[Federal Register Volume 87, Number 203 (Friday, October 21, 2022)]
[Notices]
[Pages 64061-64065]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-22862]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Agency Information Collection Activities: Proposed Collection: 
Public Comment Request; Information Collection Request Title: Initial 
and Reconciliation Application Forms To Report Graduate Medical 
Education Data and Full-Time Equivalent (FTE) Residents Trained by 
Hospitals Participating in the Children's Hospitals Graduate Medical 
Education Payment Program; and FTE Resident Assessment Forms To Report 
FTE Residents Trained by Organizations Participating in the Children's 
Hospitals and Teaching Health Center Graduate Medical Education 
Programs, OMB No. 0915-0247--Revision

AGENCY: Health Resources and Services Administration (HRSA), Department 
of Health and Human Services.

ACTION: Notice.

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SUMMARY: In compliance with the requirement for opportunity for public 
comment on proposed data collection projects of the Paperwork Reduction 
Act of 1995, HRSA announces plans to submit an Information Collection 
Request (ICR), described below, to the Office of Management and Budget 
(OMB). Prior to submitting the ICR to OMB, HRSA seeks comments from the 
public regarding the burden estimate, below, or any other aspect of the 
ICR.

DATES: Comments on this ICR should be received no later than November 
21, 2022.

ADDRESSES: Written comments and recommendations for the proposed 
information collection should be sent within 30 days of publication of 
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular 
information collection by selecting ``Currently under Review--Open for 
Public Comments'' or by using the search function.

FOR FURTHER INFORMATION CONTACT: To request more information on the 
proposed project or to obtain a copy of the data collection plans and 
draft

[[Page 64062]]

instruments, email [email protected] or call Samantha Miller, the 
acting HRSA Information Collection Clearance Officer, at (301) 443-
9094.

SUPPLEMENTARY INFORMATION: When submitting comments or requesting 
information, please include the ICR title for reference.
    Information Collection Request Title: Initial and Reconciliation 
Application Forms to Report Graduate Medical Education Data and FTE 
Residents Trained by Children's Hospitals Participating in the 
Children's Hospitals Graduate Medical Education (CHGME) Payment 
Program; and FTE Resident Assessment Forms to Report FTE Residents 
Trained by Organizations Participating in the Children's Hospitals and 
Teaching Health Center Graduate Medical Education (THCGME) Programs, 
OMB No. 0915-0247--Revision.
    Abstract: The Healthcare Research and Quality Act of 1999 (Pub. L. 
106-129) established the CHGME Payment Program, Section 340E of the 
Public Health Service Act, most recently amended by the Dr. Benjy 
Frances Brooks Children's Hospital Graduate Medical Education (GME) 
Support Reauthorization Act of 2018 (Pub. L. 115-241). In 2010, the 
Patient Protection and Affordable Care Act (Pub. L. 111-148) 
established the THCGME Program, Section 340H of the Public Health 
Service Act, most recently amended by the Consolidated Appropriations 
Act, 2021 (Pub. L. 116-260). The American Rescue Plan Act of 2021 (Pub. 
L. 117-2) provided additional funding for the THCGME Program.
    The CHGME Payment Program and the THCGME Program provide federal 
funding to support GME programs that train medical and dental 
residents. Specifically, the CHGME Payment Program supports residency 
programs at freestanding children's hospitals that train residents in 
pediatric, pediatric subspecialty, and non-pediatric care. The THCGME 
Program supports training for primary care residents (including 
residents in family medicine, internal medicine, pediatrics, internal 
medicine-pediatrics, obstetrics and gynecology, psychiatry, general 
dentistry, pediatric dentistry, and geriatrics) in community-based 
ambulatory patient care settings.
    Children's hospitals and teaching health centers funded by HRSA's 
CHGME and THCGME programs, respectively, are required to report the 
number of FTE residents trained during the federal fiscal year (FY). 
Fiscal intermediaries are contracted by HRSA to carry out an assessment 
of FTE resident counts reflected in participating children's hospitals 
and teaching health centers applications to determine any changes to 
the resident FTE counts initially reported. Fiscal intermediaries audit 
the data reported by the children's hospitals and the teaching health 
centers and report the verified FTE resident counts to HRSA. An 
assessment of the children's hospital and teaching health center data 
ensures that applicable Medicare regulations and HRSA program 
requirements are followed when determining the number of full-time 
equivalent residents eligible for funding.
    HRSA plans to submit an Information Collection Request for several 
reasons. First, the current OMB clearance for the CHGME Payment Program 
application and FTE resident assessment forms and exhibits expires 
January 31, 2023. Second, in addition to using the FTE resident 
assessment forms and exhibits for the CHGME Payment Program audits, 
HRSA plans to use CHGME FTE resident assessment forms and exhibits for 
THCGME Program audits. HRSA combined the FTE resident assessments of 
participating children's hospitals and teaching health centers into one 
audit contract to reduce costs to the federal government and to 
facilitate the fiscal intermediary's review of those residents training 
in both children's hospitals and teaching health centers funded by 
HRSA. As part of the FTE resident assessment process, the fiscal 
intermediary must ensure resolution of overlaps identified in the FTE 
residents reported between CHGME children's hospitals and the THCGME 
teaching health centers. The overlap reports indicate when an FTE 
resident is claimed for CHGME payment during the same period of 
training time claimed for reimbursement from any other source of 
federal GME funding, to include the THCGME Program. The use of the same 
FTE resident assessment forms and exhibits during the audit of both the 
children's hospitals and teaching health centers is more efficient for 
fiscal intermediaries to complete that perform both CHGME and THCGME 
audits, and for HRSA to review. Lastly, HRSA is proposing changes to 
the current CHGME Payment Program application and the FTE assessment 
forms and exhibits to be used for the CHGME Payment Program and THCGME 
Program. The changes are only proposed to the HRSA 99-1 form (also 
known as Exhibit O(2)), the HRSA 99-5 form, and the FTE resident 
assessment exhibits. All other CHGME Payment Program application and 
FTE resident assessment forms are the same as currently approved. The 
changes described require OMB approval and are as follows:
    1. CHGME Payment Program Application Instructions and Guidance: 
Update initial and reconciliation application instructions and 
guidance. Some of the examples provided in the instructions and 
guidance reference the FY 2010 application cycle and related dates. 
HRSA will update these dates to FY 2020 or more information that is 
relevant to applicants.
    2. CHGME Payment Program Application HRSA 99-1 form: Revise Lines 
4.05a, 5.05a, and 6.05a of the HRSA 99-1 form to include language 
referencing additional add-ons to the cap.
    To the extent that it is reasonable and feasible, HRSA adheres to 
Centers for Medicare & Medicaid Services (CMS) regulations to ease the 
burden for children's teaching hospitals participating in the CHGME 
Payment Program that must also comply with CMS regulations. 
Specifically, per 66 FR 12940 (March 1, 2001) and 66 FR 37980 (July 20, 
2001) the CHGME Payment Program follows the regulations provided at 42 
CFR 413.86(f), (g), (h), and (i), which are now reflected in 42 CFR 
413.79, regarding the application of the FTE resident caps as described 
in Section 1886(h) of the Social Security Act.
    The CHGME Payment Program application forms have been revised to 
accommodate the final rule with comment period issued by CMS on 
December 27, 2021 (86 FR 73416). CMS issued the final rule to implement 
policies based on legislative changes relative to Medicare GME for 
teaching hospitals provided by Sections 126, 127, and 131 of the 
Consolidated Appropriations Act (CAA), 2021 (Pub. L. 116-260).
    The final rule implements Sections 126, 127, and 131 of the CAA 
affecting Medicare direct GME and indirect medical education (IME) 
payments to teaching hospitals. Section 126(a) of the CAA amended 
section 1886(h) of the Social Security Act by adding a new section 
1886(h)(9) of the Social Security Act requiring the distribution of 
additional residency positions to qualifying hospitals. Section 127 of 
the CAA amended section 1886(h)(4)(H)(iv) of the Social Security Act to 
specify that in the case of a hospital not located in a rural area that 
established or establishes a medical residency training program (or 
rural track) in a rural area, the hospital, and each such hospital 
located in a rural area that participates in such a training, is 
allowed to receive

[[Page 64063]]

an adjustment to its FTE resident limit. Section 131 of the CAA also 
amended section 1886(h)(4)(H)(i) of the Social Security Act to provide 
an opportunity for hospitals that meet certain criteria and that have 
very small FTE resident caps to replace those caps if the Secretary 
determines the hospital begins training residents in a new program 
beginning on or after enactment (December 27, 2020) and before 5 years 
after enactment (December 26, 2025).
    HRSA proposes to revise lines 4.05a, 5.05a, and 6.05a of the HRSA 
99-1 form, which currently provide: ``Addition (to the cap) for the 
unweighted resident FTE count for allopathic and osteopathic programs 
due to Sec.  5503 of ACA.'' The revised language in lines 4.05a, 5.05a, 
and 6.05a of the HRSA 99-1 form would provide: ``Addition (to the cap) 
for the unweighted FTE resident count for allopathic and osteopathic 
programs due to Sec.  5503 of ACA, Sec.  126, Sec.  127, and/or Sec.  
131 of the CAA.''
    3. CHGME Payment Program Application HRSA 99-5 form: Remove items 
on the initial/reconciliation application form HRSA 99-5 form 
checklist.
    HRSA proposes to remove ``(1) a computer disk containing completed 
HRSA forms; and (2) a copy of the hospital's completed application 
package''. A computer disk of the completed HRSA application forms and 
a copy of the completed application package are no longer needed 
following the CHGME Payment Program application's integration into 
HRSA's Electronic Handbooks. The application forms and supporting 
documentation are currently provided electronically via the Electronic 
Handbooks Tasks and Reports functions.
    4. Revisions to the existing FTE resident assessment exhibits for 
use by both the CHGME Payment Program and THCGME Program:
     Exhibit F--CHGME Fiscal Intermediary Introductory Request 
Letter to Hospital: This letter introduces the fiscal intermediary to 
the hospital and teaching health center and is a formal request to the 
hospital and teaching health center for documentation to support FTE 
residents claimed on the hospital's and teaching health center's 
application. HRSA proposes revising the title and content of the letter 
to provide clarity, reduce errors, and add language inclusive of 
teaching health centers. The revised title will be Fiscal Intermediary 
Introductory Request Letter to Teaching Provider.
     Exhibit N--Points for Future CHGME Auditors: This form 
facilitates continuity of communication from one fiscal intermediary to 
the next and helps HRSA and fiscal intermediaries track and follow up 
any issues with each hospital in a timely manner. HRSA proposes 
revising the title and content to include an area for points from prior 
years and to add language inclusive of teaching health centers. The 
revised title will be Points for Future Audits.
     Exhibit S--Final Medicare Administrative Contractor (MAC) 
Letter/``Top Memorandum'': This letter is sent from the fiscal 
intermediary to the MAC of each children's hospital and any teaching 
health center affiliated hospital following completion of the audit. 
This letter is to notify the MAC of the completion of the resident FTE 
assessment for each respective children's hospital or teaching health 
center affiliated hospital and to provide a summary report of the audit 
findings to be incorporated into the Medicare cost report, if 
applicable. HRSA has proposed revising the title and content to include 
the notification to the MAC of the identification of an overlap and the 
release of FTE resident(s) by the children's hospital or a teaching 
health center affiliated hospital to resolve an overlap, if applicable. 
The revised title will be Final MAC Adjustment and Overlap Resolution 
Letter.
    5. Addition of one FTE resident assessment exhibit for use by both 
the CHGME Payment Program and THCGME Program:
    HRSA proposes to add Exhibit E--Fiscal Intermediary Introductory 
Request Letter to MAC which would request hospital information prior to 
the commencement of the audit. This is a document that the fiscal 
intermediaries currently use internally and include in their own 
working papers. HRSA proposes to have this document included as part of 
the FTE resident assessment report submitted by the fiscal 
intermediaries to HRSA.
     This letter introduces the fiscal intermediary to the MAC 
and is a formal request to the MAC for documentation to support FTE 
residents claimed on the children's hospital's application and the 
teaching health center's affiliated hospital Medicare Cost Report.
    6. Deletion of one FTE resident assessment exhibit previously used 
by the CHGME Payment Program.
    HRSA proposes to discontinue the use of the FTE Resident Assessment 
Cover Letter, which is no longer needed to share information from the 
fiscal intermediary. The Conversation Record exhibit currently provides 
the same information.
     This letter includes a brief description of the audit that 
was performed and for which years, as well as a list of the documents 
included for review by the CHGME Payment Program.
    A 60-day notice published in the Federal Register on August 8, 
2022, vol. 87, No. 151, pp. 48182-48186. There was one public comment 
requesting information on types of residents reported, and a request to 
view the draft forms and documentation.
    Need and Proposed Use of the Information: Information collected 
will be used during the CHGME Payment Program initial application and 
the reconciliation process for both the CHGME Payment Program and 
THCGME Program to determine the amount of graduate medical education 
payments to be distributed to participating children's hospitals and 
teaching health centers. The CHGME Payment Program initial application 
forms and the FTE resident assessment forms for both the CHGME Payment 
Program and THCGME Program will also be used to determine CHGME Payment 
Program and THCGME Program eligibility and compliance with the 
programs' requirements.
    Likely Respondents: The CHGME Payment Program applicants, CHGME 
Payment Program participants, and fiscal intermediaries auditing data 
submitted by the participating children's hospitals and teaching health 
centers.
    Burden Statement: Burden in this context means the time expended by 
persons to generate, maintain, retain, disclose, or provide the 
information requested. This includes the time needed to review 
instructions; to develop, acquire, install, and utilize technology and 
systems for the purpose of collecting, validating, and verifying 
information, processing and maintaining information, and disclosing and 
providing information; to train personnel and to be able to respond to 
a collection of information; to search data sources; to complete and 
review the collection of information; and to transmit or otherwise 
disclose the information. The total annual burden hours estimated for 
this ICR are summarized in the table below. The CHGME participating 
children's hospitals report their FTE residents using forms and 
exhibits approved by OMB (#0915-0247). The THCGME participating 
teaching health centers report their FTE residents using forms, tools 
and exhibits approved by OMB (#0915-0342 and #0915-0367). The FTE 
resident assessment forms and exhibits currently approved for use by 
the CHGME Payment Program under OMB clearance #0915-0247 will be 
reviewed or completed by the fiscal intermediaries during the audit of 
the

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FTE residents reported by the teaching health centers participating in 
the THCGME Program. The FTE resident assessment forms and exhibits are 
submitted to HRSA for approval. The fiscal intermediaries currently 
reviewing or completing the forms and exhibits to perform the audit of 
the 60 children's hospitals will utilize the forms and exhibits during 
the audit of 60 teaching health centers. The increased number of 
responses from the fiscal intermediaries related to the additional 60 
THCGME audits performed results in an increase of approximately 2,000 
burden hours.

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                                                    Number of                     Average burden
  Total estimated annualized       Number of      responses per  Total responses   per response    Total burden
   burden hours: Form name        respondents      respondent                       (in hours)         hours
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Application Cover Letter       60..............               2  120............            0.33            39.6
 (CHGME Initial and
 Reconciliation).
HRSA 99 Form (CHGME Initial    60..............               2  120............            0.33            39.6
 and Reconciliation).
HRSA 99-1 Form (CHGME          60..............               1  60.............           26.50         1,590.0
 Initial).
HRSA 99-1 Form (CHGME          60..............               1  60.............            6.50           390.0
 Reconciliation).
HRSA 99-1 (Supplemental)       30..............               2  60.............            3.67           220.2
 (CHGME FTE Resident
 Assessment Only).
HRSA 99-2 Form (CHGME          60..............               1  60.............           11.33           679.8
 Initial).
HRSA 99-2 Form (CHGME          60..............               1  60.............            3.67           220.2
 Reconciliation).
HRSA 99-4 Form (CHGME          60..............               1  60.............           12.50           750.0
 Reconciliation).
HRSA 99-5 Form (Initial and    60..............               2  120............            0.33            39.6
 Reconciliation).
CFO Form Letter (CHGME         60..............               2  120............            0.33            39.6
 Initial and Reconciliation).
Exhibit 2 (CHGME Initial and   60..............               2  120............            0.33            39.6
 Reconciliation).
Exhibit 3 (CHGME Initial and   60..............               2  120............            0.33            39.6
 Reconciliation).
Exhibit 4 (CHGME Initial and   60..............               2  120............            0.33            39.6
 Reconciliation).
Conversation Record (CHGME     30..............               2  60.............            3.67           220.2
 FTE Resident Assessment
 Only).
Exhibit C (CHGME and THCGME    30..............               4  120............            3.67           440.4
 FTE Resident Assessment).
Exhibit E (CHGME and THCGME    30..............               4  120............            3.67           440.4
 FTE Resident Assessment).
Exhibit F (CHGME and THCGME    30..............               4  120............            3.67           440.4
 FTE Resident Assessment).
Exhibit N (CHGME and THCGME    30..............               4  120............            3.67           440.4
 FTE Resident Assessment).
Exhibit O(1) (CHGME and        30..............               4  120............            3.67           440.4
 THCGME FTE Resident
 Assessment).
Exhibit O(2) (HRSA 99-1)       30..............               2  60.............            26.5          1590.0
 (CHGME FTE Resident
 Assessment Only).
Exhibit P (Reconciliation      30..............               4  120............            3.67           440.4
 Tool) (CHGME and THCGME FTE
 Resident Assessment).
Exhibit P(2) (CHGME and        30..............               4  120............            3.67           440.4
 THCGME FTE Resident
 Assessment).
Exhibit S (CHGME and THCGME    30..............               4  120............            3.67           440.4
 FTE Resident Assessment).
Exhibit T (CHGME FTE Resident  30..............               2  60.............            3.67           220.2
 Assessment Only).
Exhibit T(1) (CHGME FTE        30..............               2  60.............            3.67           220.2
 Resident Assessment Only).

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Exhibit 1 (CHGME FTE Resident  30..............               2  60.............            0.33            19.8
 Assessment Only).
Exhibit 2 (CHGME FTE Resident  30..............               2  60.............            0.33            19.8
 Assessment Only).
Exhibit 3 (CHGME FTE Resident  30..............               2  60.............            0.33            19.8
 Assessment Only).
Exhibit 4 (CHGME FTE Resident  30..............               2  60.............            0.33            19.8
 Assessment Only).
    Total....................  90 (60            ..............  180 (60          ..............    *** 9,980.40
                                children's                        children's
                                hospitals and                     hospitals
                                30 fiscal                         applications,
                                intermediaries                    60 CHGME
                                *.                                audits and 60
                                                                  THCGME audits)
                                                                  **.
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* The total respondents are 90 because children's hospitals (60) and fiscal intermediaries (30) are completing
  the forms.
** The total responses are 180 because children's hospitals (60) and fiscal intermediaries for the CHGME audits
  (60) and the THCGME audits (60) are completing the forms.
*** The increase of 2,000 burden hours is due to the additional 60 THCGME audits.

    HRSA specifically requests comments on (1) the necessity and 
utility of the proposed information collection for the proper 
performance of the agency's functions, (2) the accuracy of the 
estimated burden, (3) ways to enhance the quality, utility, and clarity 
of the information to be collected, and (4) the use of automated 
collection techniques or other forms of information technology to 
minimize the information collection burden.

Maria G. Button,
Director, Executive Secretariat.
[FR Doc. 2022-22862 Filed 10-20-22; 8:45 am]
BILLING CODE 4165-15-P