The deadline for teaching hospitals to submit graduate medical education (GME) affiliation agreements for the upcoming academic year to the Centers for Medicare and Medicaid Services (CMS) is 11:59 p.m. on July 1, 2011. Historically, CMS has taken a very hard line that hospitals abide by the deadline. In email notifications and during the June 1, 2011 Hospital Open Door Forum, CMS has encouraged hospitals to submit affiliation agreements in PDF form by email to Medicare_GME_Affiliation_Agreement@cms.hhs.gov. However, CMS will accept paper copies of affiliation agreements one final time for this coming academic year. CMS representatives have said that hospitals that electronically submit their affiliation agreements will receive an automatic reply indicating the agreement was timely received. All hospitals that are party to an affiliation agreement must submit copies of the agreement, and each must copy its individual Medicare contractor using the contractor’s preferred submission method. Contractors are not required by CMS to accept electronic submissions. Hospitals with existing affiliation agreements that automatically renew on July 1 may, but are not required to, submit those agreements to the CMS email address.