Frequently Asked Questions about the MERC Application
General Application Questions
When are applications due?
Signed applications must be received each year by 4 p.m. on October 31, in order to qualify for the following
year's grant. An example of the timeframe based on the 2009 Application:
• 2009 Applications were due October 31, 2008
• Contained Fiscal Year 2007 Training Sites and Data
• Grant Payment Expected Fall/Winter of 2009
If the application is on the Web, how can I control who makes changes to it?
The Minnesota Department of Health has assigned each sponsoring institution a user ID and a password, so
only people authorized by the sponsoring institution will have access to the application. Therefore, no changes
can be made to the application by anyone other than the sponsoring institution, and the Minnesota Department
of Health will use all available security devices to ensure that no one has access to the application in transit. It is
important to note, however, that most data contained in the MERC applications is public data, so after the
submission of either a paper or electronic application, the public has access to this data upon request.
The statute says that for an Advance Practice Nursing program to qualify for the MERC grant they must be
sponsored by certain institutions. Please explain.
Under a revised statute from the 2003 Legislative session, the eligibility criteria for Advanced Practice Nursing
programs was modified requiring that all APN programs be sponsored by the Academic Health Center or Mayo
Foundation, or by institutions that are part of the Minnesota State Colleges and Universities System (MnSCU)
or members of the Minnesota Private College Council. Programs that are not sponsored by eligible institutions
are not eligible for funding.
Is a training site with no public program revenue eligible for the MERC Fund?
No, training sites with no public program revenue are not eligible for funding.
Is it true that nursing facilities are no longer eligible for the MERC grant?
Correct, based on a Legislative change that began with the 2008 Application, nursing facilities are no longer
eligible to apply for MERC grant.
The application requests Fiscal Year data. Our institution uses a July-June fiscal year, but many of our sites
have different fiscal years. We are having the training sites provide some portions of the data requested in
the application, and for each program we have many training sites. Do the sites need to provide data in the
same time period as our fiscal year, or can we accept data from them based on their fiscal year?
It is acceptable to have the sites report their own fiscal year data. Ideally, we'd have liked all reporting to be
based on a standard time period (say a calendar year) but this would have added to the reporting burden. By
allowing programs and sites to report based on their own fiscal year, some standardization is lost, but reporting
is more manageable. Please note somewhere on the application which questions were answered by data from
the sites, and confirm that each site used their own fiscal year for reporting that data. Sites using a different
fiscal year should state their fiscal year information under their billing address in Question 7b. If more space is
needed, another page can be attached to the application.
How much will the grant pay out per trainee? How can I tell if it is worth completing the application?
The amount the grant will pay out per trainee depends on the size of the fund and the amount of public program
revenue the site receives. As far as the cost/benefit of completing this application, it is up to the sponsoring
institution/teaching program to determine if funds are needed or desired. The application is complex, and it is
possible that for a very small training site with little public program revenue, the grant may not be much more
than the costs associated with preparing the form.
If we train three different types of advanced practice nurses, are we one program or three? If we are more than one program, do we need to submit three different Part II's? If we have two tracks within a program
(such as one for Clinical Nurse Specialists and one for Nurse Practitioners) and the tracks have different
clinical requirements, is this one program or two?
Each distinct program must be reported on a separate Part II. For example, a sponsoring institution may have
residency programs for physicians in Family Practice, Pediatrics, Surgery, etc. Each of these is a separate
program, and must be reported on separate Part II's. If you have separate programs for different advanced
practice nursing professions (such as clinical nurse specialist, nurse practitioners, etc), each should be reported
as a separate program and separate Part II's must be completed. If the training results in the same degree,
certificate, or other recognition at the point of completion, and has substantially the same training requirements
for all trainees, it is one program. If the training results in different degrees at the end or has different
requirements, they are separate programs.
What are clinical teaching activities?
Clinical teaching activities or clinical training can be defined for the purposes of MERC as accredited training
for physicians (medical students and residents), doctor of pharmacy practitioners, dentists, advanced practice
nurses (clinical nurse specialist, certified registered nurse anesthetists, nurse practitioners, and certified nurse
midwives), and physician assistants that is funded in part by patient care revenues and that occurs in either an
inpatient or ambulatory patient care training site. (Source: Minn. Stat. §62J.69, subd. 1(b)) It includes the
patient care component of health professional education. Clinical training is training that occurs in patient care
settings and involves the care of patients. It includes providing or observing patient care, conducting
examinations, doing tests or procedures on actual patients, labwork for specific patients, consultation with other
professionals regarding a specific patient, etc. It does not include classroom work, lectures, presentations,
research lab work, and other activities that do not involve patient care.
Are classes considered clinical?
No. The definition of clinical focuses on patient-care settings only. Classroom work, lectures, meetings,
research lab work and anything else that is not based in a patient care setting is not considered clinical.
Site Questions
I just received a MERC grant back from one of our training sites; while the site is still operating, it is no longer providing training for students/residents in our program. Should I return their check to MDH?
In some of our programs, training sites change from year to year. A site may have trainees for a year, then
not have any trainees for a semester, then cycle back in. How do we deal with this type of situation? Are
these sites still eligible for grants every year?
Although MERC applications request information about FTE counts for a reference year two years prior to the
actual application date, this information is designed to be used as a proxy for current costs. The goal of MERC
is to fund ongoing clinical training, not to reimburse sites for past training per se. However, we are aware that
some sites may cycle in and out as clinical training providers for a particular program; they may choose, in any
given semester or quarter, to not host trainees, or may choose to terminate their affiliation with a program for a
variety of reasons. Keeping in mind the broader purpose of MERC funds, sponsoring institutions should include
a site in the application if, at the time the application is submitted, the site meets both of the following
conditions:
1) The site is still affiliated with the program. For the purposes of MERC, this can mean that the site has a
formal written agreement with the teaching program to host a given number of FTEs each quarter/semester or at
various times throughout the year. Alternatively, for a site that does not have FTEs at the exact time that the
application is being completed, this can also mean that the site has either had trainees in the 12 months prior to
the application period or has agreed to provide clinical training for a program's students or residents within the
next 12 months.
2) The site had FTEs in the reference year for which the application is gathering data (for the MERC 2009
application, the reference year is FY2007). For example, if a site provided training in FY2006 and FY2008 but
did not have any trainees in FY2007, the site would not be included in the 2009 MERC Application, but could
be included the following year.
At the time of application for each year's MERC grant, as you gather information on FTEs from each training
site, you should also verify that each of the sites is still affiliated with the program for which you are applying
for a grant. If one or both of the above conditions are not met, you should not include the site in that year's
application. If both conditions are met, the site should be included.
When grants are distributed, the same conditions should apply. For example, Site A may not have trainees at the
time the grants are disbursed but will have them again within 12 months; in that case, Site A can keep their
grant. But if the sponsoring institution discovers at the time of grant disbursement that Site A is no longer
affiliated with the teaching program and will not be providing training in the next 12 months, and that the
affiliation had ended by the time of application, Site A should return their grant.
We received a check for a site that recently closed. Should we return the check?
One of our training sites was recently closed by the health system that owns it, but all operations, including
training, were shifted to another clinic that is also owned by the health system. How do we deal with this in
our application? Is the 'new' site eligible for a grant immediately, or must they wait for two years like other
new sites?
In general, if a site ceased operations in between the time when the application was submitted and the grant
funds received, the check should be returned to MDH. Returned checks are rolled into the next year's fund. If a
site offered training in the application's reference year but was closed by the time the application was submitted,
the site should not be included in the application.
However, an exception to this policy exists in cases where the closing of one clinic shifts the training function
to a different physical location within a health system that owns multiple clinics. If a clinic that is owned by a
health system (for example, a Fairview Health Services, HealthPartners, Allina, or Park Nicollet Health
Services-owned clinic) is closed and all operations or services, including training, shift along with the closed
clinic's accounts receivable and other debt to another owned clinic within the same health system, the grant can
also move to the new site. In these cases, MDH should be alerted to the situation and grants should be
forwarded to the new facility. If this situation arises at the time of application, as in a case where operations
have shifted location within a system at some point between the application's reference year and the time the
application is submitted, sponsoring institutions should include cost and FTE information for the 'old' site along
with contact and address information for the 'new' site and attach a note to the application explaining the
situation. The Medicaid provider numbers for both the old and new sites should be included with the
application.
This exception only applies to cases where training has moved from one site to another within a system of
clinics that is owned by the same entity due to the closure of the initial training site. If a clinic closes, and the
preceptor moves to a new clinic outside of the system, the new site would not be eligible to apply for a MERC
grant until there is data for the reference year.
Is a system of five clinics with one central billing department one training site or five training sites?
This system would be five training sites. The definition of a training site is "the facility at a given practice
address where clinical training occurred." A corporate billing office is not the location where medical
professionals participate in clinical training; therefore, it is not the training site. It is very important that the
facility, not a system wide, medical assistance provider number identifies the site. It is even more important
that the total PMAP/PGAMC/GA/MA revenue is the total net revenue received from the Minnesota Department
of Human Services for Minnesota Medicaid patients at the location where the clinical training occurred. If a
system of clinics defined themselves as one training site with a total PMAP/PGAMC/GA/MA revenue equal to
the sum of all of clinics' Medicaid revenue, and half of this Medicaid revenue was generated by non-teaching
institutions, then this system's PMAP/PGAMC/GA/MA revenue (and share of the public program factor of the
PMAP portion of the MERC Trust Fund) would be inflated by a factor of two. It is inequitable that training
sites that do not participate in medical education in effect receive funds that are intended to finance clinical
training expenses. Therefore, systems of clinics, regardless of the extent their finances are integrated, must list
the locations that students or residents participate in clinical training as the training site on the MERC
application.
What information does a training site need to collect to apply for MERC Fund grants?
The training site or the teaching program must provide the sponsoring institution with the number of FTE (fulltime
equivalent) trainees that train at the site. The training site must provide the sponsoring institution or
teaching program with the name and address of the facility where training was completed, a billing/accounting
address (when it differs from the facility address), a contact person, and the facility National Provider
Identification Number (NPI) and MN Medical Assistance Identification Number (MAID). Due to statutory
constraints, a site that does not supply its sponsoring institution with its identification number will not receive
any funds from the MERC Fund.
Question-Specific Issues
Application Question #1
Is it OK just to report the year or the year and month? Many of our programs began many years ago, and it would be difficult to track down the specific day of the month that programs began operation.Yes, if the program began before 1996, you may report only the year if month and/or day of the month are not easily accessible.
Application Question #7
What do you mean by Full Time Equivalent (FTE)?FTE (full time equivalent) should be determined primarily by specific requirements of the program. Whatever the program considers full time (whether it is 35 hours per week or 80 hours per week) should be considered an FTE. For question 7, where programs are asked to identify FTEs at each training site, the total number of FTEs is allocated out over all training sites the trainee receives training at. For example, if 15 full time trainees each rotate to three training sites over the year, then each training site would be allocated 5 FTEs for those trainees. Summing up all of the FTEs at each training site in a program should give the total number of FTEs in that training program.
ALL FTES IN A PROGRAM SHOULD BE ACCOUNTED FOR IN QUESTION 7. If the program is only partially clinical, then the non-clinical training FTEs should be aggregated and documented in 7a.
What is an FTE? Our organization considers 9 credits of graduate course work plus 4 hours clinical work per credit per week to be full time.
Basically, the concept of FTE is specific to the program. In your example, a full time student would have 9 credits of course work, and also work 36 hours a week of clinical time (9 credits times 4 hours per credit per week). If you had a student who was taking only 6 credits and working 24 hours per week in clinical time, this student would count as 2/3 of an FTE. When you allocate these students to training sites, allocate based on this standard of full time.
In counting FTEs, should the first day of the month count be used?
The FTE count for each site is intended to allow the allocation of time across various training sites. For example, if there are 10 full-time trainees in a program, and they spend half their time in one training site and half in another, each site would record 5 FTEs. If the training site has 5 trainees on site full time all year long (even if they are different people rotating through), they would report 5 FTEs. But if the site has 5 full time trainees for only 3 months of the year, then the site would report 1.25 FTEs. Adding up all of the FTEs in the various training sites should add up to the total number of FTEs in the program.
Should I report all students enrolled in the program, even those who currently do not participate in clinical training?
A program can be defined to be only the students who participate in clinical training. For example, if a program trains medical students who do not participate in clinical training during their first two years, the program should be defined to include only third and fourth year students. It would also be logical to call third year students their own program, and fourth year students another program. Regardless of how you define the program, you should account for all non-clinical FTEs within that program under 7a(ii). It is very important, however, that the same program defined in question 7 is reflected in question 8 (the cost data). Therefore, if only third and forth year students are included in the program, then all costs reported in question 8, which must come from audited data, must be the costs associated with training third and fourth year students only.
Application Question #7b
If I have a variety of students training in a variety of departments at Hennepin County Medical Center (HCMC), do I list HCMC once, or do I list each HCMC department separately?If students in the same teaching program train in several departments at a given practice address, such as HCMC, HCMC should be listed once, and number of trainees in all departments should be aggregated. HCMC should be considered one site for the program, regardless of how many departments students train in.
Application Question #7b(iv)
Our training occurs only at ambulatory care sites. Are we still eligible for a MERC grant?
Yes. The law requires only that the clinical training of qualified practitioners is funded in part by patient care
revenues and occurs in either an inpatient or ambulatory patient care training site.
What is included in the term ambulatory? Does it include Hospice, Long Term Care (LTC), Public Health Departments, occupational nursing in businesses, etc?
Inpatient sites would include inpatient hospital settings, long term care, or residential institutional settings. Ambulatory settings should include all other patient care settings.
Should emergency room services be considered inpatient or outpatient (ambulatory) services, for purposes of determining whether the training "setting type" is ambulatory or inpatient?
Although emergency room services are generally delivered at hospital locations, they are considered to be outpatient (ambulatory) services.
Application Question #7b(vi)
What if multiple individual training sites have the same billing address? Do we still list them as individual
training sites?
The sites should be listed separately on the application each with their own identification number. The billing
address should be noted in the space provided.
Application Question #8 and #9
(Not included in the Application at this time)
Cost data is not required at this time. Beginning with the 2006 Application, it was decided that the frequency of
collecting this data would now be at the Minnesota Department of Health’s discretion. It is envision that this
data will be collected every three to five years.
If you have questions or comments about this page, please contact our Health Policy at (651)-201-3566 or diane.reger@state.mn.us.
