Affiliation Agreement (AA): an agreement required for rotations of 30 days or more; The rotations required for all residents in a specific program; and/or rotations to affiliate sites that are hospitals or similar companies. Starting July 1, 2019, new teaching hospitals will be able to enter into agreements with groups close to Medicare GME and act as donors for their excess caps for other teaching hospitals; this is a change from previous rules, in which they could only get slots from existing hospitals. Clinical rotation: an educational activity that includes direct or indirect tasks of patient care. Hospitals that have set a ceiling below the new exception for teaching hospitals have not historically been allowed to enter into an agreement of the Medicare GME group and have benefited from an adjustment that has reduced the hospital`s ETP ceiling (i.e., the new hospital could obtain slots as part of an agreement on an affiliate group, but was unable to play the role of donor in the agreement). In its annual update of the Fixed Payment System (IPPS) for fiscal year 2019, which came into effect on August 17, 2018, CMS amended this directive to provide new teaching hospitals with greater flexibility to participate in Groups close to Medicare GME and to increase cooperation between the country`s teaching hospitals. AFFILIATION VA ACCORDS (use the same agreement with or without reimbursement) Teaching hospitals can share the direction between organizations by entering into a Medicare GME group agreement. Master Affiliation Agreement (MAA): an agreement maintained by the GME Office to conclude an agreement between companies on programs within the meaning of the CMA. CMS funds most of the funding for postgraduate medical training (GME) in the United States. For cost reasons, the Business Budget Act of 1997 set a cap or “ceiling” for the number of living spaces (or slots) that the Medicare program will fund. The new exemption from teaching hospitals allows hospitals that have not been residents since 1996 to create a new cap on residences, which has increased the total number of Medicare-funded places across the country. Two or more hospitals may form a Group linked to Medicare GME if they have a common rotation agreement and meet at least one of the following criteria: a group contract related to Medicare GME, which gives the names of participating hospitals/providers, their respective ETP ceilings established at the DGME and the ME, and the proposed adaptation to the ceiling of each hospital and the number of resident FTEs must be submitted annually to the CMS.