```

[Federal Register Volume 78, Number 105 (Friday, May 31, 2013)]
[Notices]
[Pages 32663-32664]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-12952]

-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1459-N]

Medicare Program; Notification of Closure of Teaching Hospitals 
and Opportunity To Apply for Available Slots

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice announces the closure of two teaching hospitals 
and the initiation of an application process where hospitals must apply 
to the Centers for Medicare & Medicaid Services (CMS) for consideration 
of Infirmary West Hospital's and Montgomery Hospital's full time 
equivalent (FTE) resident cap slots.

DATES: We will consider applications received no later than 5 p.m. 
(e.s.t) August 29, 2013. Applications must be received, not postmarked, 
by this date.

FOR FURTHER INFORMATION CONTACT: Miechal Lefkowitz, (212) 616-2517.

SUPPLEMENTARY INFORMATION: 

I. Background

    Section 5506 of the Patient Protection and Affordable Care Act 
(Pub. L. 111-148), as amended by the Health Care and Education 
Reconciliation Act of 2010 (Pub. L. 111-152) (collectively, the 
``Affordable Care Act''), ``Preservation of Resident Cap Positions from 
Closed Hospitals,'' authorizes the Secretary to redistribute residency 
slots after a hospital that trained residents in an approved medical 
residency program closes. Specifically, section 5506 of the Affordable 
Care Act amended the Social Security Act (the Act) by adding subsection 
(vi) to section 1886(h)(4)(H) of the Act and modifying language at 
section 1886(d)(5)(B)(v) of the Act, to instruct the Secretary to 
establish a process to increase the full time equivalent (FTE) resident 
caps for other hospitals based upon the FTE resident caps in teaching 
hospitals that closed ``on or after a date that is 2 years before the 
date of enactment'' (that is, March 23, 2008). In the November 24, 2010 
Calendar Year (CY) 2011 Outpatient Prospective Payment System (OPPS) 
final rule (75 FR 72212), we established regulations and an application 
process for qualifying hospitals to apply to CMS for consideration of 
the direct graduate medical education (GME) and indirect medical 
education (IME) FTE resident cap slots from the hospital that closed. 
We made certain modifications to those regulations in the Fiscal Year 
(FY) 2013 Hospital Inpatient Prospective Payment System and FY 2013 
Long Term Care Hospital Prospective Payment System final rule (FY 2013 
IPPS/LTCH PPS final rule (77 FR 53434 through 53447)).

II. Provisions of the Notice

a. Notice of Closure of Teaching Hospitals and Application Process

    CMS has learned of the closure of two teaching hospitals; Infirmary 
West Hospital of Mobile, AL and Montgomery Hospital of Morristown, PA. 
The purpose of this notice is to notify the public of the closure of 
these two teaching hospitals, and to initiate another round of the 
application and selection process described in section 5506 of the 
Affordable Care Act. This round will be the fifth round (``Round 5'') 
of the application and selection process. The table below identifies 
the two closed teaching hospitals, which are part of the Round 5 
application process under section 5506 of the Affordable Care Act:

                                           Teaching Hospitals Closure
----------------------------------------------------------------------------------------------------------------
                                                                                    IME Cap       Direct GME Cap
                                                                                 (including +/-   (including +/-
                                                                 Terminating      MMA Sec. 422     MMA Sec. 422
  Provider No.     Provider name    City and state  CBSA code        date       \1\ and +/- ACA  \1\ and +/- ACA
                                                                                 Sec. 5503 \2\    Sec. 5503 \2\
                                                                                  Adjustments)     Adjustments)
----------------------------------------------------------------------------------------------------------------
010152..........  Infirmary West   Mobile, AL.....      33660  November 1,      10.08 + 21.66    10.08 + 21.76
                   Hospital.                                    2012.            section 422      section 422
                                                                                 increase =       increase =
                                                                                 31.74 \3\.       31.84 \4\.

[[Page 32664]]

 
390108..........  Montgomery       Morris-town, PA      37964  October 16,      17.16-0.60 =     15.33.
                   Hospital.                                    2012.            16.56 \5\.
----------------------------------------------------------------------------------------------------------------
\1\ Section 422 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Pub. L. 108-
  173, redistributed unused residency slots effective July 1, 2005.
\2\ Section 5503 of the Affordable Care Act, Public Law 111-148, redistributed unused slots effective July 1,
  2011.
\3\ Infirmary West's 1996 IME FTE cap is 10.08. Under section 422 of the MMA, the hospital received an increase
  of 21.66 to its IME FTE cap: 10.08 + 21.66 = 31.74. We note that, under 42 CFR 412.105(d)(4), IME FTE cap
  slots associated with an increase received under section 422 of the MMA are to be paid using a special
  multiplier of 0.66.
\4\ Infirmary West's 1996 direct GME FTE cap is 10.08. Under section 422 of the MMA, the hospital received an
  increase of 21.76 to its direct GME FTE cap: 10.08 + 21.76 = 31.84. We note that under 42 CFR 413.77(g),
  direct GME FTE cap slots associated with an increase received under section 422 of the MMA are to be paid
  using the appropriate locality-adjusted national average per resident amount (PRA).
\5\ Montgomery Hospital's 1996 IME FTE cap is 17.16. Under section 5503 of the ACA, the IME FTE cap was reduced
  by 0.60: 17.16-0.60 = 16.56.

b. Application Process for Available Resident Slots

    The application period for hospitals to apply for slots under 
section 5506 of the Affordable Care Act is 90 days following 
notification to the public of a hospital closure. Therefore, hospitals 
wishing to apply for and receive slots from the above hospitals' FTE 
resident caps must submit applications directly to the CMS Central 
Office no later than August 29, 2013. In previous rounds of section 
5506 of the Affordable Care Act, hospitals submitted applications to 
their respective CMS Regional Office. However, under this round (Round 
5), hospitals need not submit applications to their respective CMS 
Regional Office. The mailing address for the CMS Central Office is 
included on the application form. Applications must be received by the 
August 29, 2013 deadline date. It is not sufficient for applications to 
be postmarked by this date. After an applying hospital sends a hard 
copy of a section 5506 application to the CMS Central Office mailing 
address, we strongly encourage the hospital to send an email to: 
ACA5506application@cms.hhs.gov. In the email, the hospital should 
state: ``I am sending this email to notify CMS that I have mailed a 
hard copy of a section 5506 application to CMS.'' An applying hospital 
should not attach an electronic copy of the application to the email. 
The email will only serve to notify CMS Central Office that a hard copy 
application has been mailed to CMS Central Office.
    In the CY 2011 OPPS/ASC final rule with comment period, we did not 
establish a deadline by when CMS would issue the final determinations 
to hospitals that receive slots under section 5506 of the Affordable 
Care Act. However, we will review all applications received by the 
deadline, and notify applicants of our determinations as soon as 
possible.
    We refer readers to the CMS Web site at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dgme.html 
to download a copy of the application form (Section 5506 CMS 
Application Form) that hospitals are to use to apply for slots under 
section 5506 of the Affordable Care Act. We also refer readers to this 
same Web site to access a copy of the CY 2011 OPPS/ASC final rule with 
comment period, a copy of the FY 2013 IPPS/LTCH PPS final rule (77 FR 
53434 through 53447), and a list of additional section 5506 guidelines 
for an explanation of the policy and procedures for applying for slots, 
and the redistribution of the slots under sections 1886(h)(4)(H)(vi) 
and 1886(d)(5)(B)(v) of the Act.

III. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995 (44 U.S.C. chapter 35). Furthermore, 
the information collection requirements associated with the 
preservation of resident cap positions from closed hospitals are not 
subject to the Paperwork Reduction Act, as stated in section 5506 of 
the Affordable Care Act.

(Catalog of Federal Domestic Assistance Program No. 93.773 
Medicare--Hospital Insurance Program; and No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: May 24, 2013.
Marilyn Tavenner,
 Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2013-12952 Filed 5-30-13; 8:45 am]
BILLING CODE 4120-01-P
```