Children's Hospitals Graduate Medical Education Payment

Published on AidPage by IDILOGIC on Jun 24, 2005

Administered by:

Purpose of this program:

The Children's Hospitals Graduate Medical Education Payment Program (CHGMEPP) provides funds to children's teaching hospitals to support the training of pediatric and other residents in graduate medical education (GME) programs. Since Federal financial support of graduate medical education is extensively supported by the Medicare system, the CHGME program compensates for the disparity in the level of Federal funding for pediatric teaching hospitals versus other types of teaching hospitals. The Secretary of DHHS has delegated the authority for the administration of the CHGME payment program to Health Resources and Services Administration (HRSA), which redelegated it to the Bureau of Health Professions (BHPr).

Possible uses and use restrictions...

Funds are restricted to eligible children's hospitals for direct expenses and the other indirect expenses associated with operating approved graduate medical residency programs.

Who is eligible to apply...

Applicants (children's teaching hospitals) must meet the following eligibility requirements in accordance with the Federal Register Notice, Vol. 66, No. 41 published on March 1, 2001: 1) Participate in an approved graduate medical education program; 2) have a Medicare provider agreement; 3) be excluded from the Medicare Inpatient Prospective Payment System (PPS) under Section 1886(d)(1)(B)(iii), of the Social Security Act and its accompanying regulations; and 4) be a "freestanding" children's hospital.

Eligible Applicant Categories:
Eligible Functional Categories:

Payments will be determined in accordance with the Department of Health and Human Services (DHHS) legislation - Public Health Service Act, Title III Part D, Section 340E, 42 U.S.C. 256E, as amended; Graduate Medical Education Programs in Children's Hospitals, Title 20; Federal Register Notice (FRN) Vol. 65, No. 118, published on June 19, 2000; FRN Vol. 66, No. 41, published on March 1, 2001; FRN Vol. 66, No. 140 published on July 20, 2001; and FRN Vol.67, No. 186, published on September 25, 2002.

Note:This is a brief description of the credentials or documentation required prior to, or along with, an application for assistance.

About this section:

This section indicates who can apply to the Federal government for assistance and the criteria the potential applicant must satisfy. For example, individuals may be eligible for research grants, and the criteria to be satisfied may be that they have a professional or scientific degree, 3 years of research experience, and be a citizen of the United States. Universities, medical schools, hospitals, or State and local governments may also be eligible. Where State governments are eligible, the type of State agency will be indicated (State welfare agency or State agency on aging) and the criteria that they must satisfy.

Certain federal programs (e.g., the Pell Grant program which provides grants to students) involve intermediate levels of application processing, i.e., applications are transmitted through colleges or universities that are neither the direct applicant nor the ultimate beneficiary. For these programs, the criteria that the intermediaries must satisfy are also indicated, along with intermediaries who are not eligible.

How to apply...

Application Procedure:

Applications are made by submission of application face page (HRSA 99), determination of weighted and unweighted resident FTE count form (HRSA 99-1), indirect medical education data related to the teaching of residents form (HRSA 99-2), assurance/certification attestation form (HRSA 99-3), and the performance data (GPRA) tables (HRSA 99-4). For children's teaching hospitals that file full Medicare Cost Reports, adjudication is conducted by comparing the hospital's application to the Medicare Fiscal Intermediary reports. The aforementioned documents are available electronically via the CHGMEPP web site at

Note: Each program will indicate whether applications are to be submitted to the Federal headquarters, regional or local office, or to a State or local government office.

Award Procedure:

Notification of award is made in writing by a notice of award letter issued from the headquarters office.

Note: Grant payments may be made by a letter of credit, advance by Treasury check, or reimbursement by Treasury check. Awards may be made by the headquarters office directly to the applicant, an agency field office, a regional office, or by an authorized county office. The assistance may pass through the initial applicant for further distribution by intermediate level applicants to groups or individuals in the private sector.

Deadlines and process...


Contact the Headquarters Office for application deadlines. The CHGME web site will also publish the information ahead of time.

Note: When available, this section indicates the deadlines for applications to the funding agency which will be stated in terms of the date(s) or between what dates the application should be received. When not available, applicants should contact the funding agency for deadline information.

Range of Approval/Disapproval Time

Not applicable.

Preapplication Coordination

Not applicable. This program is excluded from coverage under E.O. 12372.

Note: This section indicates whether any prior coordination or approval is required with governmental or nongovernmental units prior to the submission of a formal application to the federal funding agency.


The appeals process will be addressed as the rule-making process evolves.

Note: In some cases, there are no provisions for appeal. Where applicable, this section discusses appeal procedures or allowable rework time for resubmission of applications to be processed by the funding agency. Appeal procedures vary with individual programs and are either listed in this section or applicants are referred to appeal procedures documented in the relevant Code of Federal Regulations (CFR).


Eligible children's hospitals must complete a CHGMEPP application for inclusion in the program for each fiscal year that they are applying for funds.

Note: In some instances, renewal procedures may be the same as for the application procedure, e.g., for projects of a non-continuing nature renewals will be treated as new, competing applications; for projects of an ongoing nature, renewals may be given annually.

Who can benefit...

Any public or private nonprofit and profit children's teaching hospital with an accredited residency training program which meeting all eligibility requirements may apply.

About this section:

This section lists the ultimate beneficiaries of a program, the criteria they must satisfy and who specifically is not eligible. The applicant and beneficiary will generally be the same for programs that provide assistance directly from a Federal agency. However, financial assistance that passes through State or local governments will have different applicants and beneficiaries since the assistance is transmitted to private sector beneficiaries who are not obligated to request or apply for the assistance.

What types of assistance...

Direct Payments for Specified Use

Financial assistance from the Federal government provided directly to individuals, private firms, and other private institutions to encourage or subsidize a particular activity by conditioning the receipt of the assistance on a particular performance by the recipient. This does not include solicited contracts for the procurement of goods and services for the Federal government.

How much financial aid...

Range and Average of Financial Assistance

$6,509 to $22,635,849; $4,532,717 in combined DME and IME payments.

Note: This section lists the representative range (smallest to largest) of the amount of financial assistance available. These figures are based upon funds awarded in the past fiscal year and the current fiscal year to date. Also indicated is an approximate average amount of awards which were made in the past and current fiscal years.


FY 03 $292,000,000; FY 04 est $199,000,000 and FY 05 est 303,000,000.

Note: The dollar amounts listed in this section represent obligations for the past fiscal year (PY), estimates for the current fiscal year (CY), and estimates for the budget fiscal year (BY) as reported by the Federal agencies. Obligations for non-financial assistance programs indicate the administrative expenses involved in the operation of a program.

Account Identification


Note: Note: This 11-digit budget account identification code represents the account which funds a particular program. This code should be consistent with the code given for the program area as specified in Appendix III of the Budget of the United States Government.

Examples of funded projects...


About this section

This section indicates the different types of projects which have been funded in the past. Only projects funded under Project Grants or Direct Payments for Specified Use should be listed here. The examples give potential applicants an idea of the types of projects that may be accepted for funding. The agency should list at least five examples of the most recently funded projects.

Program accomplishments...

The CHGMEPP made awards to 57 eligible children's teaching hospitals in fiscal year 2001, 59 eligible children's teaching hospitals in fiscal year 2002. It is estimated that awards will be made to 61 eligible teaching hospitals in fiscal year 2003.

Criteria for selecting proposals...

Children's teaching hospitals must meet all of the eligibility criteria before being considered for program funds. This is a noncompetitive annual award.

Assistance considerations...

Length and Time Phasing of Assistance

In accordance with the Healthcare Research and Quality Act, 1999, Public Law 106-129, the Secretary of DHHS shall determine before the beginning of each fiscal year that payments are made for a hospital. The amounts of the payments for direct and indirect medical education are made to each hospital in 26 equal interim installments during the period. The Children's Health Act, Public Law 106-310, amends the length of the CHGME Payment Program through fiscal year 2005. Payments are made by an Electronic Transfer System.

Formula and Matching Requirements

Section 340E(a) requires the Secretary of DHHS to make payments for direct and indirect expenses associated with operating approved graduate medical residency training programs for each fiscal year. The two statutory formulas (direct medical education and indirect medical education) payments to eligible children's teaching hospitals are made as outlined in Federal Register Notice (FRN) Vol. 65, No. 118 published on June 19, 2000; FRN Vol. 66, No. 41 published on March 1, 2001; and FRN Vol. 66, No. 140 published on July 20, 2001 and FRN Vol.67,No. 186, published on September 25, 2002. This program has no statutory matching requirements; and FRN Vol 68, No. 163, published October 22, 2003.

A formula may be based on population, per capita income, and other statistical factors. Applicants are informed whether there are any matching requirements to be met when participating in the cost of a project. In general, the matching share represents that portion of the project costs not borne by the Federal government. Attachment F of OMB Circular No. A-102 (Office of Management and Budget) sets forth the criteria and procedures for the evaluation of matching share requirements which may be cash or in-kind contributions made by State and local governments or other agencies, institutions, private organizations, or individuals to satisfy matching requirements of Federal grants or loans.

Cash contributions represent the grantees' cash outlay, including the outlay of money contributed to the grantee by other public agencies, institutions, private organizations, or individuals. When authorized by Federal regulation, Federal funds received from other grants may be considered as the grantees' cash contribution.

In-kind contributions represent the value of noncash contributions provided by the grantee, other public agencies and institutions, private organizations or individuals. In-kind contributions may consist of charges for real property and equipment, and value of goods and services directly benefiting and specifically identifiable to the grant program. When authorized by Federal legislation, property purchased with Federal funds may be considered as grantees' in-kind contribution.

Maintenance of effort (MOE) is a requirement contained in certain legislation, regulations, or administrative policies stating that a grantee must maintain a specified level of financial effort in a specific area in order to receive Federal grant funds, and that the Federal grant funds may be used only to supplement, not supplant, the level of grantee funds.

Post assistance requirements...



Note: This section indicates whether program reports, expenditure reports, cash reports or performance monitoring are required by the Federal funding agency, and specifies at what time intervals (monthly, annually, etc.) this must be accomplished.


DHHS, or any other authorized Federal agency, may conduct an audit to determine whether the applicant has complied with all governing laws and regulations in its application for funding. Any and all information submitted to DHHS by an applicant or participating hospital during or after the award of funds is subject to review in an audit. Eligible hospitals are subjected to the terms of the Full-Time Equivalent Assessment Process Guidance which is available electronically via CHGMEPP web site noted in Application Procedure above.

Note: This section discusses audits required by the Federal agency. The procedures and requirements for State and local governments and nonprofit entities are set forth in OMB Circular No. A-133. These requirements pertain to awards made within the respective State's fiscal year - not the Federal fiscal year, as some State and local governments may use the calendar year or other variation of time span designated as the fiscal year period, rather than that commonly known as the Federal fiscal year (from October 1st through September 30th).


In accordance with 45 CFR Part 74, Subpart D, financial and programmatic records, supporting documents, statistical records, and all other records of a participating hospital that are required by the terms of the award or may reasonably be considered pertinent to the award, must be retained for 3 years after the end of a fiscal year. Access to these records is also governed by the provisions of 45 CFR Part 74, Subpart D.

Note: This section indicates the record retention requirements and the type of records the Federal agency may require. Not included are the normally imposed requirements of the General Accounting Office. For programs falling under the purview of OMB Circular No. A-102, record retention is set forth in Attachment C. For other programs, record retention is governed by the funding agency's requirements.



Public Health Service Act, Title III Part D, Section 340E, 42 U.S.C. 256E, as amended; The Children's Health Act, 2000, Public Law 106-310, Healthcare Research and Quality Act, 1999, Public Law 106-129; Social Security Act.

Note: This section lists the legal authority upon which a program is based (acts, amendments to acts, Public Law numbers, titles, sections, Statute Codes, citations to the U.S. Code, Executive Orders, Presidential Reorganization Plans, and Memoranda from an agency head).

Regulations, Guidelines, And Literature

Healthcare Research and Quality Act, 1999 (Public Law 106-129), Section 340E of the Public Health Service Act; The Children's Health Act, 2000 (Public Law 106-310, Title XX); Social Security Act, Section 1886, 42 CFR 412.105; 42 CFR 413.86; FRN Vol. 65, No. 118 published on June 19, 2000; FRN Vol. 66, No. 41 published on March 1, 2001; and FRN Vol. 66, No. 140 published on July 20, 2001, and FRN Vol. 68, No. 163, published on October 22, 2004.

Contact information...

Web Sites
Regional Or Local Office


Note: This section lists the agency contact person, address and telephone number of the Federal Regional or Local Office(s) to be contacted for detailed information regarding a program such as: (1) current availability of funds and the likelihood of receiving assistance within a given period; (2) pre-application and application forms required; (3) whether a pre-application conference is recommended; (4) assistance available in preparation of applications; (5) whether funding decisions are made at the headquarters, regional or local level; (6) application renewal procedures (including continuations and supplementals) or appeal procedures for rejected applications; and (7) recently published program guidelines and material. However, for most federal programs, this section will instruct the reader to consult the so-called Appendix IV of the Catalog due to the large volume of Regional and Local Office Contacts for most agencies. This information is provided in Additional Contact Information (see below).

Headquarters Office

Program Contact: Ayah Johnson, Chief, Graduate Medical Education Branch, Division of Medicine and Dentistry, Bureau of Health Professions, Health Resources and Services Administration, Department of Health and Human Services, 5600 Fishers Lane, Room 9A-05, Rockville, MD 20857. Telephone: (301) 443-1058.

Note: This section lists names and addresses of the office at the headquarters level with direct operational responsibility for managing a program. A telephone number is provided in cases where a Regional or Local Office is not normally able to answer detailed inquiries concerning a program. Also listed are the name(s) and telephone number(s) of the information contact person(s) who can provide additional program information to applicants.

Additional Contact Information (Appendix IV)

Due to the large volume of regional and local office contacts for most agencies, full contact information is also provided separately here in a PDF format: