Lawmakers get update on status of Riverview

Matthew Stone/Bangor Daily News

Maine Department of Health and Human Services Commissioner Mary Mayhew in August discusses the state's request to the federal government to reduce Medicaid coverage.

AUGUSTA — Lawmakers on the Legislature's Health and Human Services Committee on Tuesday were updated on the status of the state's embattled Riverview Psychiatric Center.

The state's only "forensic" hospital that houses people with violent mental illnesses has for months been under the scrutiny of the federal Centers for Medicare and Medicaid Services.

The hospital is required by state law to accept people from the criminal justice system who are too dangerous to themselves or others to be safely housed in a jail or prison.

The hospital also has beds for patients who are committed to the system via a civil court process. But Maine Department of Health and Human Services Commissioner Mary Mayhew told lawmakers Tuesday that the hospital was deferring requests for civil bed space to the state's other private facilities.

The hospital already houses 52 so-called "forensic" patients who have been sent to the facility from the courts or prison system. Another 22 are at Riverview from the civil side, Mayhew said.

The hospital learned recently that changes it made in an effort to keep about $20 million in federal funding did not go far enough.

A move that created a 20-bed segregated unit, which is ineligible for federal funding because of the presence of Department of Corrections officers, is a concern for the Centers for Medicare and Medicaid Services because the hospital "commingles" staff between the certified and decertified units, Mayhew said.

The issues with underlying safety concerns at the hospital that emerged in March after a patient attacked and seriously injured a health care worker mostly have been addressed, Mayhew said.

She told the committee the state was appealing the CMS decision to make the entire hospital ineligible for federal funds while it was making changes and reapplying for federal certification.

Lawmakers and Gov. Paul LePage attempted to address some of the federal government's underlying concerns with legislation passed in September that expanded capacity and treatment staff for a mental health ward at the Maine State Prison in Warren. The expansion of the prison's mental health ward to 30 beds is expected to relieve some of the demand for beds at Riverview.

But under the new law, individuals found either not criminally responsible for their actions by the courts or those determined to be incompetent to stand trial would remain at Riverview.

The committee also learned more details from Mayhew and Riverview Superintendent Mary Louise McEwen about efforts to re-establish federal certification for the entire hospital.

Efforts are ongoing to improve staff training and pay as an eventual means toward eliminating the need for corrections officers at Riverview.

McEwen said they are focusing first on the currently decertified unit because it's the most pressing need.

Changes at the hospital might include the full-time staffing of a Capitol Police resource officer at the hospital, McEwen said. 

Capitol Police, a fully certified division of the Maine Department of Public Safety, is tasked with providing security and law enforcement for state-owned facilities in Augusta. 

The Riverview resource officers would not be stationed in a treatment unit but would be able to quickly respond to emergencies anywhere in the hospital, Mayhew said.

Those officers would also help provide security checks and screening of visitors while working to correct safety risks. The officer would conduct criminal investigations stemming from incidents at the hospital.

McEwen told the committee Tuesday that about 95 percent of Capitol Police criminal investigations originate at Riverview.

Sen. Margaret Craven, D-Lewiston, asked about ongoing efforts to increase pay for registered nurses and psychologists at the facility in an effort to improve staff retention and recruitment. 

Mayhew and McEwen said efforts were underway between the various employee unions and the Maine Department of Administration and Financial Affairs to ensure the pay scales were being adjusted upward. 

The hospital also is looking at ways to bring additional staff on board via other agencies that can provide trained staffing, McEwen.

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JOHN PAINTER's picture

It's not about the money, or is it?

While Commissioner Mayhew is certainly correct that CMS is concerned that staff are co-mingled between the certified, and decertified unit the hospital created, she also misses the other concerns CMS is raising in their response.

One of the core issues CMS undoubtably has with Maine's plan to address people being hurt in a hospital that was receiving federal Disproportionate Share Hospital (DSH) funds, was to decertify the unit where staff and patients were harmed so that CMS wouldn't have oversight of the conditions which are causing people to be harmed.

Another factor CMS is likely interested in is just how Maine uses/misuses DSH funds since Maine is just one of several states which use DSH funds exclusively for psychiatric hospitals which tend to have a high volume of Medicaid (MainCare) patients. This may be a matter of interest CMS has since it has already identified some systemic problems in Maine and might be questioning whether Maine is really target all or even most of its DSH funds (and federal match) on those hospitals as it should, or using the money for other purposes. A $20 million litmus test?

Another issue, one Maine (and other states not expanding Medicaid) should be paying attention to is the reduction in DSH funds as part of the Affordable Care Act (ACA). The ACA has a built in gradual but significant reduction in DSH payments, this will happen because as more people are covered by their own insurance less DSH funds will be necessary to cover unpaid expenses/charity care.

While I agree with Senator Craven's concerns that you get what you pay for, resolution to Riverview Hospitals problems are more closely tied to essential culture change and in treatment modalities used at Riverview not spending more money.

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