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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
1 The name of each displaced resident;
2 the last four digits of each displaced residents social security number; 3 the IPF and program in which each resident was training previously; and 4 the amount of the cap increase needed for each resident based on how much the receiving IPF is in excess of its cap and the length of time for which the adjustments are needed. We proposed to require the receiving hospital to only supply the last four digits of each displaced residents social security number to reduce the amount of personally identifiable information PII
included in these agreements.
We also clarified, as previously discussed in the May 6, 2011 IPF PPS
final rule 76 FR 26455, the maximum number of FTE resident cap slots that could be transferred to all receiving IPFs is the number of FTE resident cap slots belonging to the IPF that has the closed program or that is closing. Therefore, if the originating IPF is training residents in excess of its cap, then being a displaced resident does not guarantee that a cap slot will be transferred along with that resident. Therefore, if there are more IPF displaced residents than available cap slots, the slots may be apportioned according to the closing IPFs discretion. The decision to transfer a cap slot if one is available will be voluntary and made at the sole discretion of the originating IPF.
However, if the originating IPF decides to do so, then it will be the originating IPFs responsibility to determine how much of an available cap slot will go with a particular resident if any. We also note, as we previously discussed in the May 6, 2011 IPF PPS final rule 76
FR 25455, only to the extent a receiving IPF would exceed its FTE cap by training displaced residents would it be eligible for a temporary adjustment to its resident FTE cap. Displaced residents are factored into the receiving IPFs ratio of resident FTEs to the facilitys average daily census.
Comment: We received 3 comments on our proposed updates to IPF teaching policy. All commenters appreciate the alignment of IPF teaching policy with IPPS. They believe it is important to protect medical education. Therefore, decreasing confusion and streamlining the process gives residents and program directors more time to find a new program or rotation site, which can only help the transfer process.
Response: We thank these commenters for their support.
Final Decision: For FY 2022, we are finalizing the closure policy as proposed. Section 124 of the BBRA
gives the Secretary broad discretion to determine the appropriate adjustment
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factors for the IPF PPS. We are finalizing our proposal to implement the policy regarding IPF resident caps and closures to remain consistent with the way that the IPPS teaching policy calculates FTE
resident caps in the case of a receiving hospital that obtains a temporary IME
and direct GME cap adjustment for assuming the training of displaced residents due to another hospital or residency programs closure. We are also finalizing our proposal that in the future, we will deviate from IPPS
teaching policy as it pertains to counting displaced residents for the purposes of the IPF teaching adjustment only when it is necessary and appropriate for the IPF PPS.
In addition, we are finalizing our proposal to amend the IPF policy with regard to closing teaching IPFs and closing residency programs to address the needs of residents attempting to find alternative IPFs in which to complete their training. This proposal addresses the incentives of originating and receiving IPFs with regard to ensuring we appropriately account for their indirect teaching costs by way of an appropriate IPF teaching adjustment based on each programs resident FTEs.
We are also finalizing our proposal to change two aspects of the current IPF
policy, which are discussed in the following section.
First, rather than link the status of displaced residents for the purpose of the receiving IPFs request to increase their FTE cap to the residents presence at the closing IPF or program on the day prior to or the day of program or IPF
closure, we are finalizing our proposal that the ideal day will be the day that the closure was publicly announced, for example, via a press release or a formal notice to the Accreditation Council on Graduate Medical Education ACGME. This will provide greater flexibility for the residents to transfer while the IPF operations or residency programs were winding down, rather than waiting until the last day of IPF or program operation. This will address the needs of the first group of residents as previously described: Residents who leave the IPF program after the closure was publicly announced to continue training at another IPF, but before the day of actual closure.
Second, by removing the link between the status of displaced residents and their presence at the closing IPF or program on the day prior to or the day of program or IPF closure, we are finalizing to also allow the second and third group of residents who are not physically at the closing IPF/closing program, but had intended to train at or return to training at, in the case of
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residents on rotation to be considered a displaced resident. Thus, we are finalizing our proposal to revise our teaching policy with regard to which residents can be considered displaced for the purpose of the receiving IPFs request to increase their FTE cap in the situation where an IPF announces publicly that it is closing or that it is closing an IPF residency programs.
Specifically, we are adopting the definitions of closure of a hospital, closure of a hospital residency training program, and displaced resident as defined at 42 CFR 413.79h but with respect to IPFs and for the purposes of accounting for indirect teaching costs.
In addition, we are finalizing our proposal to change another detail of the IPF teaching policy specific to the requirements for the receiving IPF. To apply for the temporary increase in the FTE resident cap, the receiving IPF will have to submit a letter to its Medicare Administrative Contractor MAC
within 60 days of beginning the training of the displaced residents. As established under existing regulation at 412.424d1iiiF1ii and 412.424d1iiiF2i, this letter must identify the residents who have come from the closed IPF or program that have caused the receiving IPF to exceed its cap, and the receiving IPF
must specify the length of time the adjustment is needed. Moreover, we are finalizing the clarifications on how the information will be delivered in this letter. Consistent with IPPS teaching policy, the letter from the receiving IPF
will have to include: 1 The name of each displaced resident; 2 the last four digits of each displaced residents social security number; 3 the IPF and program in which each resident was training previously; and 4 the amount of the cap increase needed for each resident based on how much the receiving IPF is in excess of its cap and the length of time for which the adjustments are needed. We are also finalizing our proposal to require the receiving hospital to only supply the last four digits of each displaced residents social security number to reduce the amount of personally identifiable information PII included in these agreements.
We are also finalizing the clarification that the maximum number of FTE
resident cap slots that could be transferred to all receiving IPFs is the number of FTE resident cap slots belonging to the IPF that has the closed program or that is closing. Therefore, if the originating IPF is training residents in excess of its cap, then being a displaced resident does not guarantee that a cap slot will be transferred along
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