June 22, 2012 MERC Advisory Committee Meeting Minutes - Minnesota Dept. of Health

December 7, 2012
MERC Committee Meeting:

Committee Members Present:
Michael Belzer, Dawn Ludwig, Jeff Ogden, Carl Patow, John Rodewald and Marilyn Speedie.

Alternate Present:
Deb Mayland-Poyzer for Mary Edwards.

Interested Parties Present:
Leon Assael, Karl Broderius, Diane Buschena-Brenna, Gina Danyluk, Kate Dean, Rena Garni, Tim Held, David Knowlan, Peg Lamin, Margo Marko, Janet McCarthy, Jeff Richter, Rick Roberts, Colette Salmanowicz,* Erin Sexton, Joe Schindler, Trisha Schirmers, Troy Taubenheim and Joel Tomlinson.

MDH/DHS Staff Present:
Diane Reger, Diane Rydrych and Mark Schoenbaum – MDH
Virginia Zawistowski – DHS

* Indicates Attendance via Conference Call

I. Introductory Remarks – Carl Patow, Interim Committee Chair

Dr. Patow opened the meeting.  He briefed the committee on the agenda and asked those in attendance for introductions. 

Before beginning the agenda, he announced that he will be leaving the MERC committee and HealthPartners for a position with the Accreditation Council for Graduate Medical Education (ACGME) and this would be his last MERC meeting.

MERC staff would like to thank Dr. Patow for serving on the committee along with many other subcommittees over his years of service. His input will be missed.

II. Committee – Mark Schoenbaum, MDH / Dr. Carl Patow

At the last meeting, Mark discussed the low attendance of committee members at meetings and how the committee may benefit from a review of the current membership. He and Carl drafted Operating Guidelines and shared this document with the committee present at the meeting. Suggested changes to the document included:

  • Committee members having the option to designate an alternate to attend and vote during their absence.
  • Members will be asked to notify MDH staff if they cannot attend a meeting and notify staff if they plan to send an alternate to vote on their behalf.
  • Members may attend meetings by conference call.
  • Within a calendar year, members will be allowed two absences.
  • There will be between two to four meetings per calendar year.
  • Members will be appointed based on a variety of geographic, organizational, MERC provider types, potential grantees, associations, work background, etc.
  • Electronic voting will be allowed for decision making purposes.
  • Interested Parties as well as the public can attend MERC meetings. They will not be allowed to vote. Interested Parties may be asked to be on subcommittees and workgroups.
  • The committee will develop a work plan calendar.

Mark contacted Jeff Ogden and Carl Patow and asked them to recommend a nomination for chair and vice chair. Jeff and Carl addressed the committee and spoke of their recommendation of Marilyn Speedie as chair and Kathy Meyerle as vice chair.

The draft Operating Guidelines will be revised and shared with the existing committee members. A vote will be taken on approval of the Operating Guidelines and the nominations for chair and vice chair. Existing committee members will also be asked if they are interesting in continuing on the committee and would like to be considered.

III. 2012 MERC Grant Update – Diane Reger, MDH

The 2012 Application process was delayed last summer due to the government shutdown which had a trickle effect. The data verification didn’t begin as early as it had in prior years due to the on a delay with the 2011 MERC distribution along with setting up the 2013 grant application that began immediately after 2011 was released. The process has been more time consuming with the additional hospital data that is now being provided on training site applications.

Inconsistencies have been identified on the information provided by training facilities to multiple teaching programs primarily on the identification number included on a hospital’s application. We have also identified that some facilities submitted grant applications as non-provider based clinics but then also were listed on the hospital’s application as a provider-based clinic. This has presented a challenge to MERC staff and teaching programs since they are uncertain which information is correct for a facility. Before Diane can provide training site data to DHS for gathering the Medicaid revenue used in calculating the MERC grant, the data on the training site applications that are inconsistent need to be verified. All 1,845 non-distinct sites are not being contacted, only those that were submitted by multiple teaching programs and had inconsistent information between the programs. Through this step many amendments are being processed.

The State Plan Amendment (SPA) is currently pending approval from CMS on an amendment to allow direct funding to Gillette for the next distribution. CMS has ‘stopped the clock’ on the approval process pending follow-up questions which are being handled by DHS and MERC staff. The 2012 MERC distribution had a deadline to release funds to the sponsoring institutions by the April 30, 2013, State Plan Amendment deadline. Since the State Plan Amendment is not currently approved, that deadline is no longer confirmed. At this time, we’re uncertain if CMS will approve the State Plan Amendment and funding to Gillette. If approved, $300,000 will be removed prior to the distribution formula for payment to Gillette. Since these funds will be removed from the formula, CMS may decide that the initial funds are no longer eligible for federal match.

Once the State Plan Amendment is finalized, DHS will determine if there is room under the hospital’s Upper Payment Limit (UPL) to seek full federal match on available tobacco funds. If full match is received and not affected by changes to the SPA, estimated grant funds will be approximately, $31 million.

IV. Revenue Workgroup Recommendations – Virginia Zawistowski, DHS

This summer DHS and MDH convened a technical workgroup to develop methodology that can be used to report Medicaid revenue used in the MERC grant calculations. Ginny provided a handout that details the methodology. She also provided calendar year reports to facilities involved in the technical workgroup that volunteered to be part of a test group (HCMC, Regions, Park Nicollet, Allina, and Fairview.) Those facilities were asked to review the reports provided at the meeting and to contact Ginny directly with their feedback. During the meeting, Children’s Hospital requested their data and Ginny agreed to provide it. The workgroup will reconvene on January 17 to finalize the methodology that will be used for the 2012 MERC grant.

V. MERC Survey Results – Mark Schoenbaum

This spring, MDH convened a workgroup to develop an online mechanism for collecting data from training facilities related to the use of MERC funds. The intent was to gather information from training facilities to share with the legislature to reinforce the importance of MERC funding. Survey letters were sent out to 478 training facilities in July and responses were requested by mid-September. The data was collected through an online survey. The response rate was near 50 percent. Mark provided a handout that showed some of the data collected. He asked the committee for their feedback.

VI. Meeting Schedule

It was suggested that the meetings be moved from Friday afternoons in December and June to different months and another day of the week. Those traveling from out-of-town prefer afternoon meetings over morning to allow travel time.

Staff will contact committee members to determine what months, days of the week, and times work best for the majority. The committee may begin to meet more frequently ranging from two to four times a year.

This will be the last meeting held at the Snelling Office Park location which will no longer be available to MDH. An alternate meeting place will be determined once dates are selected.

Wednesday, January 09, 2013 at 09:34AM