MERC Committee Meeting
May 13, 2015
Committee Present:
Chair:
Dawn Ludwig, PA
Vice Chair:
Michael Belzer, MD
Members:
Glen Anderson *Kate Dean, Mary Edwards, Heather Froehlich, *Kathleen Macken,
Merri Moody, Michelle Noltimier (HealthPartners), Jeff Ogden, *Kurt Otto, John
Poe, Lisa Richardson, John Rodewald, Marilyn Speedie, Troy Taubenheim, and
*Richard Wehseler.
Interested Parties Signed-in:
Christine Kiel, Rena Garni, David Knowlan, *Sue Kostka, Peg Lamin, Deb Mayland-Poyzer, Janet
McCarthy, Sarah McVaugh, Peg Lamin, Jeffrey Richter, Alan Rose, Rick Roberts, Trisha Schirmers,
Joe Schindler, Joel Tomlinson, and Eric Velleux.
MDH Staff Present:
Cindy LaMere, Diane Reger, Darwin Flores Trujillo and Mark Schoenbaum.
*Via tele-conference
I. Introductory Remarks – Dawn Ludwig, Committee Chair
Dawn Ludwig, opened the meeting and briefed the committee on the agenda. All members and
interested parties introduced themselves. February 2015 meeting minutes were approved.
II. Presentations and Discussions
Federal Evaluations Requirements – Minnesota Department of Human Services (DHS): Ann
Berg, State Program Administrator Manager Principal, Medicaid Director
Ann Berg started her presentation by giving a quick background on Medicaid and MERC. She also
explained the PMAP+Waiver, which is authorized under section 1115 of the Social Security Act.
This type of waiver allows DHS to make payments that aren’t normally allowed under Title XIX.
She shared that these type of waivers require an evaluation, which is intended to demonstrate
whether or not the federal authority is accomplishing its intended goal.
Ann informed the committee that the waiver generally runs for three years at a time, but due to all of
the program changes related to expansion and the Affordable Care Act the waiver was renewed for
two, one-year intervals for 2014 and 2015. As a result, DHS owes CMS two new evaluation plans:
one for CY 2015, and another evaluation plan for 2016 through 2018, both due on June 30, 2015. In
renewing the waiver for 2015, CMS made clear that they want evaluation of all of the remaining
elements of the waiver (prior to this, the evaluation DHS provided was really about the quality of
care provided in MinnesotaCare compared to all other Medicaid). Since MinnesotaCare is no longer
part of the equation, MERC becomes the primary focus of this waiver. Ann Berg finalized her
presentation by asking Mark Schoenbaum to explain to the group the terms and conditions of the
evaluation design.
Mark Schoenbaum reported that when both MDH & DHS staff learned about the evaluation, they
met to work together on how to fulfill the requested evaluations. For the fiscal year 2014 evaluation,
MDH will submit data from the annual legislative report. The data included in this report will include
the name of sponsors, training sites, FTEs, awards, etc.
To report fiscal year 2015 MDH & DHS will use item 49. Submission of Draft Evaluation Design
from the most recent CMS 1115 Waiver conditions for Minnesota. Also, CMS staff suggested
research questions to include in the evaluation plan for the current waiver period January 1, 2015
through December 31, 2105.
For the suggested questions, how do the recipients of payments issued through the MERC fund use
those monies? How many graduate medical training slots are supported through MERC? Mark
reported that data collected by MDH will be used. A committee member asked what kind of data the
agency has to report to CMS. Mark responded that MDH has been collecting expenditures data from
training sites, which will be enough to respond to the suggested questions.
For the questions, what is the impact of MERC on the number of providers available to serve the
needs of the Medicaid eligible population? Did the number of primary providers increase in rural
Minnesota as compared to providers in urban counties? MDH is still working on the details.
MERC committee members gave their opinions about these questions and MDH will take them into
consideration to complete this inquiry.
For the questions, did the number of primary providers increase in rural Minnesota as compared to
providers in urban counties? Mark reported that MDH will submit information comparing physician
and primary care provider supply with other states after December 31, 2015. A committee member
commented that MERC funds had a good impact on rural training sites, funds have helped to bring
more residents to these sites.
The final question, what is the advantage of distributing payments from a medical education trust
fund, compared to making GME subsidy payments directly to providers? Mark replied that this
question is hypothetical and Minnesota has no way to answer it definitively. Committee members
gave different opinions about the question.
State of Clinical Education, Fairview Health Services: Laura Beeth, System Director Talent
Acquisition, Human Resources
Laura emphasized the importance to be partners to educate, train, and prepare health care
professionals who are highly qualified and experienced to practice in current and future health care
delivery models. This partnership can improve the overall health of the community. Also, Laura
commented that a good committed and trusting relationship will provide a platform to build a strong
partnership. Working together to understand the value proposition for each partner and the
commitment to define a process and infrastructure to achieve accountability.
Laura provided examples of Workforce Development Education Strategy; some of these examples
were: Collaborating with Primary Institutional Partners on student clinical experiences, adjunct
faculty contracts, education/job fairs, scholarships/sponsorships, inter-professional and diversity
summits, workforce planning, advisory board participation, and research opportunities.
III. Program Updates – Darwin Flores Trujillo and Diane Reger
Diane gave an update on the MERC plan state amendment and MERC formula FY12 training-FY15
funds. The state amendment hasn’t been approved, because of this Diane had to use two formulas to
calculate the grant. PMAP formula large amount of funding was calculated first, facilities with 0.98
percent relative revenue or higher qualified for a 10 percent supplemental grant. The funding pool to
those under 0.98 percent relative revenue has been reduced and grants cannot exceed the 95th
percentile grant per full-time equivalent (FTE). Facilities whose grant calculation total is below
$5,000 do not qualify. The funds are redistributed to those meeting the $5,000 minimum. Also,
grants cannot exceed the facility’s reported clinical training expenditures.
The Tobacco formula is a small amount of funding and new providers don’t qualify. These grant
funds cannot exceed expenditures. Facilities whose grant calculation total is below $1,000 do not
qualify. The funds are redistributed to those meeting the $1,000 minimum.
Diane provided a breakdown of the calculation. There were 608 distinct training sites that applied
for funding. Of the 608, 460 qualified for PMAP funds. What this means is that these training sites
had Medicaid revenue, submitted expenditures, and had over 0.1 FTEs. Of the 608, 418 qualified for
tobacco funds. These sites had remaining expenditures after the PMAP grant was calculated. There
is no FTE cutoff in the calculation of this part of the grant. Therefore, some facilities that did not
qualify for the PMAP funds, did qualify for the tobacco funds. New provider types were excluded for
this part of the grant. Darwin provided a breakdown of the expenditures collected. There were 608
participants; 534 completed the expenditures report. Of the 534, 349 used estimates, 125 used
actuals, 60 used a combination, 34 withdrew and 27 did not respond to the request to report.
IV. Future Meeting Schedule
Monday, August 17, 2015, 1 p.m. to 3 p.m.
Wednesday, November 4, 2015, 1 p.m. to 3 p.m.
Location:
Hiway Federal Credit Union
840 Westminster Street
St. Paul, MN 55130
Please refer to the advisory committee section of the MERC website for meeting updates.