May 1st, 2012

Law shifts care to community-based focus

Vermont legislators passed legislation to create a decentralized system of mental health care in the aftermath of Hurricane Irene, which forced the closure of the 54-bed Vermont State Hospital last summer.

Gov. Peter Shumlin in April signed into law a bill that shifts care from the institution-based system to a more community-based focus.

The Vermont House of Representatives and Senate each approved plans in February, but the bills had one difference: the size of the state-owned and operated acute inpatient psychiatric facility to be built in central Vermont. The House approved a bill calling for construction of a 25-bed facility; the Senate approved a 16-bed facility, which was what the state’s plan recommended.

However, in mid-March, Shumlin’s office announced that the governor and lawmakers had worked out an agreement. The parties agreed to a proposal to create 45 acute care beds in the state’s mental health care system – including up to 25 beds in a new hospital – with six at the Rutland Regional Medical Center and 14 at Brattleboro Retreat.

While many, including the Vermont State Employees Union, advocated for a larger hospital, the state had asserted that a psychiatric hospital larger than 16 beds would not be eligible for Medicaid funding. The state aimed to preserve that funding while also moving toward a decentralized mental health system that includes “step-down” facilities, relies more on a regionalized community care system and offers increased peer services.

In announcing the agreement in a press release, the governor’s office said the Shumlin administration received assurances from the federal Centers for Medicare and Medicaid Services (CMS) that, through the Global Commitment Demonstration, Vermont can expect financial reimbursement for patients in a 25-bed facility or reduce the number of beds to 16 if the Global Commitment Demonstration is not renewed in 2013 and reimbursement is denied.

Other than differing opinions on the number of beds for the new facility, Vermont Mental Health Commissioner Patrick Flood says legislators and advocates have been very supportive of the state’s plan.

“There have been some tweaks of the various parts of language in the bill, but they are not substantive changes of the plan,” Flood says. “What’s amazing in this story is that something as complex and what has been controversial for so long – we have 98 percent of the people agreeing on 98 percent of the bill.

“They not only have approved the idea that we’re going to ramp up our community services so that people are not likely to go into crisis – which is a key element of this bill – but they’ve also agreed that having distributed acute psychiatric beds is also acceptable.”

Flood says the legislation should quickly address immediate needs for intensive care capacity because it authorizes the use of federal disaster relief funds for renovations at Brattleboro Retreat and Rutland Regional Medical Center, two of the facilities that have been assisting with the overflow of patients since Vermont State Hospital was evacuated in August. “That will enhance our capacity right away,” Flood says.

Since August, private facilities throughout the state have been taking on patients who would normally be at Vermont State Hospital. “I really can’t say enough good about what they’ve done,” Flood says. “First of all, they literally took this on overnight. They had no warning this was coming. And they opened their door and they really didn’t know what they were in for. Certainly it hasn’t been 100 percent smooth. There have been challenges and there remain some challenges, but I just can’t say enough about what those hospitals have done to help us in this situation.”

Employees from Vermont State Hospital have continued working at various facilities in other parts of the state, but the state announced in February that about 80 former employees were being laid off, effective in April.

By Pamela Berard

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