Medicare FY 2022 Inpatient PPS Graduate Medical Education Final Rule Provisions

Date: January 25, 2022

In late December, the Centers for Medicare and Medicaid Services (CMS) released a final rule for FY 2022 on implementation of the 1,000 graduate medical education (GME) slots established in the Consolidated Appropriations Act (CAA), 2021, phasing in 200 slots per year over years, for a total of $1.8 billion in new funding for residencies over the next 10 years.

The final rule will enhance the health care workforce and fund additional medical residency positions in hospitals serving rural and underserved communities. It implements statutory changes to GME caps for rural training tracks and changes to the determination of per resident amounts. Attached, NRHA compares each of these three sections with our June comments, explaining what was final, and what the Administration didn’t act on.

Additional Residency Positions: Apply by March 31, 2022

The first round of 200 residency slots will be announced by January 31, 2023, and will become effective July 1, 2023. You can apply online for Consolidated Appropriations Act, 2021, Section 126 additional residency positions. Submit fiscal year 2023 applications no later than March 31, 2022. For details, see the Section 126: Distribution of Additional Residency Positions section of the Direct Graduate Medical Education webpage.

Overall, the National Rural Health Association (NRHA) is supportive with the final version of this regulation and is happy to see CMS implement the 1,000 new residency slots in a manner that will disperse the FTEs to the communities most in need. NRHA will continue monitoring implementation of these slots into the future. Beyond the yearly Inpatient Prospective Payment System (IPPS), NRHA will continue working with Congress and the Administration to ensure the rural health workforce expands and that policy is created with rural providers in mind. For questions on this year’s IPPS, or on NRHA’s workforce priorities, contact Josh Jorgensen (

2022.01.07 IPPS GME Final Summary.pdf