Children's Hospital GME Annual Report Program Information

Department of Health and Human Services
Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

Bureau of Health Professions

December 1, 2010
Dear Children’s Hospital:
The Children’s Hospitals Graduate Medical Education (CHGME) Payment Program was reauthorized
for a period of five years by the Children’s Hospital GME Support Reauthorization Act of 2006 (Public
Law 109-307) in October 2006. The reauthorizing legislation requires children’s hospitals participating
in the CHGME Payment Program to provide information about their residency training programs in an
Annual Report submitted as an addendum to the hospitals’ annual applications for funds.
Enclosed is the CHGME Payment Program Annual Report package, which includes all applicable forms,
guidance and instructions. It is important to thoroughly read the detailed annual report guidance and
instructions before completing the required forms. Additional copies of the annual report package may be
obtained electronically via the CHGME website at:

http://bhpr.hrsa.gov/childrenshospitalgme/annualreport.
Your completed annual report package must be mailed following the guidance provided in the “Annual
Report and Deadlines” section of the enclosed package.
If you have questions regarding the annual report, please call the Graduate Medical Education Branch at
301-443-1058 or e-mail at childrenshospitalgme@hrsa.gov.

Sincerely yours,

Associate Administrator

Enclosures

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Department of Health and Human Services
Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

Children’s Hospitals Graduate Medical Education (CHGME)
Payment Program Annual Report Package
Table of Contents
Section
Section I: Overview of the CHGME Payment Program

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A. Introduction
B. Description
C. Administration
Section II: Annual Report Deadline and Statutory Requirements
A.
B.
C.
D.
E.
F.

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Effective Date of Annual Report Requirement
Release of Annual Report Materials
Electronic Availability of Annual Report Materials
Annual Report DEADLINE
Annual Report Statutory Requirements
Structure of Annual Report and Compliance

Section III: CHGME Payment Program Annual Report Forms and Instructions

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Summary of Annual Report Data Collection Instrument

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A.
B.
C.
D.
E.

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Screening Instrument :
Hospital Level Information:
Program Specific Information:
Certification Form:
Annual Report Checklist:

HRSA 100-1
HRSA 100-2
HRSA 100-3
HRSA 100-4
HRSA 100-5

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Section IV: References

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A. Commonly Used Acronyms
B. Definitions

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Department of Health and Human Services
Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

Section I: Overview of the CHGME Payment Program

Introduction
The Children’s Hospital Graduate Medical Education (CHGME) Payment Program provides funds to
freestanding children’s hospitals to support the training of pediatric and other residents in graduate
medical education (GME) programs. This program compensates for the disparity in the level of Federal
funding for freestanding children’s hospitals and other teaching hospitals supported by Centers for
Medicare and Medicaid Services (CMS) GME funds.
Description
The CHGME Payment Program was established in 1999 when Congress passed the Healthcare Research
and Quality Act. The act was signed on December 6, 1999 and the legislation authorized the program for
Federal fiscal year (FY) 2000 and FY 2001. On October 17, 2000, the Children’s Health Act of 2000
amended the Healthcare Research and Quality Act of 1999 extending the CHGME Payment Program
through FY 2005. On December 23, 2004, additional amendments under Public Law 108-490 were made
to Section 340E of the Public Health Service Act affecting the CHGME Payment Program. The
Children’s Hospitals Graduate Medical Education (CHGME) Payment Program was reauthorized again,
for a period of five years, by the Children’s Hospital GME Support Reauthorization Act of 2006 (Public
Law 109-307) in October 2006. In FY 2010, the CHGME Payment Program was funded at $317.5
million.
There are about 60 freestanding children’s teaching hospitals across the country that train about 30
percent of the Nation’s pediatricians, nearly half of pediatric sub-specialists, and provide valuable training
for physicians in many other specialties. These are the physicians who care for America’s youngest
population – its children. Almost 50 percent of the patient care that children’s teaching hospitals provide
is for low-income children, including those covered by Medicaid and those who are uninsured. In
addition, these hospitals are regional and national referral centers for very sick children, often serving as
the only source of care for many critical pediatric services. More than 75 percent of inpatient care at
children’s hospitals is devoted to children with one or more chronic conditions.
The CHGME Payment Program provides a more adequate level of support for GME training in U.S.
children’s teaching hospitals that have a separate Medicare provider number. These hospitals receive
relatively little funding from Medicare for GME. Funding received by other teaching hospitals from
Medicare was expected to exceed $9 billion in FY 2010
The CHGME Payment Program law authorized $280 million for payments in FY 2000, $285
million in FY 2001, and “such sums as necessary” for fiscal years 2002 through 2005. Congress
appropriated $40 million for the program in FY 2000, $235 million in FY 2001, $285 million in FY
2002, $292 million in FY 2003, $305 million for FY 2004, and $303 million for FY 2005. For both
FY 2004 and FY 2005 Congress implemented a rescission reducing total appropriated amounts.
For both FY 2006 and FY 2007, the annual appropriation for the CHGME Payment Program was
$297 million. In FY2009, the appropriation was $301 million, and in FY 2010, the appropriation
was raised to$317.5 million. In FY 2009, the CHGME appropriation provided GME support to 56

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Department of Health and Human Services
Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

children's hospitals in 31 states supporting more than 5,631 unweighted resident full-time
equivalents (FTEs) training in these hospitals. Since the inception of this program, the program has
disbursed more than $2.5 billion in Federal GME support to freestanding children’s teaching
hospitals.
Administration
With delegated authority from the Secretary, Health and Human Services, the CHGME Payment Program
is administered by the Health Resources and Services Administration, Bureau of Health Professions.
Questions regarding the CHGME Payment Program should be directed to the:
Department of Health and Human Services
Health Resources and Services Administration
Bureau of Health Professions
Division of Medicine and Dentistry
Graduate Medical Education Branch
Parklawn Building
5600 Fishers Lane, Room 9A-05
Rockville, Maryland 20857
Telephone: 301-443-1058 Fax: 301-443-1879

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Department of Health and Human Services
Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

Section II: Annual Report Deadline and Statutory Requirements
Effective Date of Annual Report Requirement
The effective date of Public Law 109-307 applies to the FY 2008 CHGME Payment Program application
year and each subsequent fiscal year through FY2011.
All children’s hospitals receiving CHGME Payment Program funding must submit a completed Annual
Report as an addendum to each participating children’s hospital’s (initial) application for funding.
Hospitals who fail to submit their completed annual report by this date are subject to penalty (See Failure
to Report below).
Release of Annual Report Materials
As mentioned above, the annual report will be an addendum to each participating children’s hospital’s
(initial) application for funding. The CHGME Payment Program Annual Report Package will be released
(to hospitals) on or about December 1, 2010. The Annual Report forms will be made available for
hospitals to download from the CHGME Payment Program website on or about this date.
Electronic Availability of Annual Report Materials
Annual report materials will be available electronically via the CHGME Payment Program website at
http://bhpr.hrsa.gov/childrenshospitalgme/annualreport.htm.

Annual Report Submission and Deadline
Annual reports accepted for review must be completed following the annual report guidance and
instructions provided herein, submitted in English, typed, and include the above completed forms and
supporting documentation as identified in the Annual Report (HRSA 100-1, HRSA 100-2, and HRSA
100-3), certification (HRSA 100-4) signed by the individual authorized to sign for the applicant
institution (HRSA-99-3) and the Annual Report Checklist (100-5). The completed, signed annual report
package must be postmarked by February 4, 2011 and submitted to the:
Health Resources and Services Administration
Bureau of Health Professions
Division of Medicine and Dentistry
Graduate Medical Education Branch
Parklawn Building
5600 Fishers Lane Room 9A-05
Rockville, Maryland 20857
Reports that are not postmarked by the specified deadline will not be accepted for processing and will be
returned to the applicant.

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Department of Health and Human Services
Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

Annual Report Statutory Requirements
As mandated by Public Law 109-307, the CHGME Payment Program Annual Report requires
participating children’s hospitals to report the following information for the residency academic year
completed immediately prior to the fiscal year for which the children’s hospital is applying for CHGME
Payment Program funding. The current report, effective for the FY2011 application year, will report
information related to the July 1, 2009 to June 30, 2010 academic year.
Information Required by Public Law 109-307:
i. The types of resident training programs that the hospital provided for residents, such as
general pediatrics, internal medicine/pediatrics, and pediatric subspecialties, including both
medical subspecialties certified by the American Board of Pediatrics and non-medical
subspecialties approved by other medical certification boards.
ii. The number of training positions for residents, the number of such positions recruited to fill,
and the number of such positions filled.
iii. The types of training that the hospital provided for residents related to the health care needs of
different populations, such as children who are underserved for reasons of family income or
geographic location, including rural or urban.
iv. The changes in residency training for residents which the hospital has made during such
residency academic year (except that the first report submitted by the hospital shall be for
such changes since the first year the hospital received payment including (I) changes in
curricula, training experiences, and types of training programs, and benefits that have
resulted in such changes; and (II) changes for purposes of training residents in the
measurement and improvement of the quality and safety of patient care.
v. The numbers of residents who completed their residency training at the end of such residency
academic year and care for children within the borders of the service area of the hospital or
within the borders of the State in which the hospital is located. Such numbers shall be
disaggregated with respect to residents who completed their residencies in general pediatrics
or internal medicine/pediatrics, subspecialty residencies, and dental residencies.
According to the Public Law 109-307, the residents referred to in the paragraphs above are those who:
(i) are in full-time equivalent resident training positions in any training program
sponsored by the hospital; or
(ii) are in a training program sponsored by an entity other than the hospital, but who
spend more than 75 percent of their training time at the hospital.
Structure of the Annual Report and Compliance
The CHGME Payment Program Annual Report data collection instrument includes three Excel-based
workbooks including a Screening Instrument (HRSA 100-1) and the two-part Annual Report (HRSA 100-2

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Department of Health and Human Services
Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

and HRSA 100-3) for qualifying hospitals. Each workbook has multiple worksheets, each designed to
meet a legislative mandate delineated in Public Law 109-307.
All participating hospitals must complete the HRSA 100-1, Screening Instrument, the HRSA 100-4
Certification Form and the HRSA 100-5, Annual Report Checklist.
Only certain hospitals (those qualifying by virtue of sponsoring any GME training programs with at least
one resident or training residents sponsored by another institution who spend more than 75 percent of
their training time training in the children’s hospital) are required to complete the two- part Annual
Report (HRSA 100-2 and HRSA 100-3).
The HRSA 100-1 (Screening Instrument) includes five worksheets and is designed to determine whether
the children’s hospital is required to complete the additional components of the Annual Report (HRSA
100-2 and HRSA 100-3).
Those training programs meeting the requirement of having (1) at least one resident in a full-time
equivalent (FTE) training position in any GME training program sponsored by the children’s hospital; or
(2) at least one resident in a GME training program sponsored by another entity, but who spends more
than 75 percent of his or her training time at the children’s hospital are required to complete the HRSA
100-2 and the HRSA 100-3. The HRSA 100-2 requires hospital-level information and the HRSA 100-3
requires program-specific information.
One HRSA 100-3 Form must be completed for each qualifying training program.
Details and instructions of the requirements are provided in Section III of this Guidance.
Failure to Report
According to Public Law 109-307, failure to report shall result in a 25 percent reduction in payment if
the Secretary determines that“(I) the hospital has failed to provide the Secretary, as an addendum to the hospital’s application
under this section for such fiscal year, the report required under subparagraph (B-Annual Report) for the
previous fiscal year; or
“(II) Such report fails to provide the information required under any clause of such
subparagraph.
“(ii) NOTICE AND OPPORTUNITY TO PROVIDE MISSING INFORMATION.----Before imposing
a reduction under clause (i) on the basis of a hospital’s failure to provide information described in
clause (i)(II), the Secretary shall provide notice to the hospital of such failure and the Secretary’s
intention to impose such reduction and shall provide the hospital with the opportunity to provide the
required information within a period of 30 days beginning on the date of such notice. If the hospital
provides such information within such period, no reduction shall be made under clause (i) on the basis
of the previous failure to provide such information.

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Department of Health and Human Services
Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

Procedures and Schedule for Providing a Missing Report or Missing Information
As required by Public Law 109-307, upon notice by the Secretary, hospitals will be allowed 30 days to
provide an annual report or required information missing from a submitted annual report. It is
anticipated that notices will be made no later than March 8, 2011 with a requirement that hospitals
provide the annual report or missing information postmarked no later than April 7, 2011.
Opportunity for Amending a Completed Report
Hospitals may provide amended information to a completed report by June 30 of the fiscal year in
which the Annual Report is submitted.

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Department of Health and Human Services
Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

Section III: Annual Report Forms and Instructions

Summary of Annual Report Data Collection Instrument
As noted above, the CHGME Payment Program Annual Report data collection forms include three Excelbased workbooks: a Screening Instrument (HRSA 100-1) and a two- part Annual Report (HRSA 100-2
and HRSA 100-3) to be completed by qualifying hospitals. Each workbook has multiple worksheets,
each of which is designed to meet a legislative mandate delineated in Public Law 109-307.
All participating hospitals must complete the HRSA 100-1, Screening Instrument, the HRSA 100-4
Certification Form and the HRSA 100-5, Annual Report Checklist.
The HRSA 100-1 (Screening Instrument) includes five worksheets and is designed to determine whether
the children’s hospital is required to complete the additional components of the Annual Report (HRSA
100-2 and HRSA 100-3).
Those training programs meeting the requirement of having (1) at least one resident in a full-time
equivalent (FTE) training position in any GME training program sponsored by the children’s hospital; or
(2) at least one resident in a GME training program sponsored by another entity, but who spends more
than 75 percent of his or her training time at the children’s hospital are required to complete the HRSA
100-2 and the HRSA 100-3.
The HRSA 100-2 requires hospital-level information with statistics about discharged patients and ,
hospital patient safety initiatives..
The HRSA 100-3 requires program-specific information. One HRSA 100-3 Form must be completed for
each qualifying training program. Details and instructions of the requirements are provided in Section IV
below.
If any GME training programs are highlighted in the final worksheet of the HRSA 100-1
(worksheet HRSA 100-1-E), indicating that your children’s hospital trained at least one resident
in a sponsored program or at least one resident who spent more than 75 percent of his or her
training time for the academic year receiving training in your hospital, your hospital must
submit a completed HRSA 100-2 with hospital-level information for the hospital as a whole
and one HRSA 100-3 for each highlighted program. The hospital may be submitting as many
as 30 or more separate HRSA 100-3 forms, depending on how many programs are
highlighted in worksheet 100-1-E.
Specific instructions for completing each worksheet in each workbook are provided below.

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Department of Health and Human Services
Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

INSTRUCTIONS FOR HRSA 100-1: CHGME PAYMENT PROGRAM

ANNUAL REPORT SCREENING INSTRUMENT
CHGME Payment Program Annual Report
HRSA 100-1, Screening Instrument (Academic Year July 1, 2009 – June 30, 2010)

The HRSA 100-1, (the Annual Report Screening Instrument) requires information about your children’s
hospital, its training programs and number of resident trainees. The Excel workbook includes five
worksheets, the HRSA 100-1-A, HRSA 100-1-B, HRSA 100-1-C, HRSA 100-1-D, and the HRSA 100-1E. All CHGME Payment Program participating hospitals must complete the screening instrument.
All worksheets of the form must be completed unless otherwise specified (for example, hospitals that do
not sponsor any programs are instructed to skip the worksheet HRSA 100-1-C). The responses provided
in this screening instrument will be used to determine which hospitals are required to complete the next
two workbooks, the HRSA 100-2 and HRSA 100-3.
Complete the worksheets in the HRSA-100-1 in the order that the sheets are presented. Specific
instructions for each worksheet are provided below.
The information about residency programs and residents refers to the academic year completed
immediately prior to the hospital’s initial application for CHGME Payment Program funds. Academic
years run from July 1 through June 30. The FY2010 CHGME Annual Report, which will be submitted by
your hospital as an addendum to the FY2011 application for funds, requires information on the academic
year July 1, 2009 – June 30, 2010.
HRSA 100-1-A CHILDREN’S HOSPITAL IDENTIFICATION:
This worksheet requests hospital demographic information and identification of the Federal Fiscal Years
for which your hospital received CHGME payments. The sheet also includes a drop down box to indicate
whether this is the initial filing of the annual report or the provision of missing information. The
information you provide on the name of your hospital, the Medicare provider number, and the date of
your report will carry over from the first worksheet to the other worksheets in the HRSA 100-1.
HRSA 100-1-B CHILDREN’S HOSPITAL GME PROGRAM STATUS AND PROGRAM
CHANGE:
The 100-1-B is the central worksheet of the 100-1 workbook because responses in the following forms
depend on correct responses in the 100-1-B. Please read the instructions below carefully.
At the top, the worksheet asks for the number of outside institution(s) that send residents to your hospital
for training. Outside institutions include medical schools and other hospitals. For your FY2011 annual
report, the number reported should apply to the 2009-2010 academic year.

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Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

The main body of the worksheet requests information on all accredited GME training programs by
“status” and “program change.” “Status” is whether your hospital is a sponsoring institution, a major
participating institution, and/or a rotation site. (See Definitions in Section IV of this Guidance for a
definition of each of these terms.) “Program change” refers to whether the program was added or
dropped since the previous academic year.

For each program listed in worksheet 100-1-B, including those listed at the end of the form by
the hospital, the hospital will indicate whether the program is sponsored by the hospital, the
hospital serves as a major participating institution of rotation site for the program, or the program
was not offered in academic year 2009-2010 AND whether the program was added, dropped, or
had no change since the previous academic year. There must be at least TWO check marks in
each row of the form where the name of a program is listed, one checkmark to indicate program
status and one checkmark to indicate program change. (There may be more than two check
marks. )
Program Status: Identify all accredited GME training programs by “status.” For any GME training
program, the hospital may be a sponsoring institution, a major participating institution, and/or a rotation
site. If your hospital is a sponsoring institution and/or a major participating institution and/or a

rotation site, check all that apply. A hospital may be both a sponsoring institution and a rotation
site.
“Not Offered” is one of the options and MUST be checked if the program is not offered at your hospital
in the most recent academic year (2009-2010).
Be sure to cursor through the complete list of GME training programs. If your hospital trains residents in
GME training programs other than those listed, you may add the name of the program at the end of the
list and specify the “status” of the additional programs.
Remember that there must be a check for each program listed whether or not the hospital trains residents
in the program. Check the ‘Not Offered” box for programs for which no residents were training in the
previous academic year.
Under the heading “Program Status,” there must be at least one box checked for each program listed.
Because a hospital can be both a sponsor and a rotation site for the same program, it is possible to have
two check marks under the heading “Program Status.”
Program Change: Under the columns for program change, indicate whether each program listed was
added or dropped since the previous academic year by checking the appropriate box. If a program was
neither added nor dropped, check “no change.”
Under the heading “Program Change” there must be at least one box checked for each program listed.
Entire Form 100-1-B: As noted above, there must be at least TWO check marks in each row of
the form 100-1-B where the name of a program is listed, to indicate program status AND
change. (There may be more than two check marks, for example, when a hospital is both a

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Department of Health and Human Services
Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

sponsor and a rotation site for a program and under program change there has been no change
since the previous year. See some specific examples below. )
Examples:
1. Young Friends Children’s Hospital (YFCH) sponsors three GME programs: Pediatrics,
Adolescent Medicine, and Pediatric Oncology. There has been no change in the status of these
programs since the previous academic year. In addition to sponsoring its own Pediatrics program,
YFCH serves as a rotation site for a Pediatrics program sponsored by a nearby medical school.
Also, for the first time, YFCH served as a rotation site for a Surgery program.
In Form 100-1-B, for the Pediatrics program, there would be 3 checkmarks, one for “sponsor, one
for “rotation site” and one for “no change” under Program Change.
For the Adolescent Medicine and Pediatric Oncology Program rows, there would be two
checkmarks, one for “sponsor” and one for “no change”.
For the Surgery program there would be two check marks, one for “rotation site” and one for
“added.” Cursor all the way down to “S” to find the Surgery program listed on the left hand side
of the form.
For all other programs listed on the left hand side of the worksheet, there would be two
checkmarks, one for “not offered” and one for “no change.”

2. Metropolitan Children’s Hospital (MCH) is a large institution sponsoring 15 GME training
programs. All 15 GME programs should be checked as “sponsoring institution.”
Metropolitan is also a rotation site for numerous specialties, 20 in all. Not all the specialties are
listed in the worksheet. All 20 programs should be checked as “rotation sites.” Those that are not
listed should be written in at the end of the worksheet, and “rotation site” should be checked.
None of the 35 programs was added or dropped in the most recent academic year, so “no change”
should be checked under Program Change.
All other programs listed down the left side should have two check marks, one for “not offered”
and one for “no change.”

3. Southwest Children’s Hospital sponsored a program in Pediatric Cardiac Imaging in the
previous academic year, but has dropped its sponsorship of the program in the current academic
year due to the loss of faculty. Pediatric Cardiac Imaging will two check marks in the row-- one
for “not offered” and one for “Program Dropped Since Previous Academic Year.”
4. Midwest Children’s Hospital added a new sponsored program in Pediatric Sports Medicine
since the previous academic year. The row listing Pediatric Sports Medicine will have a check

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Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

mark in the first column for sponsored programs and a check mark in the column labeled
“Program Added Since Previous Academic Year.”

HRSA 100-1-C SPONSORING INSTITUTIONS: Number of Trainees
In this worksheet, if your hospital is sponsoring one or more GME training programs, the name of the
sponsored GME training program will be listed and highlighted (as a result of your having identified the
program in the previous worksheet (HRSA 100-1-B).
If your hospital is not a sponsoring institution for any GME training programs, no GME programs will be
identified and highlighted, and you should proceed to the next worksheet (HRSA 100-D).
Complete the required row information for the highlighted GME programs. If you attempt to enter
residents for a program that was not checked in the previous worksheet, you will receive an error
message. Please ensure that all of the appropriate programs are selected in the HRSA 100-1-B.
The required row information includes number of approved resident positions, number of recruited
positions, number of resident positions filled, and the number of FTE residents. The first three columns
refer to positions only. The last column is for number of FTE residents (people). See examples below.
Positions: These are approved GME training positions (slots) in a GME training program sponsored by
the children’s hospital. The positions may have been approved by the Accreditation Council for
Graduate Medical Education, the American Board of Pediatrics, or other official body. Recruited
positions are those positions the program recruited to fill in the relevant academic year only. For
example, a program may have a total of 93 approved positions. For the academic year 2008-2009, the
program recruited to fill only 31 of these slots. The number of positions filled is the number of filled
positions for the entire program (all FTE years). This number should be significantly larger than the
number recruited for the current academic year.
Residents: These are people (trainees) who are in full-time equivalent resident training positions in
any training program sponsored by the hospital. For this worksheet, HRSA 100-1-C, residents are those
in your sponsored programs only.
Example:
The Pediatrics program at Young Friends Children’s Hospital (YFCH) is accredited (approved)
for 45 positions (15 positions for PGY1, PGY2, and PGY3), and recruited to fill 17 positions this
year (15 PGY 1’s and 2 PGY 2’s (2 former residents left the program). For the academic year,
only 43 positions were actually filled. The last column heading refers to the residents (people)
who filled the 43 positions. Forty-five (45) residents actually filled the 43 positions because four
of the residents worked half-time.

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Health Resources and Services Administration

OMB No. 0915-0313
Expiration Date: 11/30/2010

SPONSORING INSTITUTION:
Program

Pediatrics

Number of
Approved
Positions
45

Number of
Recruited
Positions
17

Number of
Positions Filled
43

Number of
Residents in FTE
Training Positions
45

HRSA 100-1-D Major PARTICIPATING INSTITUTION, ROTATION SITE, OTHER
PARTICIPATING: Number of Trainees
In this worksheet, if your hospital is a major participating institution and/or rotation site for one or more
GME training program(s) as you indicated on the HRSA 100-1- B, the name of the GME training
programs will be listed and highlighted.
Complete the required row information for the highlighted GME program(s). If your hospital is not a
major participating institution or rotation site for any GME training programs, no GME training
program(s) will be identified or highlighted and you should proceed to the next worksheet (HRSA 100-1E).
The required row information includes 1) the number of approved positions (for your hospital as a major
participating institution), 2) the number of recruited positions (the number of approved positions the
program attempted to fill in the most recent academic year) , 3) the number of residents rotating through
the program in your hospital in the most recent academic year (July 1, 2009- June 30, 2010 for the
FY2011 report), and 4) the number of trainees spending more than 75 percent of their training time under
your children’s hospital supervision. If you attempt to enter residents for a program that is not checked in
the HRSA 100-1-B, you will receive an error message. Please ensure that all of the appropriate programs
are selected in the HRSA 100-1-B. Note: Many programs for which the hospital serves as a rotation site
will not have a specified number of approved positions. Only those programs for which the hospital is
listed as a major participating institution (but not a sponsoring institution) are likely to have a specific
number of approved rotation positions. If the program does not have a specific number of approved
rotation positions, enter zero (0) in the first column.
The first two column headings in this worksheet (HRSA 100-1-D) refer to approved and recruited
positions only. The second two column headings refer to residents (people). Positions and people are
distinguished below:
Positions: These are approved GME training positions (slots) in a GME training program for which
your hospital is a “major participating institution.” The positions may have been approved by the
Accreditation Council for Graduate Medical Education, the American Board of Pediatrics, or other
approving body.
Residents: These are people (trainees) who participated in the training program sponsored by an entity
other than your children’s hospital and received training in your children’s hospital during the most
recent academic year (July 1, 2009- June 30, 2010 for the FY2011 report). For this worksheet, HRSA

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Expiration Date: 11/30/2010

100-1-D, residents are those who are training in your hospital in a program sponsored by another entity
such as a medical school or another hospital only.
Residents Rotating through Programs
The heading “Number of Residents Rotating through Programs in the Most Recent Academic
Year” refers to all residents coming to the hospital in the academic year. It includes those
residents who may spend only two weeks of the year training in the hospital. Some of the larger
CHGME hospitals may have as many as 700-800 residents (people, not FTEs) training in the
hospital over the academic year.
75% Time Residents
The heading “Number of Trainees Spending 75% under Children’s Hospital Supervision” refers
to the percent time residents in a program not sponsored by your children’s hospital receive
training in your children’s hospital during the academic year on which you are reporting the
“75% time” stipulation requires that residents spend more than three-fourths or more of the total
time required to fulfill the residency requirements for the year in the non-sponsoring institution
(your children’s hospital) in order to be counted here.
Residency requirements should be interpreted broadly to include all required clinical, in house
and pager call, research, and scholarly activities supervised by the children’s hospital. Total time
required to complete a year of training can be counted in days, weeks, months, or blocks
according to the program’s typical rotation schedule. Vacation time should be omitted from the
denominator. The following is an example of 75% time:
A general pediatrics resident (PGY1) who has spent 36 or more of
the required 48 weeks (52 -- 4-week vacation block) of rotations in a
non-sponsoring institution.
HRSA 100-1-E: LIST OF PROGRAMS FOR ANNUAL REPORT:
You do not insert any information into this worksheet. After completion of the preceding worksheets, the
programs for which your hospital is required to complete subsequent components of the CHGME
Payment Program Annual Report (HRSA 100-2 and HRSA 100-3) will be highlighted in this sheet.
If no GME training programs are highlighted in the HRSA 100-1-E, you will be asked to sign the Annual
Report Certification Form (HRSA 100-4) and fill out the Annual Report Checklist (HRSA 100-5)
indicating that your hospital will be submitting the HRSA 100-1, the HRSA 100-4 and the HRSA 100-5.
No additional information will be required. Your CHGME Payment Program Annual Report is complete.
If any GME training programs are highlighted in the HRSA 100-1-E (indicating that your children’s
hospital trained at least one resident in a sponsored program or at least one resident from a program not
sponsored by your hospital who spent more than 75% of his or her training time for the academic year
receiving training in your hospital), your hospital must submit a completed HRSA 100-2 with hospitallevel information for the hospital as a whole and one HRSA 100-3 for each highlighted program. The
hospital may be submitting as many as 35 or more separate HRSA 100-3 workbooks, depending on

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how many programs are highlighted in worksheet 100-1-E.
B. INSTRUCTIONS FOR HRSA 100-2: CHGME PAYMENT PROGRAM ANNUAL REPORT,

HOSPITAL LEVEL INFORMATION
CHGME Payment Program Annual Report
HRSA 100-2, Hospital Level Information (Academic Year July 1, 2009 – June 30, 2010)
The HRSA 100-2 includes three worksheets (HRSA 100-1-A, HRSA 100-2-B, and HRSA 100-2-C.
requiring hospital level data on the care provided to children who are underserved for financial, social,
geographic or medical reasons and hospital-level patient safety initiatives relevant to GME training
programs..
Patient discharge data are required in the first two worksheets (HRSA 100-2-A and HRSA 100-2-B).
Individuals with access to your discharge data should complete the 100-2-A, DISCHARGES BY
PAYOR, ZIP and 100-2-B, DISCHARGES BY SELECTED CHRONIC DISEASES. This information
will serve as proxy measures for potential exposure that residents experience in their respective training
programs to underserved populations.
As with all information for the FY2011 annual report, the information provide must be for the academic
year July 1, 2009 – June 30, 2010.
Specific instructions on each sheet are provided below.
HRSA 100-2-A: DISCHARGES BY PAYOR, ZIP:
This worksheet requests summary data, at the hospital level, on payor mix and patient city, state and
residential zip code. Payor categories include private insurance, Medicaid and/or SCHIP, Medicare,
Other Public Payors, Self-Pay and Uncompensated Care. (Self-pay refers to out-of-pocket payments by
patients for hospital services.)
Discharge categories include inpatient discharges, outpatient visits, and emergency department visits
occurring during the academic year July 1, 2009 through June 30, 2010. (Outpatient Visits do not
include visits for lab services only).
 Please note that the city, state, and zip code data should be provided for all zip codes
and sent to HRSA on a CD along with the CHGME Annual Report package. The
table on the HRSA 100-2-A worksheet is provided as an example only. No paper
copy of the Discharges by Zip Code is required.
HRSA 100-2-B: DISCHARGES BY SELECTED CHRONIC DISEASE:
This worksheet requests summary data, at the hospital level, on selected patient chronic disease
diagnoses. The selected chronic diseases are listed in the worksheet. At-risk neonates are identified using
V codes for low birth weight. Discharge categories include inpatient discharges, outpatient visits, and
emergency department visits. (Outpatient Visits do not include visits for lab services only). Data

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provided by the hospital in the worksheets should cover the academic year from July 1, 2009 through
June 30, 2010.
 Please note that the primary diagnosis and all secondary diagnoses should be used
to complete this table.
HRSA 100-2-C: HOSPITAL LEVEL PATIENT SAFETY INITIATIVES:
This worksheet requests information on hospital level patient safety initiatives. For each safety-related
initiative listed, the form uses checkboxes for you to indicate whether the area was part of the hospital’s
patient safety program in the most recent academic year (July 1, 2009 – June 30, 2010) and whether the
hospital has made changes in the initiative since the previous academic year (2007-2008). No check mark
in the box indicates that the particular initiative is not part of the hospital’s patient safety program.
 The list of initiatives is based on references in the patient safety literature. Other
examples may apply and may be listed by you at the end of the list.
The worksheet also provides space in text boxes for you to provide a narrative description of the reasons
for any changes that have been made to the initiative and the benefits of each initiative. Each text box
can include as many as 32,000 characters. If you prefer, you may make a response on a separate sheet of
paper and attach it to your paper submission of the annual report.

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C. INSTRUCTIONS FOR HRSA 100-3: PROGRAM SPECIFIC INFORMATION
CHGME Payment Program Annual Report
HRSA 100-3, Program Specific Information (Academic Year July 1, 2009 – June 30, 2010)
The HRSA 100-3 workbook should be completed for each of the GME training programs identified in
HRSA 100-1-E, "LIST OF GME PROGRAMS FOR ANNUAL REPORT." Multiple 100-3 workbooks
do not have to be aggregated at the hospital level.
Example: If 27 GME training programs are identified on the HRSA 100-1-E, "LIST OF GME
PROGRAMS FOR ANNUAL REPORT," 27 workbooks will be completed and submitted to
HRSA together with one HRSA 100-1 workbook and one HRSA 100-2 workbook.
Type in the name of the program being reported on in the space provided at the top of the worksheet
HRSA 100-3-A. The name of the program will carry over to all pages of the HRSA 100-3 workbook.
SAVE the workbook with the name of the program, the Medicare Provider Number, and the Federal
Fiscal Year of the report.
Example: For a report on a pediatric cardiology program, you could save the workbook as
pedscard16-3301FY10.xls

The HRSA 100-3 includes six (6) worksheets (HRSA 100-3-A, HRSA 100-3-B, HRSA 100-3-C, HRSA
100-3- D, HRSA 100-3-E, and HRSA 100-3-F). Each worksheet uses either "drop down boxes" or
"check boxes" for the responses to the questions regarding GME training.
In some instances, space is provided for written answers to specific questions regarding changes in and
respective benefits of changes in training. Each text box can include as many as 32,000 characters. If
you prefer, you may make a response on a separate sheet of paper and attach it to your paper submission
of the annual report. If you choose to include information on a separate sheet, please indicate the
Medicare provider number, the name of the GME program, and the question you are answering on each
sheet.
Complete the worksheets of the HRSA 100-3 in the order that the sheets are presented.

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HRSA 100-3-A DIFFERENT POPULATIONS: TYPES OF (APPROACHES TO) TRAINING:
This worksheet asks about approaches used in training including didactic approaches, clinical
experiences, community-based experiences, research and other types of training approaches. A drop
down box gives three choices for a response: required, elective, and not currently used. One of these
responses must be chosen.

The worksheet further asks (in the drop down box to the right) whether the particular approach
to training addressed care of a particular underserved population or combination of
underserved populations. If the type of training is not currently used or if underserved
populations are not addressed by the particular type of training, the second drop down box
should be left BLANK.
Examples:

1. Under “Didactic Approaches” at the left of the table, your program does not require
attendance at “Workshops” as a teaching approach. Choose “Not currently Used” in
the first drop down box. Because this approach is not currently used, leave the
second drop down box blank.
2. Under “Clinical Experiences” at the left of the table, your program requires “Bedside
Training” as a teaching approach. Choose “Required” in the first drop down box.
3. When the bedside training occurs it usually addresses socio-cultural issues and
medical issues for underserved patients. Choose “two or three populations” in the
second drop down box.
4. Under Community Based Experiences, “Juvenile detention facilities,” this setting is
offered as an elective rotation site for residents. Choose “Elective” in the first drop
down box. The facility includes underserved youth from all backgrounds. Choose
“All of the above” in the second drop down box.
HRSA 100-3-B DIFFERENT POPULATIONS: CONTENT OF TRAINING:
This worksheet requires information about the content of training related to underserved populations.
Check boxes are provided for responses to indicate whether the topic is addressed in didactic training,
clinical experience, research training, or not currently addressed in the curriculum. At least one check box
per row must be marked. The worksheet provides for multiple responses for each topic listed.
 For example, a particular topic (e.g., “substance abuse”) may be addressed in didactic
training, clinical experiences, and research. Mark all that apply.

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HRSA 100-3-C: CHANGES IN CURRICULUM AND EXPERIENCES IN RESIDENCY
TRAINING:
This worksheet requires information about topics in the curriculum/ part of training in the most recent
academic year (2009-2010) and curriculum change(s) that may have occurred since the previous
academic year (2008-2009) and the reasons for and benefits of any change(s). Specific topics are listed
under general headings such as didactic training in basic science, health promotion, and other didactic
training; dental care; community health system topics; clinical training and rotations; and types of
evaluations of resident training used.
The worksheet uses checkboxes and provides space in a text box for a narrative description of the
reasons for and benefits of any change(s) made. Each text box can include as many as 32,000
characters. If you prefer, you may make a response on a separate sheet of paper and attach it to your
paper submission of the annual report.
There must be at least one check mark in each row. A check in the checkbox in the first column
indicates NO-- the topic was not in the curriculum/part of training in the most recent academic year. A
check in the second box indicates YES--the topic was in the curriculum/part of training in the most
recent academic year. If the topic was part of training in 2009-2010, answer the questions in the next
two columns.
Examples:
1. The topic Oral Health was not part of the program’s curriculum in the most recent
academic year. Only the first box should be checked.
2. The topic Genomic/Proteomics was newly added to the program’s curriculum in
the most recent academic year. The second and third boxes should be checked.
3. The topic Procedure Logs was part of the program’s curriculum in the most recent
academic year. It has been part of the curriculum since 1995-1996. No changes to
the teaching of this topic have been made since 1995-1996. Only the second box
should be checked.
4. The topic Obesity-related care has long been part of the programs curriculum, but
the training was significantly expanded and improved in 2009-2010. The second
and fourth boxes should be checked.

HRSA 100-3-D CHANGES IN TRAINING RELATED TO TRAINING IN QUALITY
IMPROVEMENT
This worksheet requests information on curriculum components relevant to quality improvement, changes
in such curricula, and the resulting benefits of any changes. For each of the topics related to training in
the quality of care, use the check boxes to indicate the changes in your curriculum or training program
that have occurred since the previous academic year.
The instructions are the same as those for the HRSA 100-3-C. There must be at least one checkmark in
each row. A check in the checkbox in the first column indicates NO-- the topic was not in the
curriculum/part of training in the most recent academic year. A check in the second box means YES--

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the topic was in the curriculum/part of training in the most recent academic year. If the topic was part
of training in 2009-2010, answer the questions in the third and fourth columns.
Provide reasons for any change(s) and describe resulting benefits from change(s) in the space (text box)
provided below each list. Each text box can include as many as 32,000 characters. If you prefer, you
may make a response on a separate sheet of paper and attach it to your paper submission of the annual
report.

HRSA 100-3-E CHANGES IN NUMBER OF RESIDENTS AND FACULTY/BENEFITS:
This worksheet requires information on the number of faculty and residents affiliated with your training
program in the previous academic year (2008-2009) and in the most recently completed academic year
(2009-2010).
The form also asks about the benefits of any changes in the number of residents and/or the number of
faculty in your program. Space is provided in a text box for a narrative response related to reasons and
benefits. Each text box can include as many as 32,000 characters. If you prefer, you may make a
response on a separate sheet of paper and attach it to your paper submission of the annual report.
HRSA 100-3-F PRACTICE LOCATIONS OF GRADUATING RESIDENTS:
This worksheet requests the city, state and zip code of each graduating resident's first position lasting 6
months or more. Graduating residents include those who are in programs sponsored by the hospital and
those in programs sponsored by other institutions but who spent more than 75 % of their training time
training in your children’s hospital in 2009-2010 and who graduated at the end the academic year.

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D. Instructions for HRSA 100-4: CHGME Payment Program Annual Report Certification
CHGME Payment Program Annual Report
HRSA 100-4: Annual Report Certification

The certification form must be signed by the individual authorized to sign for the applicant
institution, the same person who signs the HRSA 99-3 in the CHGME Payment Program
application for funds. The form must contain original signatures. Faxed or photocopied
signatures will not be accepted.
E. Instructions for HRSA 100-5: CHGME Payment Program Annual Report Checklist
CHGME Payment Program Annual Report
HRSA 100-5: Annual Report Checklist
HRSA 100-5: Annual Report Checklist
The annual report checklist must be completed following the instructions provided on the checklist itself.
All required forms and supporting documentation should be included in the annual report package mailed
to the CHGME Payment Program in the order that the forms and supporting documentation are listed on
the checklist.
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Section IV: References
A. Commonly Used Acronyms
ACGME
BHPr
CHGME
CMS

ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION
BUREAU OF HEALTH PROFESSIONS
CHILDREN’S HOSPITALS GRADUATE MEDICAL EDUCATION
CENTERS FOR MEDICARE AND MEDICAID SERVICES

DHHS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

DMD

DIVISION OF MEDICINE AND DENTISTRY

FY

FISCAL YEAR

FFY

FEDERAL FISCAL YEAR

FRN

FEDERAL REGISTER NOTICE

FTE

FULL-TIME EQUIVALENT

GME

GRADUATE MEDICAL EDUCATION

GMEB

GRADUATE MEDICAL EDUCATION BRANCH

HRA

HEALTH REFERRAL AREA

HRSA

HEALTH RESOURCES AND SERVICES ADMINISTRATION

HSA

HEALTH SERVICE AREA

INT

INTERN

OMB

OFFICE OF MANAGEMENT AND BUDGET

PGY1

POST-GRADUATE YEAR (1, 2, etc.)

RES

RESIDENT (1, 2, etc.)

RRC

RESIDENCY REVIEW COMMITTTEE

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B. CHGME Payment Program Annual Report: Definitions
In completing the CHGME Payment Program Screening Instrument and Annual Report, the following
definitions apply. Many of the definitions listed here have been taken directly or adapted from the ACGME
Glossary of Terms, the CHGME Payment Program, the American Board of Pediatrics, the Health Care
Quality Glossary (Russia-USA Joint Commission on Economic and Technological Cooperation) and other
listed sources. Definitions are listed alphabetically.
75% of training time: For the CHGME Screening Instrument, this term refers to the percent time residents
in non-sponsoring institutions spend in the non-sponsoring institution during the academic year on which
they are reporting. The “75% time” stipulation requires that residents spend three-fourths or more of the total
time required to fulfill the residency requirements for the year in the non-sponsoring institution in order to be
counted by that institution in the CHGME Annual Report. Residency requirements should be interpreted
broadly to include all required clinical, in house and pager call, research, and scholarly activities supervised
by the children’s hospital. Total time required to complete a year of training can be counted in days, weeks,
months, or blocks according to the programs typical rotation schedule. Vacation time should be omitted from
the denominator. The following are examples of 75% time:
a)
b)

A general pediatrics resident (PGY1) who has spent 36 or more of the required 48 weeks (52 -- 4week vacation block) of rotations in a non-sponsoring institution.
A pediatric cardiology resident (PGY5) who has performed research at a lab in the non-sponsoring
institution for 9 of the 12 months of the residency year

Accreditation: A voluntary process of evaluation and review performed by a non-governmental agency of
peers.
Adverse event: An injury that results from medical care.
Applicant: A freestanding children’s hospitals that applies to receive Federal GME Support.
Approved Training Programs: A graduate medical education program that is approved by one of the
following: the ACGME, the Committee on Hospitals of the Bureau of Professional Education of the
American Osteopathic Association, the Commission on Dental Accreditation, the Council of Podiatric
Medicine Education and may count towards certification in a specialty or subspecialty listed in the Directory
of Graduate Medical Education or the Annual Report and Reference Handbook of the ABMS, or would be
accredited except for the accrediting agency’s reliance upon standards that require an entity to perform an
induced abortion or require, provide, or refer for training in the performance of induced abortions, or make
arrangements for such training.
Benchmarking: The process of measuring another organization’s product or service according to specified
standards in order to compare it with and improve one's own product or service.

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Benefits: Quantitative or qualitative assessments of, for example, improvement in faculty development;
hiring and retention of excellent faculty; medical education and training, as measured by the ACGMEdefined competencies; and/or patient care, such as the institution of clinical pathways, adoption of new
technologies, family-centered care, etc, and/or community involvement.
Certification/Board Certification: A process to provide assurance to the public that a certified medical
specialist has successfully completed an approved educational program and an evaluation, including an
examination process designed to assess the knowledge, experience and skills requisite to the provision of
high quality care in that medical specialty.
Children with Special Health Care Needs (CSHCN): CSHCN are those children who have or are at
increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require
health and related services of a type or amount beyond that required by children generally [Maternal and
Child Health Bureau, HRSA.]
Children's Hospital (for purposes of CHGME Payment Program): A children’s teaching hospital is
eligible for the CHGME Payment Program if (1) it has in an approved GME program; (2) it has a Medicare
Provider Agreement, (3) it is excluded from the Medicare inpatient prospective payment system (PPS) and its
accompanying regulations, and (4) operates as a “freestanding” (i.e., it does not operate under a Medicare
hospital provider number assigned to a larger health care entity that received Medicare GME payments)
children’s teaching hospital.
Clinical Supervision: A required faculty activity involving the oversight and direction of patient care
activities that are provided by residents.
Combined Specialty Programs: Programs recognized by two or more separate specialty boards to provide
GME in a particular combined specialty (e.g., internal medicine/pediatrics). Each combined specialty program
is made up of two or three programs, accredited separately by the ACGME at the same institution.
Competencies: Specific knowledge, skills, behaviors and attitudes and the appropriate educational
experiences required of residents to complete GME programs.
Consortium: An association of two or more organizations or institutions that have come together to pursue
common objectives (e.g., GME).
Consumer Assessments of Healthcare Providers and Systems (CAHPS): A broad collection of surveys
that can be used to obtain consumer valuations of their experience with providers, facilities, health plans and
other healthcare services.
Cultural Competence: Possessing interpersonal and communication skills that result in effective
information exchange with children and families from all cultural backgrounds and diverse communities.

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Curriculum: The program design and sequencing of educational experiences; must include didactic and
clinical components as well as direct experience in progressive responsibility for patient management.

Designated Institutional Official (DIO): The individual in a sponsoring institution who has the authority
and responsibility for the graduate medical education programs.
Duty-Hours: All clinical and academic activities related to the residency program, i.e., patient care (both
inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient
care, time spent in-house during call activities, and scheduled academic assignments such as conferences.
Elective: An educational experience approved for inclusion in the program curriculum and selected by the
resident in consultation with the program director.
EPSDT: The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service is Medicaid's
comprehensive and preventive child health program for individuals under the age of 21. The EPSDT program
assures the availability and accessibility of required health care resources and helps Medicaid recipients and
their parents or guardians effectively use these resources.
Faculty: Any individuals who have received a formal assignment to teach resident physicians. In some
institutions appointment to the medical staff of the hospital constitutes appointment to the faculty. Faculty
includes both those employed by program facilities as well as “voluntary” faculty with institutional affiliations
who may precept residents for community-based or continuity experiences.
FTE (Full Time Equivalent): The total time necessary to fill a full-time residency position for the academic
year. The denominator for the FTE equivalent should include all time spent in the normal work day, pager
call, and in-house call.
FTE Approved Positions: Number of positions for which the program is accredited.
FTE Positions Recruited To Fill: Number of positions that the program sought to fill through the
National Resident Matching Program for initial residency programs such as general pediatrics or
other recruiting mechanisms for pediatric subspecialties such as pediatric cardiology.
FTE Positions Filled: Number of positions filled within the program. Note that this does not refer to
the number of people in the program but rather the number of positions filled. Two persons sharing a
position in a 50%/50% split count as one FTE.
Graduate Medical Education (GME): The period of didactic and clinical education in a medical specialty
which follows the completion of a recognized undergraduate medical education and which prepares physicians
for the independent practice of medicine, also referred to as residency education.

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Health Plan Employer Data and Information Set (HEDIS): A standardized set of measures developed
by the National Committee for Quality Assurance to provide a common set of quality measures for
purchasers, consumers and health plans to use for making comparisons among health care plans.
Hospital Service Area: The geographic areas (i.e., zip codes) from which the facility draws its patient
population.
In-House Call: Duty hours beyond the normal work day when residents are required to be immediately
available in the assigned institution.
Institution: An organization having the primary purpose of providing educational programs and/or health
care services (e.g., a university, a medical school, a hospital, a school of public health, a health department,
a public health agency, an organized health care delivery system, a medical examiner’s office, a
consortium, an educational foundation).
Institutional Review: The process undertaken by the ACGME to determine whether a sponsoring
institution offering GME programs is in substantial compliance with the Institutional Requirements.
Internal Review: A self-evaluation process undertaken by sponsoring institutions to judge whether its
ACGME-accredited programs are in substantial compliance with accreditation requirements.
In-Training Examination: Formative examinations developed to evaluate resident progress in meeting
the educational objectives of a residency program. These examinations may be offered by certification
boards or specialty societies and are administered by the training program.
JCAHO: Joint Commission on Accreditation of Healthcare Organizations is an organization focused on
improving the safety and quality of care provided to the public. It accomplishes this goal by accrediting
healthcare organizations and offering healthcare improvement services.
Major Participating Institution: A residency review committee (RRC)-approved participating institution
to which the residents rotate for a required educational experience. Generally, to be designated as a major
participating institution, in a 1-year program, residents must spend at least 2 months in a required rotation;
in a 2-year program, the rotation must be 4 months; and in a program of 3 years or longer, the rotation must
be at least 6 months.
Medical Error: The failure of a planned action to be completed as intended or the use of the wrong plan
to achieve an aim.
Medical Home: Well-trained physicians, known to the family and patients, who provide accessible,
continuous, comprehensive, family-centered, and well coordinated medical care.
Medical School Affiliation: A formal relationship between a medical school and a sponsoring
institution.
Medically Needy Children: Children vulnerable due to their medical condition are those with rare,
complex, and/or chronic medical conditions that may lead to the need for a diversity of services that may
not be readily available in most communities.

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Objective Structured Clinical Examination (OCSE): Multi-station examination that tests a trainee’s
focused history and physical examination skills and basic clinical reasoning and interpretation.
Outside Institution: Training programs that send graduate medical trainees (i.e., residents or fellows) to
your facility as a required or optional educational experience or rotation of their training.
Pager Call: A call taken from outside the assigned institution.
Pediatric Medical Subspecialties: Those pediatric subspecialties certified by the American Board of
Pediatrics. Training in these subspecialties occurs after completion of a general pediatrics or an
internal medicine/pediatrics residency training program.
Pediatric Non-Medical Subspecialties: Pediatric subspecialties in fields outside of pediatrics (i.e.,
certified by a board other than the American Board of Pediatrics or not yet offering certification). This
includes pediatric surgical subspecialties, pediatric dermatology, etc.
Post Graduate-Year Level (PGY): Refers to a resident's current year of accredited GME. This
designation may or may not correspond to the resident’s particular year in a program. For example, a
resident in pediatric cardiology could be in the first program year of the pediatric cardiology program
but in his/her fourth graduate year of GME (including the 3 prior years of pediatrics). This resident
would be classified as a PGY4. Graduate Level years are generally abbreviated as PGY#, where #
represents the year of training.
Program: A structured educational experience in graduate medical education designed to conform to
the Program Requirements of a particular specialty, the satisfactory completion of which may result in
eligibility for board certification.
Program Director: The one physician designated to oversee and organize the activities for an
educational program. The Program Director is responsible for the implementation of the Program
Requirements for a specific specialty.
Program Year: Refers to the current year of education within a specific program; this designation
may or may not correspond to the resident’s graduate year level. For example, a general pediatrics
resident in his first year of training is in PGY1.
Publicly Funded/Insured: Those patients whose medical insurance comes from a public program
such as Medicaid, SCHIP, Indian Health Service, TriCare, state governments and local governments.
Quality of Care: The degree to which health services for individuals and populations increase the
likelihood of desired health outcomes and are consistent with current professional knowledge.
Quality Characteristics: According the Institute of Medicine, quality care is safe, effective, patientcentered, timely, efficient, and equitable.
Required/Mandatory: Educational experiences within a residency program designated for
completion by all residents.

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Resident Projects: A mentored, hands-on experience in community-linked endeavors to prepare
residents to be lifelong active leaders in improving and advocating for child health in the community.
Resident: A physician in an accredited graduate medical education program. (See additional
definitions below. Categorical residents, transitional year residents, interns, chief residents, and
fellows are all considered residents.)
Categorical Resident: A resident who enters a program with the objective of completing the entire
program.
Transitional Year Residents: Those in a transitional-year program (see: Transitional-Year
Program).
Intern: Historically, a designation for individuals in the first year of GME, which is no longer used by
the ACGME (i.e., residents in PGY1).
Chief Resident: Typically, a position in the final year of the residency (e.g., surgery) or in the year
after the residency is completed (e.g., internal medicine and pediatrics).
Fellow: A physician in a program of graduate medical education accredited by the ACGME or other
accrediting body who has completed the requirements for eligibility for first board certification in the
specialty. Such physicians are also termed subspecialty residents (e.g., residents in pediatric cardiology
or neonatology).
Rotation: An educational experience of planned activities in selected settings developed to meet the
goals and objectives of the program. The CHGME Payment Program has adopted the definition of a
rotation as stated by the ACGME to be a site where “an educational experience of planned activities in
selected settings developed to meet the goals and objectives of the program” (ACGME Website, 2006).
Rotation Sites / Other Participating Institutions: Those institutions to which residents rotate for a
specific educational experience for at least one month, but which do not require prior RRC approval.
Subsections of institutions, such as departments, clinics, or units in a hospital do not qualify as
participating institutions.
Rotation sites are facilities or locations outside of the resident’s primary training institution that provide
experiences and training beyond that available at their home institution (GME Training Programs in
CHGME-Funded Hospitals, 2007).

Scholarly Activity: An opportunity for residents and faculty to participate in research and the scholarship
of discovery, dissemination, application and active participation in clinical discussions and conferences.
Screening Questions: Questions used to determine which GME programs must complete the Annual
Report. Screening questions appear in the HRSA 100-1.
Self-Pay: Out-of-pocket payments made by patients for hospital services.

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Sponsoring Institution: The institution (or entity) that assumes the ultimate financial and academic
responsibility for a GME program.
The CHGME Payment Program has adopted the definition of a sponsoring institution as stated by the
Accreditation Council for Graduate Medical Education (ACGME) to be an “institution that assumes the
ultimate financial and academic responsibility for a program of graduate medical education (GME).”1
ACGME designates the following institutional requirements for a Sponsoring Institution:
i.
ii.

iii.

A residency program must operate under the authority and control of a
sponsoring institution.
There must be a written statement of institutional commitment to GME that is
supported by the governing authority, the administration, and the teaching
staff.
Sponsoring institutions must be in substantial compliance with the
Institutional Requirements and must ensure that their ACGME-accredited
programs are in substantial compliance with the Program Requirements and
the applicable Institutional Requirements.

An institution’s failure to comply substantially with the Institutional Requirements may jeopardize the
accreditation of all of its sponsored residency programs.2

State Children’s Health Insurance Program (SCHIP): Health insurance coverage for low income
children that is jointly financed by the federal and state governments and administered by the states.
Subspecialty Program: A structured educational experience following completion of a prerequisite
specialty program in graduate medical education designed to conform to the Program Requirements of a
particular subspecialty.
Systems-based practice: Practice with an awareness of and responsiveness to the larger context and
system of health care and the ability to effectively call on system resources to provide care that is of
optimum value.
Training Experiences: Required and elective rotations within and outside the institution in which
residents participate to meet the requirements of their training program.
Transformative Learning Techniques: Learning techniques that incorporate reflective exercise, roleplay, mini-presentations, buzz groups, brainstorming, and case method.
Transitional-Year Program: A one-year educational experience in GME, which is structured to
provide a program of multiple clinical disciplines; it is designed to facilitate the choice of and/or

1
2

http://www.acgme.org/adspublic/default.asp
http://www.acgme.org/acWebsite/irc/irc_IRCpr07012007.pdf

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preparation for a specialty. The transitional year is not a complete graduate education program in
preparation for the practice of medicine.
Underserved Children: Those who face substantial financial, socio-cultural, geographic, disease, or
medical barriers that limit access to appropriate health care. Underserved children may fall into one or
more groups:
Financially underserved children include those in poverty and the working poor, the uninsured and
underinsured, and those at risk for significant out-of-pocket expenditures.
Children underserved for socio-cultural reasons include those from families with uneducated or
teenage parents, single-headed households, those in families that are unstable due to substance abuse or
domestic violence, immigrant children and those from different cultures, children from families with
language barriers, and children from homeless families.
Children underserved for geographic reasons include rural residents and those who lack
transportation to services or face other geographic barriers to accessing care.
Children underserved due to their medical condition are those with rare, complex, and/or chronic
medical conditions that may lead to the need for a diversity of services that may not be readily available
in most communities.
WIC: The Special Supplemental Nutrition Program for Women, Infants, and Children which serves lowincome women, infants, & children up to age 5 who are at nutritional risk by providing nutritious foods to
supplement diets, information on healthy eating, and referrals to health care.

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