On August 2, 2018, CMS released its latest IPPS rule for fiscal year 2019 (last rule) that now allows new municipal teaching hospitals to enter into Medicare GME membership agreements to share RDT slots to allow cross-training of residents. 5. When the Medicare GME affiliate agreement ends for any reason, the ETP ceiling for each hospital in the Medicare GME affiliated group is reset to the ETP ceiling of each hospital set in accordance with point c) of this section. In particular, from July 1, 2019, a new municipal teaching hospital will be eligible for admission to a Medicare GME affiliate group, consisting of two or more new municipal teaching hospitals, and benefit from lower ETP caps. In addition, from 1 July 2018, new municipal teaching hospitals will be able to enter a Medicare GME-linked group with existing teaching hospitals (i.e. hospitals capped at 1996 FTEs) and benefit from a reduction in ETP caps as long as the caps of the new municipal teaching hospital have been in effect for five years or more. In other words, once the ceilings for a new municipal teaching hospital are effective, the new municipal teaching hospital will be able, after a cap period, to participate in a GME Medicare membership agreement with an existing teaching hospital and, after an additional five-year waiting period, obtain a reduction in the ETP caps. (4) The net effect of adjustments (positive or negative) on the total ceiling of Medicare GME hospitals for each GME Medicare affiliation agreement may be zero. iv) If the total number of ETP residents is less than the overall ceiling for ETP residents, the Medicare contractor would determine, on a hospital basis, whether the number of residents in certain hospitals is below the ceiling applicable to ETP residents (according to membership agreements) in the hospital`s reference cost report. During the fiscal year (FY) 2019, the Fixed Payment System (IPPS) proposed: to allow new municipal teaching hospitals to jointly use GME research and development niches with other new teaching hospitals, while, in the final rule of GJ 2019, CMS has expanded this proposal to allow new municipal teaching hospitals to share GME TDR slots with existing teaching hospitals that begin five years after meeting their ETP caps. This final rule could create new opportunities for the teaching of hospitals that have exceeded their ETP ceilings for slot machine subscriptions.

(iii) Exemption from the common rotation agreement requirement. During the effective period of the Medicare GME emergency contract, Hospitals of the Medicare GME Group are not required to comply with a joint rotation agreement in accordance with . 413.75, point b). (i) the requirements for the submission of Emergency Medicare GME agreements. Each hospital in the Medicare GME group must submit an emergency medicare GME affiliation agreement, written, signed and dated by the representatives of each participating hospital in the manner referred to in paragraph ii) and containing the following information: (1) Except as provided at point f) (6) of this section, each hospital in the Medicare GME group is required to submit the Medicare GME affiliate agreement. , as in. 413.75 (b) of this section, to the CMS or MAC holder who cares for the hospital, and send a copy to the CMS central office by July 1 of the residence program in which the Medicare GME membership agreement is in effect.