Patient advocates fear the Montana State Hospital could crumble further as the state-run facility is set to lose federal funding for services starting Tuesday due to repeated defaults maintaining health and safety standards.
In interviews Monday, mental health professionals painted a grim picture of the availability of beds elsewhere in the state for patients who may have to leave the public hospital due to the loss of funding.
Due to the end of reimbursement for services by the federal Centers for Medicare and Medicaid for people covered by either of those insurance programs, state officials said Monday they are considering transfers for some patients. CMS will continue to make payments for 30 calendar days for patients admitted on or before April 11.
“The department is evaluating how the transfers may benefit certain patients,” department spokesman Jon Ebelt said in an email. Although termination does not require the transfer of patients, the state will no longer be paid by CMS for certain services it provides, those covered by Medicaid or Medicare.
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The governor’s office declined to make Gov. Greg Gianforte available for an interview Monday about the recent CMS advisory, but appears to remain optimistic about the future of the state psychiatric facility.
“Montana State Hospital faces longstanding challenges that have spanned the administrations of many governors,” the governor’s office said in a statement. “The governor is encouraged by DPHHS’ commitment to reforming the facility and ensuring there is no disruption to patient care.”
The loss of reimbursements will result in a reduction of about $7 million per year, the Montana Department of Public Health and Human Services said Monday. Ebelt said most psychiatric services at the public hospital, which had 142 patients on its main campus as of last week, are not reimbursable. Ebelt did not provide information on the number of patients insured by Medicare or Medicaid.
Ebelt did not immediately return an email asking how or if the state would cover the costs of the services once paid for by federal reimbursement dollars.
The installation was already $7 million over this fiscal year’s budget due to a growing reliance on more expensive contract staff as long-term employees left the facility, citing deteriorating working conditions and what they described as callous leadership.
The Legislature appropriates approximately $47 million annually from the state’s general fund to pay for state hospital operations. Ebelt said CMS’s annual $7 million in the past went to the state’s general fund.
When CMS notified the state last Friday that it would no longer reimburse services at the public hospital, the the facility had received four “immediate peril” designations since February. These designations have been placed on the installation to:
- failing to maintain an infection control plan during a deadly outbreak of COVID-19;
- failing to protect patients against falls, including one patient who died after several falls;
- not properly training employees on the use of psychotropic drugs.
After the first three results, CMS offered an extension for the public hospital to correct the shortcomings. But in late March, the federal agency issued another “immediate danger” finding after learning of a a patient had been seriously injured by another patient in one of the hospital’s admission units while both were unattended.
According to Friday’s letter from CMS, the hospital failed to ensure patients were free from abuse, and the attack resulted in “the patient suffering significant injuries which will require, among other things, reconstructive surgery.” .
After the fourth “immediate peril” finding, in addition to learning that the previous three issues had not been corrected, CMS withdrew its offer to extend to return to compliance and issued the notice of termination.
“Overall, Montana State Hospital continues to be non-compliant with Medicare’s participation requirements for hospitals,” said Friday’s letter to MSH Administrator Kyle Fouts. “As such, termination of the supplier contract is permitted under (federal law).”
Mary Windecker, executive director of the Behavioral Health Alliance of Montana, said Monday there are few options for the state to transfer patients to community placements.
As an example, she pointed to the number of children who must be sent out of state for treatment due to Montana’s lack of treatment beds for children who need acute mental health services.
“If the same problem is going to be true with adults as it is true with children, we’re looking at a huge amount of state money currently being taken from other programs because they’re going to have to fill in what Medicaid isn’t. ain’t it won’t cover,” Windecker said.
“There are no winners,” Windecker said of CMS’s announcement. “It’s just a really, really tough time for everyone in the mental health field.”
Democrats were furious Monday with what they called the Gianforte administration’s lack of urgency about the crisis at the public hospital.
“This goes far beyond politics – this is a crisis of leadership,” Sheila Hogan, executive director of the Montana Democratic Party, said in a press release. “This is not a problem that simply exists within the four walls of the public hospital. It has far-reaching implications for our most-at-risk patients, the Warm Springs and Anaconda workforce. , our already overburdened criminal justice system, and our community-based public safety across the state.
A spokesperson for Gianforte said Monday that the problems at Montana State Hospital were inherited from previous administrations. Fouts, the hospital administrator, was hired under Democratic Gov. Steve Bullock. Hogan was the director of DPHHS under Bullock.
But no one who spoke to the Montana State News Bureau for this story, including a recently deceased employee who had worked at the state hospital since 2002, could recall that the department had lost its funding agreement with CMS before that. When asked about this story if any state facility had ever lost CMS funding before, Ebelt said “DPHS cannot comment.”
The four preventable deaths and a fifth that the hospital failed to properly investigate occurred under the watch of the current administration.
When asked on Monday why Gianforte’s office did not act sooner on the public hospital’s issues, a spokesperson for the governor issued the following statement:
“Since the governor was briefed last year on the long-standing challenges at MHS, he has shared DPHHS’ commitment to reforming MHS and ensuring there is no disruption. patient care,” Brooke Stroyke said Monday. “After previous administrations ignored the issue, the governor is encouraged by his administration’s diligent work to address it.”
Windecker agreed that the state hospital has been in a “precarious balance” due to insufficient funding for decades, including the 2017 state budget cuts that ended case management in the communities. She said the house of cards was finally toppled by the COVID-19 pandemic, which sparked a nationwide workforce crisis and simultaneously caused mental health issues in communities.
“We got it on both sides and we were just unable to keep limping along, especially at the rates people were being paid,” Windecker said.
Earlier this year, DPHHS provided sweeping raises for some positions at the state hospital after initial “immediate risk” designations were put in place.
Bernadette Franks-Ongoy, executive director of the federally mandated advocacy group Disability Rights Montana, said a critical question is how the state will fund services in Warm Springs, not just for patients who need them. , but for employees whose livelihood depends on work. at the state hospital.
“It’s a big deal that this happened in the public hospital and those services are very expensive,” Franks-Ongoy said.
Ebelt said Monday that the state hospital will reapply for certification to receive federal reimbursement assistance again “when program ready.”
Once an application is submitted, MSH will need to successfully complete two investigations before becoming a certified facility again, Ebelt said.
In November, DPHHS issued a call for contractors to take over temporary executive management of its health care facilities. Ebelt said Monday that the state has officially entered into a contract with Alvarez & Marshal Public Sector Services, LLC.
The organization, whose website says it helps the public sector improve operations at lower cost, will conduct a comprehensive assessment of all health care facilities operated by DPHHS and develop a strategic plan to improve quality care and improve operations, Ebelt said.
DPHHS Director Adam Meier, when pressed by lawmakers at an emergency hearing earlier this year to identify solutions to the hospital’s problems, said he preferred a more approach. measured and data driven. He said future contract work would lay a stronger foundation for the hospital’s longevity than emotionally-driven actions.
On Sunday evening, a patient at Galen, the forensic unit at the state hospital complex where defendants are being held for evaluations, escaped from the facility, according to a report shared Monday with the Montana State News Bureau. . The report says the patient was found by security and returned to the facility around 1:10 a.m. Monday.
Ebelt said Monday afternoon the incident was being reviewed.