---
kind: "section"
citation: "42 C.F.R. § 413.81"
title: "42"
number: "413.81"
heading: "Direct GME payments: Application of community support and redistribution of costs in determining FTE resident counts."
url: "https://uscodex.org/cfr/42/413.81"
---

# §413.81. Direct GME payments: Application of community support and redistribution of costs in determining FTE resident counts.

- (a) **For purposes of determining direct GME payments, the following principles apply—**
  - (1) **Community support.** If the community has undertaken to bear the costs of medical education through community support, the costs are not considered GME costs to the hospital for purposes of Medicare payment.
  - (2) **Redistribution of costs.** The costs of training residents that constitute a redistribution of costs from an educational institution to the hospital are not considered GME costs to the hospital for purposes of Medicare payment.
- (b) **Application.** A hospital must continuously incur costs of direct GME of residents training in a particular program at a training site since the date the residents first began training in that program in order for the hospital to count the FTE residents in accordance with the provisions of §§ [413.78](/cfr/42/413.78.md), [413.79 (c) through (e)](/cfr/42/413.79.md?p=c..e), and [413.79(k)](/cfr/42/413.79.md?p=k). This rule also applies to providers that are paid for direct GME in accordance with [§ 405.2468](/cfr/42/405.2468.md) of this chapter, [§ 422.270](/cfr/42/422.270.md) of this subchapter, and [§ 413.70](/cfr/42/413.70.md).
- (c)
  - (1) **Effective date.** Subject to the provisions of [paragraph (c)(2)](#c-2) of this section, payments made in accordance with determinations made under the provisions of paragraphs [(a)](#a) and [(b)](#b) of this section will be effective for portions of cost reporting periods occurring on or after October 1, 2003.
  - (2) **Applicability for certain hospitals.** With respect to an FTE resident who begins training in a residency program on or before October 1, 2003, and with respect to whom there has been a redistribution of costs or community support determined under the provisions of paragraphs [(a)](#a) and [(b)](#b) of this section, the hospital may continue to count the FTE resident until the resident has completed training in that program, or until 3 years after the date the resident began training in that program, whichever comes first.

## Notes

### Amendments

[69 FR 49254, Aug. 11, 2004]

### Authority

Authority: 42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 1395m, 1395x(v), 1395x(kkk), 1395hh, 1395rr, 1395tt, and 1395ww.

### Source

Source: 51 FR 34793, Sept. 30, 1986, unless otherwise noted.

### Amendments

[69 FR 49254, Aug. 11, 2004]