RI hospital eligible for $30-$40M Medicaid funding due to standalone psych facility

By Christina P. O'Neill
December 18th, 2022
Richard Charest is the director of the Rhode Island Department of Behavioral Health Care.
Richard Charest is the director of the Rhode Island Department of Behavioral Health Care.

The state-run Eleanor Slater Hospital (ESH) in Cranston, RI has created a standalone psychiatric hospital, discharging and then re-admitting 52 patients with often-longstanding mental illness. An existing care staff of 81 also moved with them.

ESH is a long-term acute care hospital treating and caring for medical patients and some psychiatric patients. It received licensure approval in late October of this year after seeking to qualify for Medicaid reimbursement, the rules of which disallow reimbursement for patients under age 65 when more than 50 percent of the patient headcount is psychiatric.

ESH’s psychiatric forensic patients (those with serious mental illnesses: those with severe and persistent mental illness who are incompetent to stand trial, those found not guilty by reason of insanity and deemed too dangerous for current release, and those serving prison sentences and require specialized treatment not available at the Adult Correctional Institutions) were included in the overall headcount in the semi-annual census that determines a hospital’s Medicaid eligibility for patients under age 65.

Separating these patients into a separate psychiatric unit qualifies the hospital for up to $40 million in annual Medicaid reimbursements to serve ESH’s medical patient component, composed of those with complex and often disabling medical conditions.

The new facility, formerly the Roosevelt Benton facility, is now relicensed as a standalone psychiatric hospital under the name Rhode Island State Psychiatric Hospital. ESH’s other facilities include the Regan and Adolf Meyer facilities on the Pastore campus in Cranston and the Beazley facility on the Zambarano Campus in Burrillville, RI.

Richard Charest, director of the Rhode Island Department of Behavioral Health Care, was part of the administrative team that effected the transition. He served as interim CEO until the arrival of Irina Beyder on November 6.

Charest credits ESH’s difficulties to widespread changes in recent years to changes in healthcare. “Medications have improved, care has improved, and this has meant that some patients who once needed long-term hospitalization no longer require it,” he said.

ESH, opened in 1828, supported a maximum of 426 patients overall. But by 2021, its headcount was a reported 191 patients, compared to 227 at the beginning of 2020. The Providence Journal reported administrative and staff turnover during 2021, during which the only unit accepting admissions was the aforementioned forensic unit for court-ordered patients.

Charest attributed the length of search for Medicaid qualification to the increase in the numbers of patients incompetent to stand trial, tipping ESH’s headcount toward more psychiatric patients than medical patients, Charest said. “This meant the hospital was technically an Institution for Mental Disease and as such it could no longer bill Medicaid for federal matches to help cover the cost of care for patients over 20 and under 65.”

An August 19, 2022 letter from the Centers for Medicare and Medicaid Services indicated that all deficiencies were corrected, and the hospital was in substantial compliance with the Medicare Conditions of Participation, and the eligibility for Medicaid funding came within reach.

ESH’s financial future looks like this: FY23 funding for the two state hospitals will include $103,544,418 in state funds and $35,001,454 in federal funds, assuming eight months of full federal billing during which Eleanor Slater Hospital is no longer an institution for mental disease.

The federal total includes $2,388,169, based on an enhanced Federal Medical Assistance Percentage (FMAP) that began with the pandemic. In addition to the above numbers, FY23 will also include $11,032,059 in one-time capital and operating costs, some of which may be reimbursable.

For FY24, the projections for the two state hospitals are $87,786,323 in state funds and $50,914,464 in federal funds.

The new Medicaid eligibility will support proposed renovations to major projects at the Zambarano and Pastore campuses including improvements to the Beazley and Regan facilities; additional infrastructure improvements that will supply and/or serve the buildings on the campus.

At the Pastore Campus, repairs and renovations at the Adolf Meyer facility to temporarily move Regan patients to Adolf Meyer to allow for renovations at Regan, making the facility ligature resistant, modifying floor layouts to enhance care delivery and safety, providing infrastructure updates, and making a floor available to the Rhode Island State Psychiatric Hospital to serve overflow from the Benton facility.

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