Medicare Approved Programs
June 13, 2018:
Congress decided Medicare should pay its share in training our future doctors, at least until the communities were ready to support the programs; over 50 years later, Medicare is still paying its share in the direct and indirect costs for graduate medical education. The rules surrounding this payment are quite complex. In this article, we will be discussing the regulations concerning which graduate medical education programs Medicare considers as approved programs and, therefore, the hospital is eligible for Direct Graduate Medical Education (DGME) and Indirect Graduate Medical Education (IME) payments.
In a hospital’s DGME and IME payment, Medicare only allows a hospital to include residents enrolled in Medicare approved medical residency programs. As defined in the regulations 1, an “Approved medical residency program means a program that meets one of the following criteria:
(1) Is approved by one of the national organizations listed…[below]
(2) May count towards certification of the participant in a specialty or sub-specialty listed in the current edition of either of the following publications:
(i) The Directory of Graduate Medical Education Programs published by the American Medical Association, and available from American Medical Association…; or
(ii) The Annual Report and Reference Handbook published by the American Board of Medical Specialties…”:
List of National Organizations 2:
- Accreditation Council for Graduate Medical Education of the American Medical Association (ACGME),
- The Committee on hospitals of the Bureau of Professional Education of the American Osteopathic Association (AOA),
- The Commission on Dental Accreditation of the American Dental Association (ADA), or
- The Council on Podiatric Medicine Education of the American Podiatric Medical Association (CODA)
To put it simply, if the program is accredited by ACGME, AOA, ADA or CODA it is a Medicare approved medical residency program. If the program is not accredited, but the training may count towards an American Board of Medical Specialties (ABMS) board certification, it is considered a Medicare approved medical residency program.
The single exception is for a “program that would be accredited except for the accrediting agency’s reliance upon an accreditation standard that requires an entity to perform an induced abortion or require, provide, or refer for training in the performance of induced abortions, or make arrangements for such training, regardless of whether the standard provides exceptions or exemptions.” 3
If a resident is enrolled in a program that is not considered a Medicare approved medical residency program, the hospital is not eligible for DGME and IME payment, however, it may be eligible for payment for “non-approved programs”. Read more about this type of payment in April’s edition of the GME Checkup Academic Medical Centers Can Be Paid for Non-Accredited Training Programs.
1 CFR 42 § 413.75(b)
2 CFR 42 § 415.152
3 CFR 42 § 413.75(b)