In a situation that was still unfolding at press time, the state of Maine has been informed that Medicare/Medicaid funding for services at the state hospital have been terminated. The Department of Health and Human Services (DHHS) was informed that the Federal Centers for Medicare and Medicaid (CMS) had decided to remove Riverview Psychiatric Center from its Medicare Provider Agreement, effectively cutting off $19-20 million, nearly two-thirds of its annual $33 million operating budget.
The hospital, which has seen a sharp rise in the number of forensic patients since 2012 without a matching increase in funding, has had a number of concerns raised about procedure and safety over the years. A lawsuit in 1989 led to the creation of a consent decree to address patients’ rights and safety. In July, the appointed court master filed a report that stopped just short of recommending “active supervision,” which the hospital had been under until 2011.
“I will confer with a judge to discuss resuming active supervision in light of these developments,” said the court master, former Maine Supreme Judicial Court Chief Justice Daniel Wathen, Esq.
In an 88-page report issued in June, the CMS raised concerns about safety and patient rights, citing the use of handcuffs and stun guns to stem violent behavior following an attack on a staff member in March.
Following the report, the hospital took steps to make changes including the immediate removal of all stun guns. A Plan of Correction was accepted by CMS to forestall termination until they could run additional audits of the facility.
“They did accept the plan of correction by the original effective date of Sept. 2 but they did not have time to do the follow-up surveys before that date,” says Mary Louise McEwen, superintendent of Riverview.
The plan included additional staff training and separating 20 beds for those who have been deemed violent. This plan would allow the hospital to transition from the use of county corrections officers to an arrangement to position a Capitol Police officer at the hospital. The remaining beds would then be federally funded in the interim.
“The officer would maintain a permanent presence, become part of the staff, similar to a resource officer at the schools,” says McEwen.
After conducting another survey in mid-September, the CMS decided to terminate funding, pointing to concerns about communications between staff and the sharing of staff members and equipment across the funded and non-federally funded areas.
“One of the satisfying things for me about the [second report] was that there was not a single filing related to the quality of care,” says McEwen. “The new issues are now administrative versus quality of care.”
Still, the decision to terminate frustrated local officials who felt they had listened to the earlier complaints and made every effort to make changes as needed. McEwen says the new compliance issues do not seem to necessitate the severity of the decision and, in the case of shared staffing, are not based on any statutes that can be identified.
“We cannot find in any of the federal rules a requirement that staffing in these units be separate,’’ says McEwen in an official release. “The staffing ratios in the hospital clearly meet federal requirements and can provide for appropriate care for our clients.”
The decision will be appealed by the state. In the meantime, the hospital will need to remain open because 51 of the 74 clients currently being treated are court-mandated to be there. The DHHS commissioner, Mary Mayhew, spoke before the Maine State Legislature’s appropriations committee in October to explain the emergency situation and the funding the hospital will need to remain open in the interim.
The Maine state legislature also approved a plan in August to address the situation at the hospital by creating a 32-bed mental health unit inside the state prison scheduled to open in February 2014.
By Catherine Robertson Souter