Current through Register Vol. 30, No. 38, September 20, 2024
A. Subject to
available funds and approval by CMS, the Administration shall annually
distribute monies appropriated for primary care GME programs approved by the
Administration to Federally Qualified Health Centers (FQHC) and Rural Health
Clinics (RHC) for direct and indirect program costs eligible for funding under
A.R.S. §
36-2907.06(I).
1. A GME program is deemed to be established
as of the date of its original accreditation. All determinations that are
necessary to make distributions described by this subsection shall be made
using information possessed by the Administration as of the date of reporting
under subsection (D).
2. For
purposes of this subsection, the term "FQHC" includes Federally Qualified
Health Center Look-Alikes.
B. Eligible health care facilities. A health
care facility is eligible for a distribution under subsection (G) if all of the
following apply:
1. It is an FQHC or RHC in
Arizona that is the sponsoring institution of, or a full member of a consortium
that is the sponsoring institution of, or a participating institution in, one
or more approved primary care GME programs in Arizona;
2. It incurs direct or indirect costs for the
training of residents in Arizona in approved primary care GME
programs;
3. The GME program is not
eligible for funding under
R9-22-712.05;
and
4. The GME program is not fully
funded by the federal government.
C. Eligible residents and resident positions.
For purposes of determining program allocation amounts under subsections (E)
and (F) the following residents and resident positions are eligible for
consideration, to the extent that the resident training takes place in Arizona
and not at a health care facility made ineligible under subsection (B):
1. All filled resident positions in approved
primary care GME programs; or
2.
For approved primary care GME programs established for less than one year as of
the date of annual reporting under subsection (D) and that have not yet filled
their first-year resident positions, all prospective residents reasonably
expected by the program to be enrolled as a result of the most recently
completed annual resident match.
D. Annual reporting. By April 1st of each
year, an FQHC or RHC seeking a distribution under this subsection shall:
1. Provide to the Administration the
following information about each approved primary care GME program:
a. The program name and number assigned by
the accrediting organization;
b.
The original date of accreditation of the program;
c. The names of the sponsoring institution
and all participating institutions current as of the date of
reporting;
d. The number of
approved resident positions and the number of filled resident positions current
as of the date of reporting;
e. The
academic year rotation schedule on file with the program current as of the date
of reporting; and
f. For programs
described under subsection (C)(2), the number of residents expected to be
enrolled as a result of the most recently completed annual resident
match.
2. Provide to the
Administration the most recent Medicare Cost Report for the FQHC or RHC seeking
the distribution, and
3. For an
FQHC or RHC that is a full member of a consortium that is the sponsoring
institution of an approved primary care GME program, provide to the
Administration a signed letter attesting to the responsibility of the full
member FQHC or RHC for direct or indirect costs of training residents in the
program.
E. Allocation
of funds for direct graduate medical education costs. Annually the
Administration shall allocate available funds for direct graduate medical
education costs to each eligible FQHC or RHC in the following manner:
1. A Medicaid utilization percent for each
FQHC or RHC seeking a distribution shall be calculated using the Medicare Cost
Report submitted under subsection (D)(2), dividing the Title XIX visit count by
the whole number of visits reported and rounding the result up to the nearest
multiple of 5 percent.
2. A total
number of residents eligible for funding in each program shall be calculated
using the information submitted under subsection (D)(1), dividing the number of
resident rotations in the year that take place in Arizona and not at a health
care facility made ineligible under subsection (B) by the total number of
resident rotations in the program for that year, multiplying the result by the
total number of filled resident positions in the program and rounding to two
digits after the decimal.
3. The
allocation for direct graduate medical education costs for each eligible FQHC
or RHC shall be calculated by multiplying the number of residents determined
under subsection (E)(2) by the statewide average per-resident amount determined
under this subsection and multiplying the result by the Medicaid utilization
percent calculated for the FQHC or RHC under subsection (E)(1). The statewide
average per-resident amount for the academic year ending June 30, 2022 is
$170,090. Annually thereafter, a statewide average per-resident amount shall be
calculated by applying the Federally Qualified Health Center PPS Market Basket
Update less Productivity Adjustment published by CMS for the calendar year in
which the GME academic year begins.
F. Allocation of funds for indirect program
costs. Annually the Administration shall allocate available funds for indirect
program costs to each eligible FQHC or RHC in the following manner:
1. By multiplying the number of residents
determined under subsection (E)(2) by the statewide average per-resident amount
determined under this subsection and multiplying the result by the Medicaid
utilization percent calculated for the FQHC or RHC under subsection (E)(1). The
statewide average per-resident amount for the academic year ending June 30,
2022 is $167,330;
2. Annually
thereafter, a statewide average per-resident amount shall be calculated by
applying the Federally Qualified Health Center PPS Market Basket Update less
Productivity Adjustment published by CMS for the calendar year in which the GME
academic year begins.
G.
Distribution of funds. On an annual basis subject to available funds, the
Administration shall distribute to each eligible FQHC and RHC the sum of all
amounts calculated for the FQHC or RHC under subsections (E)(3) and
(F).
H. The Administration may
enter into intergovernmental agreements with local, county, and tribal
governments and any university under the jurisdiction of the Arizona Board of
Regents wherein such entities may transfer funds or certify public expenditures
to the Administration. Such funds or certification, subject to approval by CMS,
will contribute to the state funding to qualify for federal matching funds.
Those funds will be used for the purposes of reimbursing FQHCs and RHCs that
are eligible under this rule and designated by the local, county, or tribal
governments for receipt of the contributed funds. The Administration shall
allocate available funds in accordance with subsections (E) and (F).
