Under section 1135(b)(5) waiver authority, CMS once again extended the submission deadline for both new Medicare graduate medical education (GME) affiliation agreements and amendments to existing Medicare GME affiliation agreements. Longstanding rules otherwise would require new Medicare GME affiliation agreements to be submitted by July 1, and amendments to existing agreements to be submitted by June 30 for the following academic year. As a result of the continuation of the COVID-19 Public Health Emergency (PHE), which HHS renewed most recently effective April 21, 2021, new Medicare GME affiliation agreements must be submitted by January 1, 2022 (for the academic year starting July 1, 2021) and amended Medicare GME affiliation agreements must be submitted by January 1, 2022 (for the academic year ending June 30, 2021). Hospitals should email new and/or amended affiliation agreements to CMS at Medicare_GME_Affiliation_Agreement@cms.hhs.gov. The subject line of the email should indicate whether it is a new or amended affiliation agreement.