October 3, 2013

Feds pull estimated $20 million in Riverview funding

Maine DHHS Commissioner Mary Mayhew says the state will appeal the decision

By Steve Mistler smistler@pressherald.com
State House Bureau

The state’s Riverview Psychiatric Center faces the loss of an estimated $20 million in federal funding because the federal government has decided that the hospital in Augusta has not solved staffing and governance problems.

The state will appeal the decision, Health and Human Services Commissioner Mary Mayhew said.

The federal Centers for Medicare and Medicaid Services made the decision to terminate Riverview’s funding after finding in two surveys that the hospital did not comply with federal guidelines.

The funding represents more than half of the hospital’s $36 million annual operating budget. If the state’s appeal fails, Maine taxpayers may have to fund the services at the hospital, or Riverview may have to scale back its operations.

In August, the situation prompted the Legislature to pass an emergency bill that allowed the hospital to send some patients to the Maine State Prison in Warren. Lawmakers and the administration viewed the measure, which will cost $3 million a year, as a small fix for lingering problems.

Mayhew said in August that she was confident the state’s broader remediation plan for the hospital would be accepted by the federal government.

On Wednesday, however, the Department of Health and Human Services received notice that the federal government will eliminate funding for Riverview. Mayhew, expressing disappointment, said the decision wasn’t justified by the violations cited by federal auditors.

“The decision made by the CMS to terminate simply does not pass the straight-face test,” she said in a prepared statement. “This inappropriate and unwarranted action jeopardizes access to vital psychiatric services for no reason and I am confident we will win our appeal.”

A spokeswoman for the Centers for Medicare and Medicaid Services in Boston did not respond to a request for comment. An automated message said she was unavailable because of the partial shutdown of the federal government.

In a letter to the state dated Sept. 27, the agency wrote that the funding was terminated because Riverview had not substantially corrected problems that included record-keeping deficiencies and assignments of staff members to multiple wards at the hospital.

The state has submitted several correction plans since inspections of the facility in March and May. In August, Mary Louise McEwen, Riverview’s superintendent, told the Portland Press Herald that the hospital was working with federal authorities and she was confident that a remediation plan would be accepted.

On Aug. 30, the Centers for Medicare and Medicaid Services notified the state that it had accepted Riverview’s correction plan pending a final on-site audit. The termination notice followed an unannounced visit Sept. 17 by federal auditors, who found ongoing deficiencies and outlined them in a 16-page report.

“We have taken significant steps to address these most critical issues around patient safety, staff safety, quality and well-documented treatment plans,” McEwen said in a prepared statement Thursday. “The remaining issues do not rise to a level of severity that warrants termination. Most are easily addressed and in one case, we are being held to a standard that we cannot find in the rules that govern participation in the Medicare program.”

Crossing boundaries

The federal audit originally found safety issues at Riverview. The hospital tried to correct the problem when it de-certified 20 beds in its Lower Saco Unit. That exempted Riverview from federal standards while resulting in the loss of federal reimbursement for that unit.

The Lower Saco Unit segregates forensic patients from the rest of the hospital’s population. Forensic patients are those committed to state custody after being found not responsible for crimes, those who are being examined to determine their competency to stand trial, and those whom a judge has declared incompetent to stand trial and are being treated to restore their competency.

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