Federal Register / Vol. 89, No. 249 / Monday, December 30, 2024 / Notices 106525 

Intimate partner and domestic violence 

includes physical violence, sexual 

violence, stalking and psychological 

aggression (including coercion), 

reproductive coercion, neglect, and the 

threat of violence, abuse, or both. 

Intervention services include, but are 

not limited to, counseling, education, 

harm reduction strategies, and 

appropriate supportive services.’’ 

(2) Breast Cancer Screening for Women 

at Average Risk 

The final Guideline for Breast Cancer 

Screening for Women at Average Risk 

reads: ‘‘The Women’s Preventive 

Services Initiative recommends that 

women at average risk of breast cancer 

initiate mammography screening no 

earlier than age 40 years and no later 

than age 50 years. Screening 

mammography should occur at least 

biennially and as frequently as 

annually. Women may require 

additional imaging to complete the 

screening process or to address findings 

on the initial screening mammography. 

If additional imaging (e.g., magnetic 

resonance imaging (MRI), ultrasound, 

mammography) and pathology 

evaluation are indicated, these services 

also are recommended to complete the 

screening process for malignancies. 

Screening should continue through at 

least age 74 years, and age alone should 

not be the basis for discontinuing 

screening. 

Women at increased risk also should 

undergo periodic mammography 

screening, however, recommendations 

for additional services are beyond the 

scope of this recommendation.’’ 

(3) Patient Navigation Services for 

Breast and Cervical Cancer Screening 

The final Guideline for Patient 

Navigation Services for Breast and 

Cervical Cancer Screening reads: ‘‘The 

Women’s Preventive Services Initiative 

recommends patient navigation services 

for breast and cervical cancer screening 

and follow-up, as relevant, to increase 

utilization of screening 

recommendations based on an 

assessment of the patient’s needs for 

navigation services. Patient navigation 

services involve person-to-person (e.g., 

in-person, virtual, hybrid models) 

contact with the patient. Components of 

patient navigation services should be 

individualized. Services include, but are 

not limited to, person-centered 

assessment and planning, health care 

access and health system navigation, 

referrals to appropriate support services 

(e.g., language translation, 

transportation, and social services), and 

patient education.’’ 

Non-grandfathered group health plans 

and health insurance issuers offering 

group or individual health insurance 

coverage must cover without costsharing the services and screenings 

listed on the updated Women’s 

Preventive Services Guidelines for plan 

years (in the individual market, policy 

years) that begin 1 year after this date. 

Thus, for most plans, this update will 

take effect for purposes of the Section 

2713 coverage requirement in 2026. 

Additional information regarding the 

Women’s Preventive Services 

Guidelines can be accessed at the 

following link: https://www.hrsa.gov/ 

womens-guidelines. 

Authority: Section 2713(a)(4) of the 

Public Health Service Act, 42 U.S.C. 

300gg–13(a)(4). 

Carole Johnson, 

Administrator. 

[FR Doc. 2024–31228 Filed 12–27–24; 8:45 am] 

BILLING CODE 4165–15–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Health Resources and Services 

Administration 

Children’s Hospitals Graduate Medical 

Education Payment Program: Updated 

Methodology To Determine Full-Time 

Equivalent Resident Count 

AGENCY: Health Resources and Services 

Administration (HRSA), Department of 

Health and Human Services. 

ACTION: Request for public comment. 

SUMMARY: This notice seeks public 

comment on updating the Children’s 

Hospitals Graduate Medical Education 

(CHGME) Payment Program’s method of 

determining an eligible children’s 

hospital (as defined within the Public 

Health Service Act) weighted allopathic 

and osteopathic full-time equivalent 

(FTE) resident count when a children’s 

hospital’s weighted allopathic and 

osteopathic FTE resident count exceeds 

its direct graduate medical education 

(GME) FTE resident cap in order to be 

consistent with the methodology used 

by the Centers for Medicare & Medicaid 

Services (CMS) beginning in the fiscal 

year (FY) 2026 application cycle. 

DATES: Comments on this notice should 

be received no later than January 29, 

2025. 

ADDRESSES: Written comments should 

be submitted to Robyn Duarte, Public 

Health Analyst, by email RDuarte1@

hrsa.gov. 

FOR FURTHER INFORMATION CONTACT: 

Robyn Duarte, Public Health Analyst, 

Bureau of Health Workforce, Division of 

Medicine and Dentistry, HRSA, 5600 

Fishers Lane, Rockville, MD 20857, 

301–443–3254. 

SUPPLEMENTARY INFORMATION: The 

CHGME Payment Program is authorized 

by section 340E of the Public Health 

Service Act. For direct GME payments, 

section 340E(c)(1)(B) requires that the 

average number of FTE residents in the 

hospital’s approved residency programs 

be determined according to section 

1886(h)(4) of the Social Security Act. As 

noticed in the March 1, 2001, Federal 

Register (66 FR 12940), section 

1886(h)(4) has been implemented by 

regulations at 42 CFR 413.78 through 

413.83 (formerly 42 CFR 413.86(f)–(i)), 

which HRSA has used to determine the 

total and weighted numbers of FTE 

residents. In the CMS FY 2023 inpatient 

prospective payment systems (IPPS) and 

long-term care hospital prospective 

payment system (LTCH PPS) final rule 

published in the Federal Register on 

August 10, 2022 (87 FR 48780, 49065– 

49072) (referred to as the ‘‘FY 2023 

IPPS/LTCH PPS final rule’’), CMS 

modified the Medicare direct GME 

payment methodology and amended 

section 413.79 by revising paragraphs 

(c)(2)(iii) and (d)(3). Through this 

notice, HRSA is seeking comment on its 

intent to adopt the same direct GME 

payment methodology as CMS when 

HRSA calculates FTE residents for the 

CHGME Payment Program beginning in 

the FY 2026 application cycle. 

Background 

To the extent feasible, HRSA has 

historically sought consistency with 

CMS regulations to minimize burden for 

children’s teaching hospitals 

participating in the CHGME Payment 

Program that must also comply with 

CMS regulations. Consistency reduces 

the potential challenges in reporting 

FTE resident counts to Medicare and 

CHGME. 

Currently, the CHGME Payment 

Program methodology for determining 

the weighted allopathic and osteopathic 

FTE resident count applies the direct 

GME FTE resident cap when a hospital’s 

weighted allopathic and osteopathic 

FTE resident count is greater than its 

direct GME FTE resident cap. The 

current CHGME direct GME 

methodology reduces a hospital’s 

weighted direct GME resident count by 

a proportion equal to the ratio of its 

GME FTE resident cap to its unweighted 

direct GME resident count. The direct 

GME FTE resident cap is applied to 

reduce the weighting factor of residents 

who are beyond their initial residency 


ddrumheller on DSK120RN23PROD with NOTICES1
106526 Federal Register / Vol. 89, No. 249 / Monday, December 30, 2024 / Notices 

period to an amount less than 0.5. See 

66 FR 12940. 

CMS GME Final Regulation Change 

In August 2022, CMS finalized a new 

methodology for applying the direct 

GME FTE resident cap when a hospital’s 

weighted allopathic and osteopathic 

FTE resident count is greater than its 

direct GME FTE resident cap, in a way 

that does not reduce the weighting 

factor of residents that are beyond their 

initial residency period to an amount 

less than 0.5. Under the new method, if 

a hospital’s unweighted allopathic and 

osteopathic FTE resident count exceeds 

its direct GME FTE resident cap, then 

the weighted allopathic and osteopathic 

FTE resident count is equal to the 

hospital’s direct GME FTE resident cap 

or its actual weighted allopathic and 

osteopathic FTE resident count, 

whichever is lesser. The direct GME 

FTE resident cap reflects the maximum 

number of allopathic and osteopathic 

residents that a hospital may count for 

purposes of direct GME payment in a 

cost reporting period. 

Alignment of CHGME and Medicare 

GME Policy 

For more than two decades, HRSA has 

followed CMS’s approach to calculating 

the FTE resident count. [See March 1, 

2001, Federal Register Notice (66 FRN 

12940), ‘‘The Department follows 

Medicare rules regarding the use of the 

initial residency period. The Medicare 

rules reduce counts for all hospitals that 

train residents beyond their initial 

residency period (i.e., fellows) with 

regard to the [direct medical education] 

DME and [indirect Medical Education] 

IME portions of the GME 

reimbursement.’’] Therefore, HRSA 

proposes to adopt CMS’s modified 

direct GME payment methodology with 

respect to determining the weighted 

number of allopathic and osteopathic 

FTE residents (i.e., fellows) for all 

eligible children’s hospitals 

participating in the CHGME Payment 

Program beginning in FY 2026. 

In this notice, we refer to the FTE 

adjusted cap (or 2013 CHGME 

Reauthorization cap pursuant to Pub. L. 

113–98) reported on Line 4.06, 5.06, and 

6.06 of the HRSA 99–1 Form as the 

‘‘direct GME FTE resident cap’’ to 

correspond with CMS terminology. 

HRSA proposes to modify its 

methodology to adopt the CMS 

methodology described in the amended 

42 CFR 413.79 in whole. HRSA 

anticipates implementing the updated 

methodology for determining the 

weighted allopathic and osteopathic 

FTE resident count starting in the FY 

2026 application cycle (project period 

October 1, 2025, through September 30, 

2026). 

Direct GME Methodology in FY 2026— 

Proposal for Public Comment 

Starting in FY 2026, where a CHGME 

participating hospital’s unweighted 

allopathic and osteopathic FTE resident 

count exceeds the hospital’s FTE 

resident cap, and the weighted 

allopathic and osteopathic FTE resident 

count also exceeds that FTE resident 

cap, the respective weighted allopathic 

and osteopathic FTE resident count is 

adjusted to make the total weighted 

allopathic and osteopathic FTE resident 

count equal the FTE resident cap. If the 

weighted allopathic and osteopathic 

FTE resident count does not exceed that 

FTE resident cap, then the allowable 

weighted allopathic and osteopathic 

FTE resident count for direct GME 

payment is the actual weighted 

allopathic and osteopathic FTE resident 

count. 

This proposed update to the 

methodology for determining the 

weighted allopathic and osteopathic 

FTE resident count for the CHGME 

Program is intended to reconcile 

weighted FTE resident counts reported 

in Lines 4.13 (both Hospital Data 

columns), 5.13, and 6.13 of the HRSA 

Form 99–1 with Lines 9 and 22 of the 

CMS Form 2552–10, Worksheet E–4, 

respectively. Entries in Lines 4.13 (both 

Hospital Data columns), 5.13, and 6.13 

report the weighted resident FTE count 

for allopathic and osteopathic programs 

following application of the direct GME 

FTE resident cap. 

This updated methodology for 

determining weighted allopathic and 

osteopathic FTE resident count may 

result in adjustments to the weighted 

FTE resident 3-year rolling average used 

to determine direct medical education 

(DME) payment amounts for the eligible 

children’s hospitals participating in the 

CHGME Payment Program. 

The DME payment amounts for 

CHGME are impacted by many factors 

including the number of residents the 

hospital trained during the year, the 

hospital’s wage index, as well as the 

overall appropriation. The updated 

methodology for determining the 

weighted FTE resident count will 

impact awardees that add more 

residents and fellows above their 

hospital’s direct GME FTE resident cap. 

The updated methodology may also 

impact the DME payments for awardees 

overall as a hospital may receive a 

different relative share of the CHGME 

appropriation due to these shifts in the 

weighted FTE resident counts 

experienced by some hospitals. 

The CHGME Payment Program 

proposes to implement this updated 

methodology beginning in FY 2026 to 

reduce burden on hospitals 

participating in CHGME and Medicare 

GME and to reduce the risk of potential 

audit discrepancies that may impact 

payments. 

Diana Espinosa, 

Principal Deputy Administrator. 

[FR Doc. 2024–31240 Filed 12–27–24; 8:45 am] 

BILLING CODE 4165–15–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Final Scientific Integrity Policy of the 

U.S. Department of Health and Human 

Services 

AGENCY: Office of the Assistant 

Secretary for Planning and Evaluation, 

Office of the Secretary, HHS. 

ACTION: Notice of final policy. 

SUMMARY: The Department of Health and 

Human Services (HHS) is publishing its 

Scientific Integrity Policy to increase 

access to and raise awareness of the 

Policy. 

DATES: The effective date of the Policy 

is October 16, 2024. 

FOR FURTHER INFORMATION CONTACT: 

Karen Wehner, Ph.D., Scientific 

Integrity Officer, Office of Science and 

Data Policy, Office of the Assistant 

Secretary for Planning and Evaluation, 

Office of the Secretary, HHS at 240– 

453–8435 or scientificintegrity@hhs.gov. 

SUPPLEMENTARY INFORMATION: Scientific 

integrity plays a vital role in the mission 

of HHS. Ensuring integrity in science 

throughout the Department allows HHS 

to foster and produce high-quality 

science, communicate effectively with 

the public, and base critical policy 

decisions on trustworthy and rigorous 

scientific findings. HHS has adopted a 

Department-wide scientific integrity 

policy to further strengthen scientific 

integrity and evidence-based 

policymaking throughout the 

Department. 

The Scientific Integrity Policy of the 

U.S. Department of Health and Human 

Services (Policy) was approved on 

September 16, 2024. The finalized 

Policy was announced to the HHS 

community and posted on the HHS 

scientific integrity website, at https://

www.hhs.gov/programs/research/ 

scientificintegrity/index.html, on 

September 30, 2024. The effective date 

of the Policy is October 16, 2024. 

The content of the finalized Policy, 

reformatted to conform to the 

requirements of the Federal Register, is 


ddrumheller on DSK120RN23PROD with NOTICES1