Bill Text: NJ AR95 | 2014-2015 | Regular Session | Introduced
Bill Title: Urges federal government to take appropriate action to ensure timely, annual provision of graduate medical education funding to new teaching hospitals.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2014-03-10 - Introduced, Referred to Assembly Higher Education Committee [AR95 Detail]
Download: New_Jersey-2014-AR95-Introduced.html
Sponsored by:
Assemblywoman CAROLINE CASAGRANDE
District 11 (Monmouth)
SYNOPSIS
Urges federal government to take appropriate action to ensure timely, annual provision of graduate medical education funding to new teaching hospitals.
CURRENT VERSION OF TEXT
As introduced.
An Assembly Resolution concerning new teaching hospitals and the timely provision of federal funding for graduate medical education.
Whereas, The federal government currently authorizes teaching hospitals to obtain federal funding through the Medicare and Medicaid programs, in order to offset the costs associated with the provision of graduate medical education (GME); and
Whereas, The amount of federal GME funding to which a teaching hospital is entitled is dependent upon the number of full-time equivalent (FTE) residents who are receiving medical residency training in the hospital complex; and
Whereas, The number of FTE residents that may be counted by a teaching hospital for the purposes of GME funding is capped by the Centers for Medicare and Medicaid Services (CMS); and
Whereas, Although CMS generally establishes an FTE resident cap by looking to the number of FTE residents that were identified by a teaching hospital in its most recent cost report for the period ending on or before December 31, 1996, CMS does not require a new teaching hospital - established on or after January 1, 1995 - to be bound by this rule, and it instead authorizes such a hospital to upwardly adjust its FTE resident cap to its final and permanent value after the passage of a specified period of time - particularly, after three years of program operation, if the hospital's new medical residency training program was established before October 1, 2012, and after five years of program operation, if the hospital's new medical residency training program was established on or after October 1, 2012; and
Whereas, In addition, and in order to account for the rapid growth and expansion that takes place in new medical residency training programs, CMS also allows for the temporary adjustment of a new teaching hospital's FTE resident cap, during each of the first three or five years of its residency program's operation, as appropriate, and prior to the date of final cap adjustment, on the basis of FTE resident tallies contained in cost reports that are annually submitted by the hospital during this three- or five-year cap-building period; and
Whereas, Although a new teaching hospital is subject to FTE resident cap adjustments both during and immediately following its initial cap-building period, a hospital's actual receipt of associated federal GME payments often lags far behind the dates of these cap adjustments; and
Whereas, This delay in the actual disbursement and receipt of federal GME payments is a consequence of the fact that it normally takes one year or more for CMS to audit and approve a new teaching hospital's annual cost report for Medicare GME funding purposes, and additional time thereafter - generally one to two years - for the audited cost report to be approved for Medicaid GME funding purposes; and
Whereas, This delay in the processing of a teaching hospital's annual cost reports means that a new teaching hospital may receive GME funding on the basis of outdated FTE resident counts, in an amount that is disproportionate to the actual number of FTE residents that were enrolled in the new medical residency training program during the immediately preceding cost reporting period; and
Whereas, Although CMS has attempted to encourage the growth and expansion of new medical residency training programs by authorizing the regular adjustment of FTE resident caps during a residency program's first years of operation, the cost report processing protocols utilized by CMS actually work to impede and obstruct the growth of new teaching hospitals, since these protocols effectively prevent these hospitals from gaining timely access to funds that are needed both to support their existing resident populations and to finance the continued expansion of these resident populations during the cap-building period; and
Whereas, Because the cost report auditing and approval protocols employed by CMS effectively hinder the rapid growth and expansion of new medical residency training programs in the State, it is both reasonable and necessary for the federal government to take appropriate action to revise these protocols, in order to ensure that GME funds are timely disbursed to new teaching hospitals, every year, based on the hospitals' most recent FTE resident data; now, therefore,
Be It Resolved by the General Assembly of the State of New Jersey:
1. This House urges the United States Congress and the Centers for Medicare and Medicaid Services to take action, as appropriate, to revise the laws and regulations associated with the provision of federal GME funding to new teaching hospitals - particularly, those laws and regulations associated with the audit and approval of cost reports submitted by a new teaching hospital for temporary or permanent FTE resident cap adjustment purposes - in order to provide the mechanisms and authorizations necessary to ensure the timely, annual disbursement of GME funds to new teaching hospitals during, and immediately following, their allotted FTE resident cap-building periods.
2. Copies of this resolution, as filed with the Secretary of State, shall be transmitted by the Clerk of the General Assembly to the Administrator of the Centers for Medicare and Medicaid Services, the President of the United States Senate, the Speaker of the United States House of Representatives, and each member of Congress elected from this State.
STATEMENT
This resolution urges the U.S. Congress and the Centers for Medicare and Medicaid Services (CMS) to take appropriate action to ensure that new teaching hospitals are timely provided with annual federal funding for graduate medical education (GME).
Teaching hospitals in the State are authorized to offset their GME expenses through federal funding provided under the Medicare and Medicaid programs. The amount of federal funding to which a teaching hospital is entitled is dependent upon the number of full-time equivalent (FTE) residents who are receiving medical residency training in the hospital complex; however the number of FTE residents that may be counted for GME funding purposes is capped by CMS. Although a teaching hospital's FTE resident cap is generally established by looking to FTE resident tallies, which were identified by the hospital during its most recent cost reporting period ending on or before December 31, 1996, new teaching hospitals are not subject to this rule, and are instead authorized to upwardly adjust their FTE resident cap after the passage of a specified period of time - specifically, after three years of operation, if the hospital's new residency training program was established before October 1, 2012, and after five years of operation, if the hospital's new residency training program was established on or after October 1, 2012. In addition, CMS authorizes the temporary adjustment of the FTE resident cap, prior to the date of its final adjustment, during each year of this three- or five-year cap-building period.
Although a new teaching hospital is subject to FTE resident cap adjustments both during and immediately following its initial cap-building period, a hospital's actual receipt of associated federal GME payments often lags far behind the dates of these cap adjustments. This delay is a consequence of the fact that it normally takes one year or more for CMS to audit and approve a new teaching hospital's annual cost report for Medicare GME funding purposes, and additional time thereafter - generally one to two years - for the audited cost report to be approved for Medicaid GME funding purposes.
This processing delay means that a new teaching hospital may receive GME funding on the basis of outdated FTE resident counts, in an amount that is disproportionate to the actual number of FTE residents that were enrolled in a new medical residency training program during the immediately preceding cost reporting period. The protocols used in the processing of hospital cost reports, therefore, actually work to impede and obstruct the growth of new teaching hospitals, since they prevent these hospitals from gaining timely access to the funds that are needed to both support their existing resident populations and to finance the continued expansion thereof during the cap-building period. Accordingly, this resolution advocates for the revision of these protocols, so that the federal government may ensure that GME funds are timely disbursed to new teaching hospitals, every year, based on the hospitals' most recent FTE resident data.
