Children's Hospitals Graduate Medical Education Payment Program

The Children's Hospitals Graduate Medical Education (CHGME) Payment Program provides funds to freestanding children's teaching hospitals to support the training of pediatric and other residents in graduate medical education (GME) programs.

Federal funding for graduate medical education (GME) is
extensively provided by the Centers for Medicare and Medicaid Services (CMS).

Prior to the enactment of the CHGME Payment Program, children?s teaching hospitals received a disproportionately low amount of this federal funding when compared to teaching hospitals that serve adult patients.

The purpose of the CHGME Payment Program is to compensate for the disparity in the level of federal funding for pediatric teaching hospitals versus other types of teaching hospitals.

The CHGME Payment Program is administered by the Bureau of Health Workforce (BHW), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS).

Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.

Office - See Regional Agency Offices.

Selected Recipients for this Program

RecipientAmount Start DateEnd Date
Stc Opco, Llc $ 13,512,200   2019-12-012021-09-30
Health, Department Of $ 2,331,929   2017-10-012021-09-30
Nemours Foundation, The $ 2,059,409   2019-10-012021-09-30
Children's Hospital Medical Center Of Akron $ 9,021,094   2017-10-012021-09-30
Children's Mercy Hospital, The $ 16,203,480   2017-10-012021-09-30
Ascension Seton $ 5,582,675   2017-10-012021-09-30
Children's Hospital $ 13,385,843   2017-10-012021-09-30
Cleveland Clinic Foundation, The $ 62,425   2017-10-012021-09-30
Valley Children's Hospital $ 1,551,749   2017-10-012021-09-30
Arkansas Children's Hospital $ 20,713,589   2017-10-012021-09-30

Program Accomplishments

Fiscal Year 2016: In Academic Year 2015-2016, the CHGME program supported the training of 5,017 pediatric residents that included general pediatrics residents, as well as residents from five types of combined pediatrics programs (e.g., internal medicine/ pediatrics). Additionally, 2,713 pediatric medical subspecialists, 285 pediatric surgical subspecialists, and 365 pediatric dentistry residents were trained. The CHGME also supported training of 3,120 non-pediatric residents and fellows in the care of children. CHGME-funded medical residents and fellows provided a total of 2,075,887 patient encounters in primary care settings and a total of 4,799,074 patient contact hours in medically underserved communities. Fiscal Year 2017: No Current Data Available. Fiscal Year 2018: No Current Data Available.

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.

Eligibility Requirements

Applicant Eligibility

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 residency training program; (2) have a Medicare provider payment agreement as defined by section 340E(g)(2) of the PHS Act; (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.

The Children?s Hospital GME Support Reauthorization Act of 2013 has expanded the eligibility to include freestanding hospitals 1) with a Medicare payment agreement and that is excluded from the Medicare inpatient hospital prospective payment system pursuant to section 1886(d)(1)(B) of the Social Security Act and its accompanying regulations; 2) whose inpatients are predominantly individuals under 18 years of age; 3) that has an approved medical residency training program as defined in section 1886(h)(5)(A) of the Social Security Act; and 4) that is not otherwise qualified to receive payments under this section or section 1886(h) of the Social Security Act.

The reauthorization permits the Secretary, ?to make available up to 25% of the total amounts in excess of $245,000,000,? but ?not to exceed $7,000,000,? for the purpose of making CHGME payments to these Newly Qualified Hospitals.

Federally Recognized Indian Tribal Government and Native American Organizations may apply if they are otherwise eligible.

Beneficiary Eligibility

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


Applicants should review the individual HRSA funding opportunity announcement issued under this CFDA program for any required proof or certifications which must be submitted with an application package. This program is excluded from coverage under 2 CFR 200, Subpart E - Cost Principles.

Aplication and Award Process

Preapplication Coordination

Preapplication coordination is required.

Environmental impact information is not required for this program.

This program is excluded from coverage under E.O.


Application Procedures

This program is excluded from coverage under 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. HRSA requires all applicants to apply electronically through All eligible, qualified applications are reviewed by HRSA Staff. Notification is made in writing by a Notice of Award. The CHGME Payment Program statute requires a yearly assessment of the full-time (FTE) resident counts reported by children hospitals. Fiscal intermediaries working under contract to HRSA assess those reported FTE resident counts. Final grant payment determinations are based on the final audited numbers.

Award Procedures

Notification is made in writing (electronic) by a Notice of Award (NOA). 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) outline payments to eligible children's teaching hospitals.


Contact the headquarters or regional office, as appropriate, for application deadlines.


Section 340E of the Public Health Service Act (42 U.S.C. 256e), Public Law 109-307 as amended by the Children?s Hospital GME Support Reauthorization Act of 2013.

Range of Approval/Disapproval Time

Approximately 120 to 180 days after receipt of applications.


Hospitals can appeal the determination of FTE resident counts by CHGME fiscal intermediaries to the Provider Reimbursement Review Board (PRRB) under section 1878 of the Social Security Act.


Eligible children's hospitals must complete a CHGME Payment Program application for inclusion in the program for each fiscal year that they are applying for funds. They must also submit a reconciliation application that will reflect the ?Secretary determination of the Final FTE resident counts? carried out by CHGME fiscal intermediaries led by a contractor. The contractor is under contract to the Bureau of Health Workforce (BHW) to conduct the assessments of residents? counts reported by children?s hospitals on their initial applications for funds.

Assistance Considerations

Formula and Matching Requirements

Statutory formulas are not applicable to this program. Matching requirements are not applicable to this program. MOE requirements are not applicable to this program.

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 the number of resident FTE counts 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 12 equal interim installments during the Federal fiscal year. See the following for information on how assistance is awarded/released: Both interim payments (prior to audits) and final payments are computed using a zero sum gain payment model. The calculations of both direct and indirect graduate medical education payments are formula based. Once payments are determined, recipients drawdown funds, as necessary, from the Payment Management System (PMS), the centralized web based payment system for HHS awards.

Post Assistance Requirements


Both program and financial reports are required.

Public Law 109-307 requires children?s hospitals receiving CHGME payments to submit an annual report that focuses on their GME training programs.

The children?s hospitals comply with the Government Performance Result Act (GPRA) and submit performance data each fiscal year as part of their reconciliation applications for funds.

The awardee will also be required to submit an annual performance report.

A Federal Financial Report (SF-425) is required according to the schedule in HRSA's Application Guide.

Cash reports are not applicable.

No progress reports are required.

No expenditure reports are required.

Performance monitoring is not applicable.


This program is excluded from coverage under 2 CFR 200, Subpart F - Audit Requirements. 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 and Assessments which is available electronically via CHGME Payment Program web site noted in Application Procedure above.


Recipients are required to maintain grant accounting records for 3 years after the date they submit the Federal Financial Report (FFR). If any litigation, claim, negotiation, audit, or other action involving the award has been started before the expiration of the 3 year period, the records shall be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular 3 year period, whichever is later.

Financial Information

Account Identification



(Direct Payments for Specified Use) FY 16 $279,033,446; FY 17 est $294,439,000; and FY 18 est $295,000,000

Range and Average of Financial Assistance

Range: $39,000-$17,786,000; average $4,798,000 in combined DME and IME payments.

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); Public Law 108-490; Public Law 109-307; 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. 204, published on October 22, 2003. HRSA awards are also subject to the requirements of the HHS Grants Policy Statement (HHS GPS) that are applicable based on recipient type and purpose of award. The HHS GPS is available at

Information Contacts

Regional or Local Office

See Regional Agency Offices.

Headquarters Office

Marshala Lee, Division of Medicine and Dentistry, Bureau of Health Workforce 5600 Fishers Lane, Room 15N142, Rockville, Maryland 20857 Email: Phone: 301-443-8681 Fax: 301-443-8890

Criteria for Selecting Proposals

Children's teaching hospitals must meet all of the eligibility criteria before being considered for program funds and must be training residents during the year for which they are applying for funding. This is a formula-based grant payment program. Application review is conducted at HRSA and an independent assessment of residents? count is conducted by fiscal intermediaries.

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