CMS has published an interim final rule with comment period addressing the treatment of teaching hospitals that are members of the same Medicare graduate medical education (GME) affiliated groups for the purpose of determining possible full-time equivalent resident cap reductions. The rule implements section 203 of the Medicare and Medicaid Extenders Act of 2010, which modified certain GME policies under the ACA. The rule is effective July 1, 2011, and CMS is accepting comments on the policy until April 13, 2011. Note that CMS also issued a separate notice making corrections to the GME portion of the November 24, 2011 Medicare hospital outpatient prospective payment system (HOPPS) final rule.