June 13, 2008
MERC Committee Meeting
Diane Buschena-Brenna for Jim Davis, Mary Edwards, Tim Gaspar, Lee Greenfield, Dawn Ludwig, Kathy Meyerle, Jeff Ogden, Carl Patow, Curtis Savstrom, and Marilyn Speedie.
Lissa Benson, Gina Danyluk, Shawntera Hardy, Mike Harristhal, David Knowlan, Michael Mahoney, Margo Marko, Deb Mayland-Poyzer, Janet McCarthy, Tara Mulloy, Jay Ness, Rick Roberts, Trisha Schirmers, and Amy Tepp.
Troy Taubenheim, Metro Minnesota Council on GME
Jim Golden, Diane Reger, and Diane Rydrych – Minnesota Department of Health
Richard Tester – Minnesota Department of Human Services
Mr. Gaspar opened the meeting by welcoming and thanking members and interested parties for attending. All committee members and interested parties then introduced themselves.
Diane Rydrych made a few announcements affecting the Committee, Interested Parties, and MERC Staff. Lee Greenfield will be retiring from HCMC at the end of June, Gerhardt Meier also retired from HCMC, and Tim Gaspar will be leaving Winona State for a position as Dean of the School of Nursing in Toledo, Ohio. Ms. Rydrych thanked each of them for their strong commitment to MERC. Diane also introduced Jim Golden, the Director of the Division of Health Policy, where MERC is housed. Jim took over Scott Leitz’ role in the division approximately 18 months ago. Scott is now in the Commissioner’s office as an Assistant Commissioner.
II. Federal GME Funding - Richard Tester, DHS
Tuesday, June 17, 2008, is the deadline by which CMS must decide whether they approve the proposed State Plan Amendment (SPA) that was submitted by the MN Department of Human Services. The SPA outlines the revised distribution process that was developed during the 2007 legislative session. If we receive approval for the SPA, we will be able to seek federal matching funds on the remaining State tobacco funds after direct payments to University of MN Medical Center - Fairview, University of Minnesota School of Dentistry, and the Academic Health Center are made.
Update: DHS informed MERC staff that the State Plan Amendment has been approved. As long as there is room under the Medicare Upper Payment Limit, $3,787,500 in state tobacco funds will be eligible for a match. This amount is derived from taking the State tobacco funds less administrative costs and direct payments to the U of MN Dental School and Academic Health Center, and half of the amount going to the University of MN Medical Center – Fairview. The direct funding going to the University of MN Medical Center – Fairview is eligible for a match; therefore, half of the direct payment will be out of the State tobacco funds and half will be from the federal match. Subject to the Upper Payment Limit, a total of $7,575,000 in matched state funds will be available for the distribution. These funds will be added to PMAP Carveout funds for the distribution.
Members questioned when funding would be available if a match was received. Richard said that once the Upper Payment Limit (UPL) was calculated he would know more on the timing. He estimated that they should have an answer to this and be able to give the go-ahead to release funds sometime in late September or October.
There were discussions surrounding whether the inclusion of CPE and safety net payments in the CY2006 revenue estimates was appropriate since no payments were made in CY2006 (the timing of the payments was shifted to early CY2007). Sponsoring Institutions felt strongly that these payments should be included with CY2006 data since claims are based on an accrual basis and not a cash basis. This question was deferred to DHS, since it is DHS that supplies MERC staff with the revenue information that is used in the grant calculation. Richard said he would look into this and get back to MERC staff. MERC staff will communicate this information once they hear back from DHS.
Update: Since the committee met, DHS has informed MERC staff that the 2006 CPE and safety net payment amounts can be included in the revenue calculations used for the 2008 MERC grant despite the payments not having been made until early 2007. This procedure will be followed in future years as well, if payments are again shifted to the following calendar year.
Diane Rydrych asked Mr. Tester whether we needed to be concerned with losing PMAP funding. According to discussions that Diane Reger had with Susan Hammersten (DHS) earlier that day, there would be PMAP funding for the 2008 distribution. Approval had been received on these funds through June 2008. After June 2008, the PMAP Waiver needs to be renegotiated with CMS. Currently, no further information is available. Susan Hammersten will communicate this information to MERC staff as it becomes available. In turn, MERC staff will inform the committee and interested parties.
III. Update on 2008 MERC/PMAP Distribution – Diane Reger, MDH
Ms. Reger recently sent each sponsoring institution their 2008 site data for final approval. This data reflects any amendments that were made after the initial application was submitted. Sponsoring institutions should approve this information by mid-June.
The revenue data that is used in the training sites’ grant calculation has been received from DHS. Some of the larger training sites requested a review of their PMAP data. Ms. Reger sent this data to them yesterday. Anyone who disagrees with their PMAP revenue figures will need to communicate that information to Ms. Reger no later than July 1. (As background, PMAP revenue figures are based on the best estimate of what would have been paid had the claims been FFS.)
MERC staff estimates that the 2008 MERC/PMAP grant will be distributed sometime this fall. The federal match process and UPL calculation will determine the timing. Once more information is known, MERC staff will update the committee.
Ms. Rydrych reminded the committee that the changes to the MERC statute that were made during the 2007 legislative session included a requirement that the Commissioner review the impact of the revised distribution on sponsoring institutions and clinical training sites with low numbers of eligible trainees. The Commissioner is directed to report the findings of the analysis to the legislature by January 15, 2009. MERC staff will be reviewing the distribution when it has been calculated, and comparing it to previous distributions to see which sites, provider types, and geographic areas were most strongly impacted by the formula change. The analysis will also include an exploration of the impact on the now-eliminated nursing home sites, as well as potentially a comparison of the geographic distribution of trainees and GME costs versus Medicaid volume.
Committee members also suggested looking at sites that are no longer eligible for MERC or that choose to no longer participate, and at the impact on community-based initiatives. A committee member noted that their program’s accrediting organization requires all students to complete a portion of their training in long term care facilities, but that training in those locations would no longer receive MERC funding, putting the program in a challenging position. The committee member suggested that the evaluation look at the state’s needs for training in light of the aging population.
The annual MERC report to the Legislature is due on February 15, 2009. This is the usual short report that MERC staff complete each year, summarizing the distribution.
V. Update on 2008 Dental Grants – Diane Rydrych, MDH
Ms. Rydrych provided an update on the MERC dental innovations grants, which are administered by MDH’s Office of Rural Health and Primary Care. There were seven grantees who received a total of roughly $1,000,000. The awards went to grantees in Brainerd, Mankato, Minneapolis, and Bemidji. Applications for the current year’s grants are due on June 30, and awards will be announced in mid-August.
VI. Resident Tracking System – Troy Taubenheim, MMCGME
The next regularly scheduled MERC meeting will be held from 1 – 4 p.m. in the Red River Room at Snelling Office Park on Friday, December 5, 2008. For directions, please visit http://www.health.state.mn.us/divs/hpsc/hep/merc/committee/index.html for further information.