Frequently Asked Questions about the MERC Application

General Application Questions

Please explain the timing of the application process.

Example:

• Applications were due October 31, 2012.
• Applications reflect state fiscal year (FY) 2011 programs and training sites.
• Available funding is based on state fiscal year 2014.
• Grants are expected to be released to sponsoring institutions in April 2014.
• Grants are released to clinic training sites within 60 days after sponsoring institution receives funding.

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. 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 Advanced 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 were modified, requiring that all APN programs be sponsored by the University of Minnesota Academic Health Center, Mayo Foundation or institutions that are part of the Minnesota State Colleges and Universities System (MnSCU) or members of the Minnesota Private College Council. Programs 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, all reporting to be based on a standard time period (say a calendar year), but this may add 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.

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 eligible provider types funded in part by patient care revenues and that occurs in either an inpatient or ambulatory patient care training site (Minn. Statutes Section 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, lab work 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 not based in a patient-care setting is not considered clinical.

Training 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. 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 example, if a site provided training in FY2010 and FY2012 but did not have any trainees in FY2011, the site would not be included when 2011 data is collected, 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. 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 as long as the clinic has recorded a change in ownership with the Managed Health Care Program (MHCP) provider enrollment area.

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.

My clinic has two satellite clinics at different practice addresses. These clinics do not have separate NPI numbers. May I group these three locations together under one training site?

No, the definition of the training site is a "facility at a given practice address where clinical training occurred." Although a provider may have one NPI number, each location should be enrolled in the MHCP according to practice address.

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 systemwide, medical assistance provider number identifies the site. It is even more important that the total Prepaid Medical Assistance Program (PMAP)/Prepaid General Assistance Medical Care (PGAMC)/General Assistance (GA)/Medical Assistance (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 the 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 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.

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)?

FTEs (full-time equivalent) should be determined primarily by the specific requirements of the program, and should be consistent with the education institution’s definition of a full time student. 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 where the trainee receives training. For example, if 15 students or residents in full-time clinical training for the whole year each rotate to three training sites over the year, then each training site would be allocated 5 FTEs for those trainees. If six trainees spend one month (1 FTE/12 month = .0833 per month) at the same training site, that site would be allocated .5 FTEs (.0833 x 6 FTEs). 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.

Basically, the concept of FTE is specific to the program, though it should be consistent with your institution’s definition of a full-time student for an academic year and with the following federal definition of a credit hour. According to the federal government, a credit hour is: “1. One hour of classroom or direct faculty instruction and a minimum of two hours of out-of-class student work each week for approximately 15 weeks for one semester or trimester hour of credit, or 10 to 12 weeks for one quarter hour of credit, or the equivalent amount of work over a different amount of time; or 2. At least an equivalent amount of work as required in paragraph (1) of this definition for other academic activities as established by the institution, including laboratory work, internships, practica, studio work, and other academic work leading to the award of credit hours.”

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 three 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).

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.

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.

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.

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.

If you have questions or comments about this page, please contact Health Policy at (651)-201-3566 or diane.reger@state.mn.us.

Updated Tuesday, 15-Apr-2014 15:04:21 CDT