CMS has finalized its proposal to include labor and delivery days as inpatient days in the Medicare utilization calculation for purposes of direct GME payments, effective for cost reporting periods beginning on or after October 1, 2013.  This will have the effect of reducing direct GME payments by an estimated $19 million for FY 2014 (up from $15 million estimated in the proposed rule).

CMS announces the closure of four teaching hospitals.  Applications for available resident slots are due August 29, 2013 (Round 5) and October 31, 2013 (Round 6).

CMS has finalized its proposed policy that an IPPS teaching hospital may not count resident time spent training at a CAH and may not be reimbursed for such time, even if the teaching hospital incurs the training costs.  Effective October 1, 2013, a CAH does not qualify as a “nonprovider site” for purposes of direct GME or IME payment.

Finally, the “freeze” that has been in effect for per-resident amounts (PRAs) that exceeded the ceiling expires beginning in FY 2014.  For cost reporting periods beginning on or after October 1, 2013, the full CPI-U update will apply to all PRAs for direct GME purposes.