OFFICE OF RURAL HEALTH AND PRIMARY CARE
MERC Committee Meeting
February 22, 2016
Committee Present:
Chair: Michael Belzer, MD
Vice-Chair: Vacant
Members: Glenn Anderson, Felix Ankel, Kate Dean, Mary Edwards, Heather Froehlich, Kathleen
Macken*, Merri Moody, Jeff Ogden, Kurt Otto, John Poe*, Lisa Richardson, Troy Taubenheim, and
Richard Wehseler*.
Interested Parties Signed-in:
Shannon Eberhardt, Rena Garni, Alicia Quella, David Knowlan, Sue Kostka, Peg Lamin, Janet
McCarthy, Sarah McVaugh, Peg Lamin, Alan Rose*, Rick Roberts, Trisha Schirmers, Joe Schindler,
Joel Tomlinson, and Eric Velleux.
MDH Staff Present:
Diane Reger, Darwin Flores Trujillo, Mark Schoenbaum, and Will Wilson.
*Via tele-conference
I. Introductory Remarks – Michael Belzer and Mark Schoenbaum
Mark Schoenbaum opened the meeting and informed the committee that Dawn Ludwig resigned
from the committee after accepting a job with the accreditation body for physician assistants. Dr.
Michael Belzer, Vice-Chair, agreed to serve as the Committee Chair for the remainder of 2016. Dr.
Belzer briefed the committee on the agenda. All members and interested parties introduced
themselves. The August 2015 meeting minutes were approved.
Handouts were provided, which included a list of current committee members, as well as Committee
Operating Guidelines. Members whose term expired January 2016 agreed to serve a second term.
Impacted members were: Felix Ankel, Michael Belzer, Kate Dean, Mary Edwards, Merri Moody,
Jeff Ogden, John Rodewald, Marilyn Speedie and Richard Wehseler. Since Dr. Belzer agreed to
serve as chair until the end of 2016, a vice chair is needed at this time and a chair will be needed in
January 2017. A nominating committee, (Michael Belzer, Kate Dean, Mary Edwards, and Felix
Ankel), was formed to select the chair and vice-chair for the next term and also consider additional
membership.
II. Program Updates – Diane Reger, Mark Schoenbaum, and Darwin Flores Trujillo
Mark gave an update on CMS PMAP Waiver Evaluation Plan Update. The agreement between CMS
and DHS has not been formally finalized; however, DHS provided some areas that were suggested
where information will be needed after approval of the waiver. There are some prerequisite concerns
that CMS had for DHS. CMS had questions and will eventually have requirements that the state
perform all of the steps included on the PMAP Waiver Evaluation Update handout. The state was
given a period of time to respond to CMS to accept the terms and conditions. The committee will
review the list of terms and conditions.
Mark gave an update on the Legislative Health Care Workforce Commission Report. Part of the
State Commission report from December mentioned the MERC recommendations. The Commission
is planning to spend time during summer 2016 looking at MERC distribution of funds, especially
between primary care and other specialists to assure centrality of primary care. They are concerned
that MERC funds are not reaching primary care training facilities to the extent the State Commission
would like. Senator Clausen has been invited to a future meeting with the MERC committee. The
committee will review the report prior to having a discussion with Senator Clausen.
Diane gave an update on Grant Distribution for FY13 & FY14 Training/FY2016 Funds. CMS has
approved the MERC Plan Amendment, which means the program now operates under one formula.
Tobacco funds are subject to the 0.1 FTE cutoff and $5,000 minimum. Sites that received a
supplemental grant because of their high volume of Medicaid, will no longer receive additional
funding. Please review the MERC grant formula handout for more information about calculation of
the grant.
Diane reminded the committee that this year’s MERC distribution would incorporate the catch-up
period as recommended by the LEAN Kaizen workgroup and approved by the committee. She
explained that eligibility for each grant application is considered separately. Diane discussed the
options she was considering to account for two separate grant applications combined into one grant.
She gave some scenarios and explained how some facilities were not eligible for both training years
and how this could affect the distribution. The committee weighed in and recommended that they
support MDH in the decision. Diane will prepare materials and share them with committee members
to seek their approval on how facilities that qualify for both training periods will be handled.
As a follow-up, the committee approved the following procedure for facilities who qualified for both
application periods:
MA/PMAP Revenue used in the MERC formula – If a facility submitted qualifying applications in
both FY13 and FY14, the higher of their two years’ MA/PMAP revenue would be used for the
formula. If a facility applied and qualified for only one of the two years, that year’s revenue would
be used for the formula.
FTEs for determining and limiting grants at the 95th percentile grant per FTE - If a facility submitted
qualifying applications in both FY13 and FY14, the higher of their two years’ FTEs would be
considered for determining the 95th percentile grant per FTE. If a facility applied and qualified for
only one of the two years, that year’s FTEs would be considered. (This is only for determining and
limiting grants at the 95th percentile grant per FTE. A facility must have a minimum of 0.1 FTEs for
the training year to qualify.)
Expenditures – Qualifying facilities would be limited to a total of their submitted expenditures. (A
facility must have a minimum of $5,000 in expenditures for the training year to qualify.)
Darwin provided a breakdown of the fiscal year 2014 expenditures collected. There were 495
participants; of the 495, 262 used estimates, 130 used actuals, 52 used a combination, 51 withdrew or
did not respond to the request to report.
Mark gave an update on LEAN and the Grant Management System. He mentioned that the catch-up
period was one of the biggest achievements of the LEAN Kaizen group. Also, MDH is working on
selecting a vendor for a new Grant Management System for all of the grants for the Health
Department. MERC features that were identified will be added to the new system.
Dr. Belzer and Mark discussed with the committee roles and opportunities. Also discussed was the
type of work that the committee does that can be beneficial and justify the committee meetings.
Some recent accomplishments of the committee are a reconstruction of the committee, bringing in
new members, new provider programs that have brought a comprehensive discussion from historic
resident training to a broader health workforce. MDH’s role to the committee is to provide technical
support. The Committee has the opportunity to suggest changes on MERC to more directly address
policy. So that the department and the governor’s office can review them, suggestions have to be
submitted by July.
Finally, Mark discussed the mechanics of the MERC program due to the possibility of a new medical
school in Minnesota and students of this new school being eligible for MERC funds. The new
medical school must be accredited in order to receive funds. The law does not provide any
exceptions for entities that have not applied for accreditation. For entities that have provisional
accreditation, the department will be in contact for further discussion. Other professions or training
may have a different situation, as some of these programs do not require accreditations.
III. Future Meeting Schedule
Monday, May 09, 2016, 1 p.m. to 3 p.m.
Wednesday, August 17, 2016, 1 p.m. to 3 p.m.
Wednesday, November 09, 2016, 1 p.m. to 3 p.m.
Location:
Hiway Federal Credit Union
840 Westminster Street
St. Paul, MN 55130
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