June 22, 2012
MERC Committee Meeting:
Committee Members Present:
Dawn Ludwig, Kathy Meyerle, Jeff Ogden, Carl Patow, and Marilyn Speedie.
Interested Parties Present:
Matt Anderson, Jacqueline Attig*, Linda Berglin, Heather Bidinger, Diane Buschena-Brenna, Gina Danyluk, Kate Dean*, Rena Garni, Judith Graziano, Shawntera Hardy, Peg Lamin, Deb Mayland-Poyzer, Janet McCarthy, Rebecca McGill, Christine Mueller, Jeff Richter, Rick Roberts, Colette Salmanowicz, Helen Schatzlein, Trisha Schirmers, Troy Taubenheim, Amy Tepp, Suzanne Taylor*, and Joel Tomlinson.
MDH/DHS Staff Present:
Diane Reger, Diane Rydrych, and Mark Schoenbaum – Minnesota Department of Health (MDH)
Susan Castellano, Kyle Stenstrom, and Virginia Zawistowski – Minnesota Department of Human Services (DHS)
* Indicates Attendance via Conference Call
Mark Schoenbaum, director of the Office of Rural Health and Primary Care, reintroduced himself. He attended the December meeting as a guest and has now assumed the role of leading MERC activities and supervising Diane Reger since Diane Rydrych is now the director of the Division of Health Policy.
II. Committee – Mark Schoenbaum, MDH
Staff noted the lack of committee members at meetings in the past few years, perhaps due to discussions becoming more process involved and not policy driven or perhaps due to members changing roles in their own organizations and time commitments no longer being feasible. It may be beneficial to look at the current membership and see if there are those who are no longer able to serve since they haven’t been attending and seek new members who can help the committee focus on broader policy surrounding the future of MERC. The process of day-to-day administration could benefit from a smaller technical workgroup that can report concerns up to a reconstituted MERC Committee.
Between the shutdown last summer that affected both the 2011 and 2012 process and the collection of revenue data due to the many additional hospital IDs, the distribution was delayed compared to prior years. The funds were released to the sponsoring institutions by the April 30, 2012, State Plan Amendment deadline. The total distribution was just over $31.5 million. The sponsoring institutions have until June 30, 2012, to release these funds to their training facilities and return their grant verification materials.
As part of a new process requested by MDH internal auditors, sponsoring institutions are required to submit an accounting report or similar documentation showing the release of these funds to their training facilities. The training sites themselves will also be asked to confirm receipt of funds and provide documentation to verify that they received the correct amount. This year, fifty sites have been selected to participate in the financial review process. They will receive a letter requesting an accounting report that will verify that the funds were received from the sponsoring institution prior to the June 30 deadline.
The MERC year-end report to the legislature is complete. Diane shared handouts at the meeting and announced that the report would be available on the MERC website in the next few days. In total there were 217 teaching programs that had trainees at 1,937 facilities in Minnesota. Since facilities can serve as a training site for multiple programs, distinctly there were 621 facilities overall. She reminded the group that the distribution now excludes sites that would have received a combined grant less than $1,000. This eliminated a total of 143 training facilities. Of the 478 facilities that received a grant, 40 percent qualified for less than $5,000 each and only 9 percent received over $100,000.
As noted earlier, the additional time required to calculate the Medicaid proxy values used in the 2011 MERC grant delayed the distribution. Mark reminded the committee that the revenue data will never match the actual PPHP reimbursement amounts and is only a proxy of how the PPHP claims would have been reimbursed if they had been FFS claims. DHS runs the PPHP claims through a FFS edit to estimate the proxies. There is concern about how those claims that do not meet the FFS edits are calculated. Mark provided a preliminary handout put together by MDH and DHS on key issues related to revenue calculation. The agencies would like to convene a workgroup to improve this process before the next round of revenue data is gathered. A project completion date is set for October 1, 2012. Staff also encourages providers to contact their MCO’s to explain the importance of submitting PPHP claims data to DHS. Individuals who are interested in participating in this group should contact Diane Reger by July 15.
This spring, MDH convened a workgroup to develop a mechanism for collecting data from training facilities related to the use of MERC funds. The intent is to gather information from training facilities to share details with policymakers on MERC activities and results. A draft survey was shared with the members. A few wording changes were suggested. MDH hopes to release the survey in July.
There was one legislative change to MERC during session. Gillette Children’s Hospital will receive a one-time payment of $300,000 from the 2012 MERC distribution. It is unknown at this time whether this will reduce the available federal match.
The 2012 application process was delayed last summer due to the government shutdown. Institutions were given an extension to allow additional time to gather applications from the training facilities to ensure facility IDs were properly provided. Diane has not started the review process at this time. She noted the difficulties she faces verifying those with multiple IDs and if the site provided consistent information across multiple programs. The goal is to have any necessary amendments completed by November 1, 2012, and provide ID numbers to DHS to request Medicaid revenue. If DHS can provide revenue data back to MDH by December 1, 2012, Diane should have an estimated distribution calculated by late December or early January. It generally takes a few weeks for approval of the federal match once the estimate has been calculated. Once DHS determines if full match is available, grant agreements will go out to the sponsoring institutions, and grants will be paid within a few weeks. MDH’s goal is payment by early to mid-February. The distribution deadline outlined in the State Plan Amendment is April 30.
The 2013 MERC application has a statutory deadline of October 31, 2012. MERC staff is seeking input from sponsoring institutions, training facilities, and the DHS Provider Enrollment staff to improve the process. There will not be a new web application developed for this application process; however, there are issues that can be addressed and clarified further to make the process smoother.
Some of the issues identified on the handout were discussed. Another issue identified at the meeting was how teaching programs should deal with training facilities that do not respond when asked for their application. Mark commented that the training facilities need to be held accountable for submitting information if they want to be included in a grant application. Diane Reger noted that it may be difficult to know if the correct person is being contacted upfront, making it difficult to know if someone in authority is aware of the grant application. It was noted that after the initial attempt to request an application from the site and no response is received, the program will make one more attempt. If the site does not respond, then they will be left off the application. The program should make note of the contact attempts in their records.
Mark shared the current draft of recommendations made by the workforce work group of the Governor’s Health Reform Taskforce. The taskforce recommended restoring funding to MERC and PMAP along with a request for additional funds to target new primary care training sites for primary care physicians, advanced practice registered nurses, physician assistants and pharmacists to meet the workforce of the state.
A concern was voiced about how some struggle with securing specialty care at their facility. MDH has received letters and comments on the recommendations.
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 7, 2012. (Note: the meeting schedule may be revisited and changed during discussions of committee membership and structure.)
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