AUGUSTA, Maine — An ongoing federal government shutdown is complicating Maine Department of Health and Human Services’ efforts to figure out what it needs to do to prevent the loss of nearly $20 million of federal funding for the state’s Riverview Psychiatric Center.
The 92-bed hospital, which houses some of the state’s most violent mental health patients, has been in the spotlight in recent months after attacks by patients against staff and each other prompted an unannounced federal inspection of the facility in March.
That audit, which determined the state was not compliant with federal rules it needs to follow in order to receive Medicaid and Medicare funding for patients at the facility, prompted the cut.
The proposed reduction amounts to about half of the hospital’s annual operating budget, and lawmakers tasked with crafting the state’s two-year budget said they’re concerned over what appears to be a huge new hole in the state’s budget.
In a nearly three-hour question-and-answer session Wednesday, Maine DHHS commissioner Mary Mayhew told members of the joint Appropriations and Health and Human Services committees her department was working on both appealing the proposed cut and developing a new corrective action plan to address the federal government’s latest concerns.
Mayhew said the state would also reapply for federal certification and would address the federal government’s new concerns in that application.
She said despite the federal government accepting a corrective action plan for the hospital on Aug. 30, a follow-up unannounced survey on Sept. 17 revealed new deficiencies, including the comingling of certain staff between two units at the hospital.
One of the units was newly created as a result of the March survey and is no longer eligible for federal funds because of the presence of guards from the Maine Department of Corrections. The guards were brought in to help maintain order and safety on the unit after a patient attacked a health care worker and seriously injured her earlier this year.
Mayhew said getting answers back from the federal government was difficult, given the federal offices the state works with on the issues have been temporarily closed due to the government shutdown.
News that the hospital was again on the federal chopping block came after lawmakers in September passed a bill during a special emergency session called by Gov. Paul LePage to address safety concerns at the hospital.
That law change, rather than bolster resources at Riverview, essentially laid the groundwork for a staff expansion of a mental health ward at the state prison in Warren. Lawmakers at the time were assured by Maine DHHS staff and Mayhew that the change would at least temporarily allay the federal government’s concerns over Riverview.
Lawmakers grilled Mayhew on Wednesday over what the state was doing and how much it was going to cost to fix the problems at Riverview.
Rep. Peggy Rotundo, D-Lewiston, House chairwoman of the Appropriations Committee, voiced frustration that DHHS had not been quickly forthcoming with information about problems at Riverview, which made it difficult for lawmakers to help solve them.
“Since March, I believe, the administration has known that funding for Riverview could be in jeopardy, but the Legislature was not informed until August,” Rotundo said. She said lawmakers were then told the bill to expand mental health services at the prison would correct those problems.
“And that we would be kept in the loop in terms of what was happening at Riverview,” Rotundo said. “But since then the Legislature was not informed that CMS had been to Riverview to do the survey.”
She said lawmakers learned through the media that “$20 million for Riverview was being terminated.”
Rotundo asked Mayhew to detail the state’s long- and short-term plans for fixing the problems at Riverview, which range from shortcomings in patient treatment plans to inadequate staffing levels as well as staff and patient safety concerns.
Rep. Mike Carey, D-Lewiston, a member of the Appropriations Committee, said after the meeting Mayhew provided a lot of details about the ongoing negotiations between the state and federal government over funding for the hospital but did not fully address Rotundo’s question about short- and long-term plans.
“She talked a lot about how the department was going to handle it, but not what the dates were, who’s responsible and how much money it was going to cost to fix the problems the federal government says Riverview has,” Carey said. “And it’s going to cost the state a lot of money.”
Mayhew countered that her department was passing along information as quickly as it could and, in the case of the latest federal notice that funding would be cut, lawmakers were notified within 24 hours of DHHS learning that information.
Mayhew also seemed frustrated that lawmakers were revisiting questions that had been addressed in previous meetings or with previous written materials that had been presented to the Legislature.
She also outlined a variety of actions she and Riverview staff had taken to research and develop a plan for the future, including reaching out to other states and mental health research experts.
Efforts to hire new staff and to increase the salaries of existing staff as a means of bolstering recruitment and retention of qualified and trained personnel were ongoing, but that process takes time.
She also said she believed the state would be able to work with the federal government to get to an agreement that allowed the federal funding to continue.
“It is unfortunate that we must continue to spend additional financial and staff resources to appeal the decision and reapply for certification,” Mayhew said. “I remain confident, however, that Riverview Psychiatric Center will be recertified by CMS and will receive necessary funding for critical psychiatric services for the people of the state of Maine.”
Mayhew also assured lawmakers that the initial concerns over staff and patient safety that had triggered federal scrutiny of the facility in March had been addressed and the new threat of a funding cut was the result of concerns unrelated to safety.
Rep. Deb Sanderson, R-Chelsea, said Mayhew appeared to be sharing all the information she could at this time regarding the ongoing problems with the Riverview. She also said there remained crossed communications between the state and the federal government.
“It’s very clear that though they are working from the same policy book, there is a severely different interpretation of what some of this stuff is meaning,” Sanderson said.
She also questioned whether the federal government had given the facility enough time to get up to speed on the new concerns in light of the recent decertification.
It was an issue that Mayhew also outlined, noting that quality improvements at any hospital were a constant process and she questioned why the federal government hadn’t offered to give the state an extension to meet its concerns before decertifying Riverview.
Mayhew also said she is not aware of any new serious safety concerns that had arisen since the last federal audit of the facility.
Following the meeting Wednesday, it remained unclear what the Legislature’s next steps would be.