October 10, 2013

Funding loss for Maine psych center scrutinized

Lawmakers question Maine state officials, with one denying the federal government’s claims that his auditors were too lenient.

By Steve Mistler smistler@pressherald.com
Staff Writer

Federal officials questioned whether state auditors were biased in evaluating conditions and enforcing compliance issues at the Riverview Psychiatric Center before they decided to cut off $20 million in annual funding to the state hospital in Augusta.

click image to enlarge

Health and Human Services Commissioner Mary Mayhew listens to a question from a legislator Wednesday during a joint hearing of the Health and Human Services and Appropriations committees at the State House in Augusta about the potential loss of $20 million in federal funding for the state’s Riverview Psychiatric Center. 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 for staffing and governance.

Staff photo by Andy Molloy

click image to enlarge

This 2012 photo shows the Riverview Psychiatric Center in Augusta. Patient advocacy groups have often complained that staffing at Riverview is inadequate, particularly for forensic patients.

Staff photo by Joe Phelan

William Roberson, associate regional director for the federal Centers for Medicare and Medicaid Services, made those assertions during a conference call on Aug. 14. Last week, his agency stripped Riverview of its funding.

His assertions were fiercely disputed by Kenneth Albert, director of the Maine Division of Licensing and Regulatory Services, whose auditors paired with federal regulators to identify problems at the 92-bed hospital earlier this year.

The dispute – documented in a memo Aug. 15 from Albert to federal authorities – raised more questions about a crisis that is forcing state officials to assess their ability to take in new psychiatric patients, with the loss of over half of the hospital’s $36 million operating budget.

Members of the Legislature’s budget-writing committee hoped to answer those questions Wednesday when they got a briefing about Riverview from Health and Human Services Commissioner Mary Mayhew. But some Democrats on the panel left the meeting uncertain about the long-term prognosis for Riverview, which they said is plagued by understaffing and management issues.

Mayhew challenged that assessment during the long – and occasionally testy – briefing, saying the federal government’s decision was unrelated to safety, staffing or quality-of-care issues.

Rep. Mike Carey, D-Lewiston, cited a federal report that said Riverview was out of compliance because it had staff members tending to both civilian patients and forensic patients – those committed as part of criminal proceedings.

“It’s very simple,” Carey said after the briefing. “You can’t have one person doing two things. Hire another person. One does one job, the other does another job. It’s really basic. We haven’t heard that they understand that or that they’re going to fix it.”

Mayhew said the Centers for Medicare and Medicaid Services was concerned more about billing of staff hours because one set of patients qualifies for federal reimbursement and the other does not.

The different interpretations of what led the federal agency to find the hospital out of compliance – staffing or billing issues – emerged as the sticking point between Mayhew and Democratic lawmakers.

Republicans on the committee backed Mayhew, saying the federal government wrongly interpreted its guidelines or adjusted them as the state tried to comply.

“As long as quality of care and patient safety isn’t affected, you would think that CMS, in order to maintain quality of care for these patients, would keep the federal funding and just approve a plan of correction,” said Rep. Deborah Sanderson, R-Chelsea.

Albert, the director of the Division of Licensing and Regulatory Services, told lawmakers Wednesday that his auditors found compliance issues at Riverview, but none that would lead to the loss of funding.

Federal officials’ suggestion of bias by state auditors emerged when Albert’s Aug. 15 memo was made public at the meeting.

In his memo to Roberson, the federal agency’s regional director, Albert rebutted claims made during the conference call Aug. 14 that state auditors were biased and too lenient on Riverview.

Albert’s auditors were commissioned by the Centers for Medicare and Medicaid Services after an assault on March 16 in which a patient at Riverview allegedly attacked a mental health worker. While Albert and the state auditors work under the state Department of Health and Human Services, they are supposed to be independent when auditing for compliance with federal rules.

Albert wrote in his memo, “Your team has expressed, on more than one occasion, a concern and guidance that (DLRS) should carefully monitor any bias it may have related to Riverview, another state entity.”

(Continued on page 2)

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