PROVIDENCE – Eleanor Slater Hospital, the state-run hospital system for people with complex medical or psychiatric conditions, was able to fix a number of problems that federal regulators found over a series of visits in the past year.
That will allow them to continue to bill the federal government for care, a crucial part of the facility’s finances. The federal government had raised issues about infection control, records, fire safety, and patient rights, among other issues, an inquiry that was sparked by an eye-gouging incident. The issues were serious enough that the federal government had threatened to pull funding from the facility; with the issues resolved – by retraining staff, installing new exit signs, and by putting corrective action plans in place, among other steps – the hospital can continue billing Medicare.
But the hospital still hasn’t solved a related issue that continues to limit its finances: The number of psychiatric patients it cares for. Because of that, it still can’t bill the Medicaid program for certain patients, one of the main federal programs for reimbursement at the hospital. Medicare and Medicaid are federal health insurance programs that cover different patient populations. It also could face fresh regulatory scrutiny after a report of an alleged sexual assault of one patient by another patient at the Adolf Meyer building in Cranston late last month.
The state announced the resolution of the problems with the Centers for Medicare and Medicaid Services last month. This week it provided in more detail an update on the separate issue that still means it can’t bill for certain Medicaid patients, and its plans to fix it by this fall.
The Medicaid billing has been an off-and-on problem jeopardizing the finances at the hospital, which has been in violation of federal rules about having more psychiatric patients than medical patients, making it an “institution for mental disease,” or “IMD.” Because of that, it’s still ineligible to bill Medicaid for patients between age 21 and 64. The budget hole that causes stretches into the millions of dollars.
The hospital says it has a plan to fix that: Spinning off one unit, the Benton facility, into the new Rhode Island State Psychiatric Hospital. The Benton facility is the state’s forensic psychiatric facility, where patients who are involved in the criminal justice system, but have certain psychiatric conditions, are cared for instead of in prison. Some are awaiting possible trial and others have been found not guilty by reason of insanity. The new psychiatric hospital would operate under a separate license from the other units in Cranston and Burrillville, helping lower the ratio of psychiatric patients.
“As significant as resolving ESH’s IMD issue will be, the most significant accomplishment has been addressing the concerns raised by (the Centers for Medicare & Medicaid Services), the Joint Commission and the State Fire Marshal,” Randal Edgar, a spokesman for the department that runs Eleanor Slater Hospital, said in an email Thursday. “The CMS concerns could have jeopardized ESH’s ability to seek future federal reimbursements.”
The Adolf Meyer building, where the report of the alleged sexual assault emerged, was slated to close as part of a broader reorganization, which is still in the works, the department said.
Last year several top doctors left, raising concerns about the over-institutionalization of patients. Eleanor Slater Hospital is licensed as a long-term acute care hospital. Its patients have a range of conditions and needs, from intellectual and developmental disabilities, long-term injuries from car crashes, ALS, or mental illnesses. Some have spent decades there. Top officials, now gone, argued the hospital wasn’t actually providing acute-level care but instead warehousing people with social, not medical, problems. The department disputed that was the case.