Electronic Submission of Medicare Graduate Medical Education (GME) Affiliation Agreements (CMS-10326)

OMB 0938-1111

OMB 0938-1111

As discussed in the FY2011 Inpatient Prospective Payment System final rule, we will allow hospitals to electronically submit the copy of the affiliation agreement that is required to be sent to the CMS Central Office. The electronic submission process consists of either an email mailbox or a Web site where hospitals must submit their Medicare GME affiliation agreements to the CMS Central Office to a designated online mailbox. A copy of the Medicare GME affiliation agreement must be received through the electronic system no later than 11:59 p.m. on July 1 of each academic year. The electronic affiliation agreement must be submitted either as a scanned copy or a Printer-Friendly Display (PDF) version of that hard copy agreement; we will not accept an agreement in any electronic format that could be subject to manipulation. The scanned and/or PDF format will enable CMS to ensure that the agreements are signed and dated as required in the regulations at 42 CFR 413.75. Hospitals will have the option to continue to submit a hard copy of its affiliation agreement to the CMS Central Office. In addition, each fiscal intermediary or MAC will continue to have the authority to specify its requirements for submittal of the Medicare GME affiliation agreement by hospitals that are part of the affiliation.

The latest form for Electronic Submission of Medicare Graduate Medical Education (GME) Affiliation Agreements (CMS-10326) expires 2021-01-31 and can be found here.

OMB Details

Development of Agreement

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-10326SAMPLE Affiliation AgreementFillable FileableForm

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