NH secures ARPA funds for psych services expansion

By Christina P. O'Neill
June 5th, 2023
Brad Kreick, SolutionHealth CEO
Brad Kreick, SolutionHealth CEO

The federal American Rescue Plan Act (ARPA) has approved $15 million for a $55-$60 million, at least 120-bed standalone hospital project in South Central New Hampshire. SolutionHealth is partnering with the state Department of Health and Human Services (DHHS) under a 10-year agreement. Planned opening date is late 2024.

Dartmouth-Hitchcock Hospital also won $1 million in ARPA funding, to add five additional psych beds for involuntary emergency admissions (IEA) under a six-year agreement. Completion is expected by August/September 2024.

New Hampshire is one of many states targeting available ARPA funds for health-related expenditures resulting from the strain that the COVID-19 pandemic put on health systems.

The DHHS issues a daily report on the status of state-run and designated acute psychiatric beds and also includes information about the number of beds offline because of staffing or renovation issues. In the May 18 DHHS daily report, 23 beds across the state were offline because of lack of staff; 49 were closed for renovation. Thirty-nine adults waited for an IEA to a designated receiving facility 18 children awaited voluntary or IEA admission.

First, a bit of legal background: on February 23, U.S. District Judge Landya McCafferty of the U.S. District Court for the District of New Hampshire ruled that the boarding situation of involuntary emergency admits violates hospitals’ Fourth amendment rights as an ‘unreasonable seizure’ of their ED property and ordered the state to establish a deadline to end it.

In a follow-up order issued May 17, the judge ruled that as of a year after the order date, the DHHS has no later than six hours after the transmittal of a completed IEA via a hospital certificate to DHHS to place the person. The state’s attorneys responded that because of staffing and other concerns, it would take two years to comply.

SolutionHealth’s facility is planned as a fully licensed and accredited inpatient/outpatient behavioral health facility. Two years after admission of its first patient, the facility must maintain average annual occupancy rate of no less than 70 percent, with that minimum occupancy rate rising to 80 percent for the remaining eight years. Thirty percent of patients must be Medicaid-eligible.

“We are pleased that the Executive Council approved funding to support this important initiative and are on track and actively working with state officials with respect to the related requirements set forth in the grant agreement,” said Brad Kreick, SolutionHealth CEO in an email.

He added that the new hospital will more than double the number of beds SolutionHealth currently provides at its member hospitals, which include Elliot Hospital, Manchester & Southern New Hampshire Medical Center, Nashua.

Dartmouth-Hitchcock Hospital’s $1 million in ARPA funding will add five additional IEA beds, freeing up emergency room capacity, said Alexander J. Horvath, director of psychiatry administration at Dartmouth Health. Dartmouth Health’s Dartmouth Hitchcock Medical Center currently operates 20 voluntary beds on two units. Permitting is planned to be completed by the end of October with the city of Lebanon, with construction beginning in November, Horvath said.

Requirements include accepting patients from across the state with 40 percent Medicaid-eligible over a year unless mutually agreed on, Horvath said.

“Being able to admit people directly needing involuntary care means that they can get care more quickly and locally, spending less time in our ED, and their families and other supporters will not have to travel as far to see them.”

“No one should have to board in an ER for days or weeks to await lifesaving care,” said Susan Stearns, executive director of NAMI New Hampshire.

She calls for a more robust array of community-based care, expanded inpatient capacity, and step down supports to help people transfer from inpatient to community-based services. The current staffing problem is exacerbated by low Medicaid reimbursement rates, although Stearns referred to a bill in the state legislature this session that seeks to increase Medicaid rates to allow better, more competitive wages for staff.

After Judge McCafferty’s May 17 ruling, NAMI New Hampshire issued a statement praising the decision and noting, “Any one of us could be that person, boarding in an emergency department, frightened, alone, and seemingly forgotten. Life circumstances and medical issues can change for any one of us when we least expect it.”

As a postscript, DHHS announced a new initiative, ‘Mission Zero,’ a plan to eliminate ED boarding of psychiatric patients by 2025.

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