Children's Hospitals Graduate Medical Education Payment Program
Freestanding children?s hospitals receive little to no Graduate Medical Education (GME) funding from Medicare because children?s hospitals have a low Medicare caseload. The purpose of the CHGME Payment Program is to compensate for the disparity in the level of Federal GME funding for freestanding children?s teaching hospitals versus other types of teaching hospitals. The CHGME program supports the education and training of future pediatricians, pediatric sub-specialists, and other non-pediatric residents in freestanding children?s teaching hospitals, including the training of residents in pediatric dentistry and pediatric psychology.
General information about this opportunity
Last Known Status
Health Resources and Services Administration, Department of Health and Human Services
Type(s) of Assistance Offered
C - Direct Payments For Specified Use
Fiscal Year 2016
In Academic Year 2015-2016, the CHGME program supported the training of 5,017 pediatric residents that included general pediatrics residents, as well as residents from five types of combined pediatrics programs (e.g., internal medicine/ pediatrics). Additionally, 2,713 pediatric medical subspecialists, 285 pediatric surgical subspecialists, and 365 pediatric dentistry residents were trained. The CHGME also supported training of 3,120 non-pediatric residents and fellows in the care of children. CHGME-funded medical residents and fellows provided a total of 2,075,887 patient encounters in primary care settings and a total of 4,799,074 patient contact hours in medically underserved communities.Fiscal Year 2017
: In Academic Year (AY) 2016-2017, CHGME supported the training of 4,975 Pediatric residents that included General Pediatrics residents, as well as residents from seven types of combined pediatrics programs (e.g., Internal Medicine/Pediatrics). Additionally, CHGME supported 2,962 Pediatric Medical Subspecialists, 234 Child and Adolescent Psychiatry fellows, 424 CHGME-funded Advanced Dentistry residents including 300 Pediatric Dentists, and 3,571 Adult Medical and Surgical Specialists. Pediatric residents supported by the CHGME program accounted for 47 percent of all Pediatric residents trained in the United States during AY 2016-2017. Additionally, Pediatric Medical and Surgical Specialists and Subspecialists supported by CHGME accounted for 58 percent of pediatric specialists trained in the United States. CHGME-funded medical residents and fellows provided care during more than 1.7 million patient encounters in primary care settings. CHGME-funded medical residents and fellows provided over 5.2 million hours of patient care in medically underserved communities.Fiscal Year 2018
No Current Data AvailableFiscal Year 2019
No Current Data Available
Section 340E of the Public Health Service Act (42 U.S.C. 256e),
Who is eligible to apply/benefit from this assistance?
A children's hospital is eligible to apply for CHGME Payment Program funding if it participates in an approved GME program; has a Medicare Provider Agreement; is excluded from the Medicare Inpatient Prospective Payment System (IPPS); and operates as a freestanding children's teaching hospital. A freestanding children's teaching hospital does not operate under a Medicare hospital provider number assigned to a larger health care entity that receives Medicare GME payments. A hospital remains eligible for payments as long as it trains residents as a freestanding children's hospital during the federal fiscal year that HRSA makes CHGME program payments.
Any public or private nonprofit and profit freestanding children's teaching hospital with an accredited residency training program which meets all eligibility requirements may apply.
Applicants should review the individual HRSA funding opportunity announcement issued under this CFDA program for any required proof or certifications which must be submitted with an application package.
What is the process for applying and being award this assistance?
Preapplication coordination is required. An environmental impact statement is required for this listing. An environmental impact assessment is required for this listing. This program is eligible for coverage under E.O. 12372, "Intergovernmental Review of Federal Programs." An applicant should consult the office or official designated as the single point of contact in his or her State for more information on the process the State requires to be followed in applying for assistance, if the State has selected the program for review. Preapplication coordination is required. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. This program is excluded from coverage under 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. HRSA requires all applicants to apply electronically through Grants.gov. All eligible qualified applications are reviewed by HRSA Staff. Notification is made in writing by a Notice of Award.
Notification is made in writing (electronic) by a Notice of Award (NOA). 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) outline payments to eligible children's teaching hospitals.
Contact the headquarters or regional location, as appropriate for application deadlines
Approval/Disapproval Decision Time
Approximately 120 to 180 days after receipt of applications.
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.
How are proposals selected?
Freestanding children's hospitals that meet the legislative requirements are deemed eligible to received funding under the CHGME Payment Program. Two type of categories of children's hospitals are eligible for CHGME funding and are either "Currently Eligible Hospitals" or "Newly Qualified Hospitals". Currently Eligible Hospitals are freestanding children's hospitals that meet the original eligibility requirements established prior to the Children's Hospital GME Support Reauthorization Act of 2013. Newly Qualified Hospitals are freestanding children's hospitals that meet the eligibility requirements in the Children's Hospital GME Support Reauthorization Act of 2013
How may assistance be used?
Funds are restricted to eligible children's hospitals for direct expenses and the other indirect expenses associated with operating approved graduate medical residency programs.
What are the requirements after being awarded this opportunity?
This program is excluded from coverage under 2 CFR 200, Subpart F - Audit Requirements. 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. 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.
Recipients 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.
Other Assistance Considerations
Formula and Matching Requirements
Statutory formula is not applicable to this assistance listing.
Matching requirements are not applicable to this assistance listing.
MOE requirements are not applicable to this assistance listing.
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 the number of resident FTE counts 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 Federal fiscal year. Both interim payments (prior to audits) and final payments are computed using a zero sum gain payment model. The calculations of both direct and indirect graduate medical education payments are formula based. Once payments are determined, recipients drawdown funds, as necessary, from the Payment Management System (PMS), the centralized web based payment system for HHS awards.
Who do I contact about this opportunity?
Regional or Local Office
Lisa Flach-Fulcher , Division of Medicine and Dentistry, Bureau of Health Workforce
5600 Fishers Lane, Room 15N190A
Rockville, MD 20857 US
(Direct Payments for Specified Use) FY 18$300,000,000.00; FY 19 est $300,000,000.00; FY 20 est $0.00; FY 17$282,823,526.00; FY 16$279,033,446.00; -
Range and Average of Financial Assistance
FY 18 Range: $32,294-$21,826,749; Average $5,161,757 in combined DME and IME payments. FY 19 Range est: $27,269-$21,538,999; Average $5,172,414 in combined DME and IME payments. FY 20 Range est: $0 ; Average $0
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 also 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/hhsgrantspolicy.pdf.
Examples of Funded Projects