C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 413—PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES; PAYMENT FOR ACUTE KIDNEY INJURY DIALYSIS › Subpart F—Specific Categories of Costs

42 C.F.R. § 413.80

Direct GME payments: Determination of weighting factors for foreign medical graduates

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(a) The weighting factor for a foreign medical graduate is determined under the provisions of § 413.79 if the foreign medical graduate—

(1) Has passed FMGEMS; or

(2) Before July 1, 1986, received certification from, or passed an examination of, the Educational Committee for Foreign Medical Graduates.

(b) Before July 1, 1986, the weighting factor for a foreign medical graduate is 1.0 times the weight determined under the provisions of § 413.79. On or after July 1, 1986, and before July 1, 1987, the weighting factor for a graduate of a foreign medical school who was in a residency program both before and after July 1, 1986 but who does not meet the requirements set forth in paragraph (a) of this section is .50 times the weight determined under the provisions of § 413.79.

(c) On or after July 1, 1987, these foreign medical graduates are not counted in determining the number of FTE residents.

(d) During the cost reporting period in which a foreign medical graduate passes FMGEMS, the weighting factor for that resident is determined under the provisions of § 413.79 for the part of the cost reporting period beginning with the month the resident passes the test.

(e) On or after September 1, 1989, the National Board of Medical Examiners Examination, Parts I and II, may be substituted for FMGEMS for purposes of the determination made under paragraphs (a) and (d) of this section.

(f) On or after June 1, 1992, the United States Medical Licensing Examination may be substituted for the FMGEMS for purposes of the determination made under paragraphs (a) and (d) of this section. On or after July 1, 1993, only the results of steps I and II of the United States Medical Licensing Examination will be accepted for purposes of making this determination.

[69 FR 49254, Aug. 11, 2004]
Notes of Decisions
Cited in 29 cases, 1991–2019 · leading case: GCI Health Care Centers, Inc. v. Thompson, 209 F. Supp. 2d 63 (D.D.C. 2002).
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GCI Health Care Centers, Inc. v. Thompson, 209 F. Supp. 2d 63 (D.D.C. 2002). · cites it 8× “” 42 C.F.R. § 413.80 . Additionally, Part B “deductibles and coinsurance amounts are reimbursable under the Program.”
Abington Crest Nursing Rehab. Ctr. v. Sebelius, 575 F.3d 717 (D.C. Cir. 2009). · cites it 6× “Medicare then reimbursed the providers for the uncollectible amounts pursuant to a Medicare regulation, 42 C.F.R. § 413.80 . 1 In the Balanced Budget Act of 1997, Congress changed the payment scheme for SNF services in two respects.”
Abington Crest Nursing & Rehab. Ctr. v. Leavitt, 541 F. Supp. 2d 99 (D.D.C. 2008). · cites it 9× “” 42 C.F.R. § 413.80 (b), (d). 1 These bad debt provisions were adopted, pursuant to congressional directive, to ensure that the “costs of efficiently delivering covered services to individuals covered by the insurance programs established by [Medicare] will not be borne by…”
Dialysis Clinic, Inc. v. Leavitt, 518 F. Supp. 2d 197 (D.D.C. 2007). · cites it 8× “42 C.F.R. § 413.80 (b). Medicare bad debts are “amounts considered to be uncollectible from accounts and notes receivable that were created or acquired.”
Battle Creek Health Sys. v. Leavitt, 498 F.3d 401 (6th Cir. 2007). · cites it 3× “In light of these documentation deficiencies, the Administrator concluded that the presumption of noncollectibility did not apply because plaintiffs had failed to establish that the accounts were “actually uncol-lectible” when claimed as worthless or that “sound business…”
Mt. Sinai Hosp. Med. Ctr. v. Donna Shalala, Sec'y of Health & Human Servs., 196 F.3d 703 (7th Cir. 1999). · cites it 5× “42 C.F.R. § 413.80 (d). In order to qualify for reimbursement of Medicare bad debts, providers must show that the unpaid deductible and coinsurance amounts are allowable costs.”
Good Samaritan Hosp. v. Shalala, 508 U.S. 402 (1993). “See 42 CFR §413.80 (1992). The agency’s development — and continued augmentation — of a list of situations in which the cost limits would be waived is difficult to harmonize with an interpretation of clause (ii) that would give a provider the right to contest the application of…”
HENNEPIN Cnty. Med. Ctr., Plaintiff-Appellee, v. Donna E. SHALALA, Defendant-Appellant, 81 F.3d 743 (8th Cir. 1996). · cites it 2× “42 C.F.R. § 413.80 (e). Congress authorized the Secretary to promulgate regulations to ensure that hospitals would not be forced to shift these costs to non-Medicare patients.”
Maine Med. Ctr. v. Burwell, 775 F.3d 470 (1st Cir. 2015). · cites it 2× “89 was formerly designated as 42 C.F.R. § 413.80 . See 69 Fed.Reg. 49,254 (Aug.”
Select Specialty Hosp. - Denver, Inc. v. Sebelius, 848 F. Supp. 2d 13 (D.D.C. 2012). “42 C.F.R. § 413.80 ; PRM §§ 310, 312, 322.”
Grossmont Hosp. Corp. v. Sebelius, 903 F. Supp. 2d 39 (D.D.C. 2012). “This regulation was formerly designated at 42 C.F.R. § 413.80 but was redesignated in 2004 at 42 C.”
Dist. Hosp. Partners, L.P. v. Sebelius, 932 F. Supp. 2d 194 (D.D.C. 2013). “In 1986, it was re-designated as 42 C.F.R. § 413.80 . Redesignation of Reasonable Cost Regulations, 51 Fed.”
Show all 29 citing cases →
— 42 C.F.R. § 413.80(d) — 1 case
Vitality Rehab, Inc. v. Sebelius, 641 F. Supp. 2d 984 (C.D. Cal. 2009).
— 42 C.F.R. § 413.80(e) — 1 case
Abington Crest Nursing Rehab. Ctr. v. Sebelius, 575 F.3d 717 (D.C. Cir. 2009). “Medicare then reimbursed the providers for the uncollectible amounts pursuant to a Medicare regulation, 42 C.F.R. § 413.80 . 1 In the Balanced Budget Act of 1997, Congress changed the payment scheme for SNF services in two respects.”
— 42 C.F.R. § 413.80(i) — 1 case
Vitality Rehab, Inc. v. Sebelius, 641 F. Supp. 2d 984 (C.D. Cal. 2009).
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