Graduate Medical Education Programs (published by the American Medical Association) or the Annual Report and Reference Handbook (published by the American Board of Medical Specialties).
