Rhode Island got permission from the federal government Thursday to start billing Medicaid again for services provided by the state-run hospital system, which could allow it to claw back millions of dollars lost there over the past year.
Eleanor Slater Hospital, which has campuses in Burrillville and Cranston, had to stop billing Medicaid in 2019 because the state realized it was in violation of rules on its mix of patients at the time. The hospital system cares for people with complex psychiatric and medical needs. But it had too many psychiatric patients compared to medical patients, which, meant it had no choice but to stop billing the Medicaid program.
Medicaid rules prevent facilities from billing the program if they have more psychiatric patients than medical patients. Those rules were put in place to prevent hospitals from becoming little more than large facilities for treating mentally ill people, a throwback to previous practice. (It also means that states are forced to pay for their care instead of the federal government.)
However, critics say the rules are outdated, and have led to shortages of psychiatric beds nationwide.
While Eleanor Slater was out of compliance with that rule, the state also decided to make sure it was following other billing rules in the industry, too, said Linda Reilly, the chief community relations officer for the state agency that runs Eleanor Slater. The state last year submitted to the Centers for Medicare and Medicaid Services a description of its billing practices. And on Thursday, the federal government signed off on it, meaning the money could flow again.
Reilly said in an e-mail that the state was still trying to figure out what effect the move would have in dollars and cents. The move is retroactive to April 1, 2020, which means the state will be able to get back at least some of the money it had lost during that time because it wasn’t able to bill Medicaid.
Gov. Dan McKee’s budget proposal said the previous estimate for the savings the state would receive from getting Eleanor Slater back into Medicaid would be about $10 million.
The future of Eleanor Slater Hospital, sometimes called the “hospital of last resort” in the state, is now the subject of scrutiny from unions, local politicians, and advocates for patients there.
The state wants to build a new facility at the site in Burrillville, called the Zambarano unit, for $65 million. That would convert the hospital there to a skilled nursing facility. The state also wants to close buildings on the Cranston campus. Those proposals have encountered pushback.
Across the Eleanor Slater system, patients at the facilities include people on ventilators, gunshot victims, people who have overdosed, and people with long-term mental health challenges. People involved in the criminal justice system live at a facility in Cranston, which would stay open under the state’s plan.
Discharges of patients from the facilities have led to concerns from patients’ families and their advocates. Kathryn Power, the director of the Department of Behavioral Health, Developmental Disabilities and Hospitals, said at a lengthy Senate oversight hearing earlier this week that the state’s only goal in discharging patients was to move them into the least-restrictive environment possible. That’s not only the law, it’s what’s in the patients’ best interests, Power said.
Some advocates for people with disabilities and mental health challenges, though, say the health care system in Rhode Island gives people nowhere else to go.
A recent fire marshal inspection at the Zambarano led to the closure of some kitchen functions, which has limited the menu for patients there. One patient shared with the Globe the new food ordering form, with some typical options crossed out and others labeled “N/A,” for “not available.” The state said Wednesday it was aiming to have the kitchen back to full operations in a week.