Hurricane Harvey, which is currently devastating the Houston area, reminds us that natural disasters and other emergencies outside a hospital's control may sometimes make it impossible for a teaching hospital to continue training residents until the situation is resolved. In such situations, Medicare's GME reimbursement rules allow a "home hospital" located in a presidentially‑declared emergency or disaster area to enter into an emergency Medicare GME affiliation agreement with a "host hospital." Under such an agreement, the home hospital lends its full-time equivalent (FTE) resident cap slots to the host hospital, so the host may receive GME reimbursement for training the home hospital's displaced residents.

Medicare GME affiliation agreements are the mechanism that enables certain teaching hospitals to share their FTE caps with their neighbor, partner, and/or sibling hospitals, the parties contractually reapportioning their collective FTE cap slots among themselves. To enter into an ordinary Medicare GME affiliation agreement, the hospitals must be located in the same geographic area (neighbors); jointly listed as the sponsor, primary clinical site, or major participating institution for one or more programs (partners); or under common ownership (siblings).

Emergency Medicare GME affiliation agreements expand this narrow cap-sharing opportunity for hospitals located in emergency or disaster areas. Emergency Medicare GME affiliation agreements enable FTE cap slots to be loaned by the home hospital to support GME training of displaced residents in potentially distant and/or unrelated institutions that would not otherwise qualify to enter into an ordinary (i.e., non‑emergency) Medicare GME affiliation agreement. These agreements must be submitted annually to CMS and to each hospital's Medicare administrative contractor, with the first such agreement to be submitted within 180 days after the end of the academic year in which the emergency began. The arrangement must terminate within four academic years following the year in which the emergency began.