December 9, 2011
MERC Committee Meeting:
Committee Members Present:
Jim Davis*, Mary Edwards, Louis Ling, Dawn Ludwig, Jeff Ogden, John Rodewald, and Marilyn Speedie
Interested Parties Present:
Gina Danyluk, Marie Davis, Kate Dean*, Holli Delperdang, Rena Garni, Judith Graziano, Shawntera Hardy, David Knowlan, Margo Marko, Deb Mayland-Poyzer, Janet McCarthy, Merri Moody, Jay Ness*, Margaret Pharris, Rick Roberts, Colette Salmanowicz, Kevin Salvatori, Joe Schindler, Trisha Schirmers, Mark Skubic, Troy Taubenheim, Suzanne Taylor*, and Joel Tomlinson
MDH Staff Present:
Diane Reger, Diane Rydrych, and Mark Schoenbaum – Minnesota Department of Health
I. Introductory Remarks – Louis Ling, Committee Chair
Dr. Ling opened the meeting. He briefed the committee on the agenda and a roll call was taken. Some members and interested parties joined the meeting via conference call.
Diane Rydrych announced that she has taken a new position within MDH as the director of the Division of Health Policy. Ms. Rydrych assured the group that MERC is an important program and a priority for MDH. Since she will now be involved in a broader role within MDH, she sees this as an opportunity to ensure that she remains a strong advocate for the MERC program with the MDH executive office, although she will no longer supervise the day-to-day work of MERC.
II. Legislative/Special Session Update – Diane Rydrych, MDH
Handouts detailing the outcome of the 2011 special session and estimated funding for the 2011 and 2012 distribution were provided. MERC staff have provided these estimates previously. The estimated amount of the distribution for FY12-13 is approximately $31.5M, a decrease of roughly 50% from FY11. A portion of this cut will be replaced in FY14-15, when the distribution increases to approximately $44.3M.
At the last meeting, MERC staff suggested bringing together a group of technical experts to assist in talking through some of the application issues and seeing whether we could develop some stronger guidance for situations related to shared NPI’s and the definitions of training sites/hospitals. It was suggested that MERC staff attend a MMCGME reimbursement committee meeting to discuss this topic further and determine the best approach to consider.
After the shutdown, a meeting was hosted by the MMCGME, at which MERC staff heard input from hospital representatives related to the use of NPI, tax identification numbers, and MA numbers. Based on that input, MERC staff developed a new approach to collecting data from MERC training sites. The goal was to develop a method of collecting training site information in a consistent, accurate manner with an emphasis on making the training sites more accountable for the data that is provided on the grant application.
MERC staff developed a new form that requires training sites to provide data that will be used in the application process. This data includes the provider’s NPI number on record with the MN Healthcare Program’s provider enrollment area. Hospitals must provide any additional subparts/departments of the hospital that are enrolled under separate Medicaid enrollment, enabling MERC staff to capture the entire hospital’s data for MERC purposes.
Since the 2011 distribution had not been calculated at the point that the new approach was implemented, MDH staff determined that this approach should be used for the hospitals that applied for the 2011 distribution as well as for 2012, due to inconsistencies in application data originally provided. A memo, application form, and report with existing 2011 application data were sent to each hospital that had applied in 2011, and MDH asked hospitals to verify their information and reply with additional subparts by November 7. As a result of this process, hundreds of additional NPI numbers were reported.
Because of this additional step, timing for the distribution was pushed back even further than the three weeks staff was already behind due to the shutdown. Due to time constraints, all 2011 training site IDs need to be sent to the Department of Human Services the week of December 12. No additional IDs will be accepted after this date. DHS will develop MA revenue estimates and supply data to MDH for calculating the MERC grant.
A member of the committee asked about ID numbers and how MERC staff handles sites that change ID numbers. Diane Reger explained that when an ID number is terminated or closed with provider enrollments, the site is considered closed and cannot be included in the application because the site is no longer enrolled or considered an active Medicaid provider. If a site has a change of ownership but remains open and continues to train student/residents, provider enrollments will indicate that there is a change of ownership on the enrollment and the old identification number will remain listed on the provider’s record, making it clear that the provider remains open but has an updated ID number due to the ownership change. If there is not a change of ownership on record, there are no ties between two facilities. Diane also explained that in the past, the MERC application would sometimes list a suggested address when the address given by a training site differed from the information on record with provider enrollments. This year, that is no longer being accepted. The training sites are responsible for keeping their records up-to-date with DHS. Since MERC is determined based on Medicaid, MDH will use the provider’s Medicaid enrollment records.
In the past, some providers have requested a review of the MA revenue that will be used in the MERC grant calculation. Because we are under a short timeframe to process data, MDH will continue to share this individually with those that request this data again this year; however, the review process will be extremely short. Providers who would like to review their data may do so upon request to MDH by providing the ID numbers that they would like to review. MERC staff will only have data for those included in the MERC application and those that request this data. As a reminder, PMAP revenue is a proxy and will not match actual reimbursements; therefore, providers requesting information will not be able to match the DHS data to their actual reimbursement data. Providers should prepare their own data analysis prior to receiving MERC information since the timeline to review/compare data will likely be a few days at most.
Once the distribution amount is finalized, grant agreements will be sent to the MERC sponsoring institutions and the distribution will be made once the agreements are all returned to MDH. If there’s a delay in any one grant agreement being returned, the entire distribution cannot be processed. MDH asks for sponsoring institutions’ assistance in quick turnaround of grant agreements. At this time, the goal is to send funding to MERC sponsoring institutions by the end of February 2012.
Once the 2011 process has been completed, Diane will begin working on 2012 applications. She asked the group if there were other provider types that have subparts (besides hospitals) that should be considered in future applications. Some interested parties noted that they have some non-hospital sites which have additional IDs. This will be looked into in the future; however, the group decided that it was too late to do this for the current process.
MERC staff was asked how training programs should handle sites that do not respond to multiple attempts for information. Staff said they should make a good faith effort to request information from training sites, but ultimately it is up to the training site to respond if they would like to be considered in the grant application process. If training sites do not respond after a good faith effort is made by the program, it’s recommended that the program note in their files when and how they attempted to request information. At this time, include these FTEs under other non-eligible.
At the last meeting, the group discussed the need to develop stronger reporting mechanisms through which sponsoring institutions and training sites would be required to submit information related to the use of funds. This information could be provided to legislators/legislative staff to educate them about the value of MERC and the impact the funding has on the State’s medical education infrastructure and health care workforce.
MERC staff will convene a group that will develop a template and principles for MERC site reports that would be submitted to sponsoring institutions and then to MDH. Those that volunteered or were nominated were: Mike Harristhal, Deb Mayland-Poyzer, Janet McCarthy, Merri Moody, Carl Patow, Jeff Richter, Rick Roberts, Colette Salmanowicz, Joe Schindler, and Marilyn Speedie. (If you volunteered and your name was not caught at the meeting, please notify Joe Schindler.)
Joe Schindler will work with Louis Ling and other members/interested parties to collect stories about the impact of MERC cuts that could be shared with the legislature.
After the 2011 distribution has been completed, MDH staff would like to explore potential revisions to the web application process. MDH will need to verify if funding is available for developing a new web application. Some things that will need to be considered:
- How can the application be modified so there are fewer duplicate submissions to/from sites with multiple programs?
- How can we gain consistency in information submitted by sponsoring institutions?
- How can MDH more efficiently verify information?
- How can we make the application process simpler for sponsoring institutions?
- Should we offer training on the application process?
- How can a program define FTEs from sites that do not apply/respond? Can these be tracked separately?
MDH asked for volunteers that would be willing to provide input and suggestions. Those who volunteered were: Margo Marko, Janet McCarthy, Jeff Richter, Rick Roberts, John Rodewald, Colette Salmanowicz, Trisha Schirmers, and Suzanne Taylor. (If you volunteered and your name was not caught at the meeting, please notify Diane Reger.) It was suggested that a representative from the MN Healthcare Programs provider enrollment area be involved in a portion of the process and potentially MDH’s Amy Camp, who works on the HAR report, and someone involved in hospital licensure.
The next regularly scheduled MERC meeting will be held from 1 – 3 p.m. in the Red River Room at Snelling Office Park on Friday, June 22, 2011. For directions and further information, please visit: