June 10, 2011
MERC Committee Meeting:
Committee Members Present: Michael Belzer, Jim Davis, Connie Delaney, Louis Ling, Kathleen Meyerle*, Jeff Ogden, and
Alternates: Deb Mayland-Poyzer for Mary Edwards
Interested Parties Present: Gina Danyluk*, Ann Bussey*, Marie Davis, Kate Dean, Rena Garni, Kerri Gordon, Leslie Hansen, Shawntera Hardy, David Knowlan, Margo Marko, Janet McCarthy, Merri Moody, Jay Ness*, Kristoffer Nordby, Joe Schindler, Trisha Schirmers, and Joel Tomlinson
MDH Staff Present: Jim Koppel, Diane Reger and Diane Rydrych – Minnesota Department of Health
* Indicates Attendance via Conference Call
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. There were some members and interested parties that joined the meeting via conference call.
Deputy Commissioner Jim Koppel, who once served on the MERC Committee in his past role with the Children’s Defense Fund, was reintroduced to the group. Deputy Commissioner Koppel thanked the group for their contributions to medical education. He spoke briefly about the proposals made during session and the health and human services omnibus bill that was vetoed by the Governor. With the potential shutdown a few weeks away, he reminded the group that the Health Department holds medical education in the highest regard and the hope is to leave as much funding intact as possible under such a large deficit, though at this point we do not know whether any restoration of funds is possible. He also reminded the committee that even the Governor’s budget included cuts to MERC, although his decision to include these cuts was not taken lightly.
II. Contingency Planning for State Government Shutdown - Diane Rydrych, MDH
Final decisions related to critical government services that would continue during a shutdown will be made by a court-appointed special master in late June. Should a budget deal not be in place by July 1, it is likely that both Ms. Rydrych and Ms. Reger will be laid off, which will delay both the 2011 distribution and the upcoming 2012 application process. This also means that if a special session does not begin until after 7/1, MERC staff would not be available to provide technical assistance related to MERC to MDH legislative staff. Diane Rydrych will work with legislative staff prior to
June 30 to ensure that they have necessary information to respond to requests or proposals related to MERC.
III. MDH Legislative Update – Diane Rydrych
A handout was provided that detailed the various proposals made during session by the Governor, House and Senate. Ms. Rydrych walked through the handout and explained each proposal, including the HHS omnibus bill that was vetoed by the Governor. Currently, there is no indication what the final outcome will be when the budget is finalized. Further significant changes to the proposed distribution formula seem unlikely, but are still possible. If the HHS omnibus bill were to pass unchanged, the proposed revisions to the MERC formula would need to be approved by CMS.
Unless and until CMS approval is obtained, the current formula would remain in place with the addition of a $1,000 minimum grant size to help alleviate the problem of many small checks resulting from a smaller distribution.
MERC staff provided the committee with two reports estimating the impact of the proposed MERC formula and funding changes. The reports compare 2010 actual training site grants to the HHS omnibus formula as well as the HHS proposed funding level. The data under the column ‘Current Formula / HHS Omnibus Funding’ leaves in the sites that would fall under the new $1,000 cutoff, so that the committee can see the number of very small grant amounts that would result if the funding pool were reduced without putting a minimum grant in place. Under the current proposal, those sites with grants under $1,000 would be eliminated from the distribution and their funds redistributed to larger sites.
IV. Update on 2011 MERC/PMAP Distribution Process and NPI/Site Definition Issues – Diane Reger, MDH
Once the 2011 application follow-up is complete, identification numbers will be sent to the Department of Human Services to develop MA revenue estimates. MDH has a list of providers who have requested this information in the past, and we will continue to provide them with the information. Providers who would like to review their data may do so upon request to MDH via email by providing the ID numbers of the sites which are part of their organization. MERC staff will only have data for those included in the MERC application. As a reminder, PMAP revenue is a proxy and will not match actual reimbursements; therefore, providers will not be able to match the DHS data up to their actual reimbursement data.
The distribution will take place after calculation of the Upper Payment Limit and receipt of federal matching funds. Depending on the duration of a potential shutdown, this process could be delayed.
Ms. Reger is working to ensure that we have a consistent approach to addressing questions surrounding identification numbers and site information submitted on the application. Many of these questions are related to the use of shared NPI numbers.
When MERC was first implemented, a training site was defined as the physical location where training took place. When the MERC formula changed over the years to a focus on MA volume rather than on number/costs of trainees, verification of the site’s Medicaid identification number became increasingly important as part of the application process. National Provider Identification Numbers (NPIs) added another layer to the various ways a provider could potentially be defined; while the hope was that each distinct physical site would have its own, single, dedicated NPI number, in reality sites can choose to have multiple numbers, single numbers, or shared numbers within and across physical sites, and each organization makes its own business decisions in this regard. This leads to the question of how a site should be defined now that the grant calculation is based solely on revenue. Should training sites still be defined as the physical location where training took place? Or should the definition be based on Medicaid identification number, NPI, tax id number, or some other identifier? Discussion among the group indicated that no one approach might be possible to use across all sites; some use a single tax ID to cover all of a large organization’s locations, while others take a different approach, much as with NPI’s.
MERC staff suggested that it would be helpful to bring together a small ad hoc group of technical experts to assist in talking through some of these issues and seeing whether we could develop some stronger guidance or decision aids for situations related to
shared NPI’s and the definitions of training sites/hospitals. It was suggested that MERC staff attend an upcoming MMCGME reimbursement committee meeting to
discuss this topic further and determine the best approach to consider. MERC staff will work with MMCGME to determine a date that works for them to attend an upcoming
The committee and interested parties also discussed how to ensure that there is sufficient accountability for the use of funds within organizations. Some committee members said that they would like to preserve the link to the physical location where training took place, as well as putting into place a rule by which MERC funding that is distributed to large organizations is certain to be passed on to the relevant programs rather than distributed based on other criteria.
Given that at least one legislator has expressed concerns with the lack of demonstrated outcomes from MERC funding, several interested parties and committee members suggested that MDH work to develop stronger reporting mechanisms through which sponsoring institutions and training sites would be required to submit information related to the use of funds and the outcome of funded training programs. Ms. Rydrych will work on developing draft language to that effect, in hopes that it could be provided to legislators/legislative staff in advance of a potential special session. Even if this is not possible, the group was interested in working together at a future meeting to flesh out what such a report would look like, and most indicated that they would be willing to submit more detailed reports even in the absence of statutory language requiring them to do so, if it would enable better communication with the legislature about the value of MERC.
V. Dental Innovations Grant Update – Diane Rydrych
Ms. Rydrych updated the committee on the dental innovations grant program, which is administered out of MDH’s Office of Rural Health and Primary Care. The program funded ten programs for a total of just over $1.1 million.
Richard Tester from the Minnesota Department of Human Services is retiring on July 1.
The next regularly scheduled MERC meetings will be held from 1 – 3 p.m. in the Red River Room at Snelling Office Park on Friday, December 9, 2011. For directions and further information, please visit: