Even if Riverview Psychiatric Center in Augusta successfully regains federal approval and the millions in funding that go with it, the steps needed to complete that process could take several months and cost Maine millions of dollars in additional lost revenue.

That’s because Riverview is back at the start line in its quest to be re-certified by the federal government. The hospital not only has to show that it corrected old problems, but must prove that overall operations are sound, as a new hospital would. The clock is ticking, and time is costing the state money.

The center is not permitted to use federal money while it is operating without that seal of approval, federal officials say, though the state has been drawing down federal money anyway over the past year. Last week, an official with the U.S. Centers for Medicare and Medicaid Services told the Press Herald that all of the federal money accessed by the state since September would have to be paid back. Estimates vary on how much the state owes, but through June 30 the total was $11 million to $17 million, based on statements by federal and state officials.

And it’s not only back money that the state will owe. The facility can’t use federal money until it proves it can operate with minimum health and safety standards in place and is re-certified. That could take months or close to a year, depending on how quickly federal officials respond and whether the problems have been resolved.

In September, Riverview lost its good standing for a number of reasons, including incidents when sheriff’s deputies used stun guns and handcuffs on patients. An administrative law judge rejected the state’s first appeal of the decertification in January, although the state is appealing again.

Meanwhile, federal officials continue to find fault with Riverview’s operations.

Riverview received another setback in June when the center failed an “initial survey” by federal officials – one of the first hurdles the hospital needed to clear on the path to re-certification. The June report highlighted serious problems at Riverview, including improper admission procedures, medication errors, poor record-keeping, failure to track patient progress and treatment errors.

“Our treatment plans are just horrible,” a Riverview employee told inspectors during a May visit.

John Martins, Maine Department of Health and Human Services spokesman, wrote in an email response to questions on Monday that the center has already submitted another certification application to the Centers for Medicare and Medicaid Services, and is working to resolve the issues noted in the June report. Martins wrote that Riverview has a new system for documenting patient treatment plans and is working to better track patient progress.

Martins also said that “CMS sets its own schedule. We are estimating that CMS will be back this fall.”

However, after Riverview was decertified in September, it took federal officials eight months to conduct the “initial survey” inspection that Riverview failed this year. Courtney Jenkins, the agency’s regional spokeswoman, said there’s no timetable for another inspection.

Riverview’s 92-person patient population is split almost in half between forensic patients – those who were sent to the facility from a criminal court sentencing – and civil patients.

Jenna Mehnert, executive director for the Maine chapter of the National Alliance on Mental Illness, said that the state should have a “strong sense of urgency” to regain good standing with the federal government.

“This should not be a someday thing,” Mehnert said.

Mehnert said it’s not only a question of funding, but of family members feeling comfortable sending their loved ones to be treated at Riverview.

“You can’t compromise on basic standards,” she said. “There needs to be some assurance that when they go there they are going to get good help and treatment.”

Rep. Drew Gattine, D-Westbrook, said he’s concerned that Riverview continues to fall short.

“These are minimum standards. They should not be that hard to meet,” Gattine said.