In addition to the LTCH PPS proposed changes, CMS is using this proposed rule as an opportunity to propose an unrelated change regarding Medicare's payment policies for graduate medical education payments to a teaching hospital when its residents are being trained in a nonhospital site. Under current rules, if residents are training in a nonhospital setting, a teaching hospital may count those residents in calculating their graduate medical education payments if, in part, the teaching hospital pays "all or substantially all of the costs for the training program in the nonhospital setting." The proposed rule would amend this, effective July 1, 2007, to require that the teaching hospital pay at least 90 percent of the total costs of training residents in the nonhospital setting (including residents' salaries, fringe benefits, travel and lodging expenses when appropriate plus the portion of the cost of teaching physicians' salaries attributable to direct graduate medical education). To reduce the administrative burden of documenting those costs, CMS has also proposed to allow hospitals to utilize specified proxies to determine those costs.

CMS will accept comments on the proposed rule for 60 days, and will publish a final rule later this spring. The final rule will be effective for discharges occurring on or after July 1, 2007 through June 30, 2008.




Note: For more information, see the CMS web site at:

www.cms.hhs.gov/LongTermCareHospitalPPS/LTCHPPSRN/list.asp

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