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American Medical Association House of Delegates Amends Policy on Cap-Flexibility

The Medical Association of Georgia (MAG) introduced a resolution at the 2019 Annual Meeting of the American Medical Association (AMA) House of Delegates calling on the American Medical Association to advocate for the Centers for Medicare & Medicaid Services (CMS) "to adopt the concept of "Cap-Flexibility" and allow new and current Graduate Medical Education teaching institutions to extend their cap-building window for up to an additional five years beyond the current window (for a total of up to ten years), giving priority to primary care residences."

The resolution further called on the AMA to advocate for CMS to provide funding to reaching hospitals prior to the arrival of any residents and to remove the clause "Medicare funding does not begin until the first resident is 'on-duty' at the hospital".

Due to concerns raised regarding the language calling on the AMA to providing funding to reaching hospitals prior to the arrival of residents, the AMA House did not adopt the resolution. Rather, it was decided that it would be preferable to amend existing AMA policy regarding cap-flexibility in lieu of adopting the resolution. You may recall that the original AMA policy on cap-flexibility is a result of a resolution that the Texas Medical Association (TMA) took to the AMA House of Delegates back in 2017.

This is a summary of the action by the 2019 AMA House of Delegates:

RESOLUTION 233 – GME CAP FLEXIBILITY

RECOMMENDATION A:

Madam Speaker, your Reference Committee recommends that Policy D-305.967 be amended by addition and deletion to read as follows: The Preservation, Stability and Expansion of Full Funding for Graduate Medical Education D-305.967

31. Our AMA will advocate to the Centers for Medicare & Medicaid Services for flexibility beyond the current maximum of five years for the Medicare graduate medical education cap setting deadline for new residency programs in underserved areas and/or economically depressed areas.to adopt the concept of “Cap-Flexibility” and allow new and current Graduate Medical Education teaching institutions to extend their cap building window for up to an additional five years beyond the current window (for a total of up to ten years), giving priority to new residency programs in underserved areas and/or economically depressed areas.

RECOMMENDATION B:

Madam Speaker, your Reference Committee recommends that Policy D-305.967 be adopted as amended in lieu of Resolution 233.

HOD ACTION: Policy D-305.967 adopted as amended in lieu ofResolution 233.

Resolution 233 asks that our American Medical Association advocate for the Centers for Medicare and Medicaid Services (CMS) to adopt the concept of “Cap-Flexibility” and allow new and current Graduate Medical Education teaching institutions to extend their cap-building window for up to an additional five years beyond the current window (for a total of up to ten years), giving priority to primary care residencies (Directive to Take Action); and be it further; that our AMA advocate for CMS to provide funding to hospitals and/or universities prior to the arrival of any residents, removing the clause where “Medicare funding does not begin until the first resident is ‘on-duty’ at the hospital.” (Directive to Take Action).

Your Reference Committee heard mixed testimony on Resolution 233. Your Reference Committee heard testimony that our AMA has existing policy in support of cap-flexibility. Your Reference Committee further heard testimony that our AMA has been actively advocating for cap-flexibility both with the Centers for Medicare and Medicaid Services (CMS) as well as the U.S. Congress. Your Reference Committee heard testimony that direct GME (DGME) payments are based on a hospital’s submission of a cost report and its residents on duty. Your Reference Committee heard further testimony that removing the residents-on-duty provision would require CMS to develop a new comprehensive formula for DGME payments and may result in less funding for GME. Testimony also indicated that, given that AMA policy on GME is based on the current formula, all existing AMA GME-related policy would need to be reviewed in light of any changes to the funding formula.

Accordingly, your Reference Committee recommends amending existing policy on GME in lieu of Resolution 233.

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