Riverview and Federal shutdown

Dear House Democrats,

This morning the Appropriations and Health and Human Services committees met to have a discussion with Mary Mayhew, Commissioner, Department of Health and Human Services about Riverview Psychiatric Center’s recent loss of federal funding for its operation.

Later discussion turned to the impact of the federal shutdown on Maine and it’s workforce. H. Sawin Millett, Commissioner, Department of Administrative and Financial Services was part of this conversation.

Chair Rotundo opened the meeting by stressing the Legislature’s eagerness to exercise its oversight responsibilities and to be a willing partner in finding solutions to challenges. She also expressed everyone’s frustration that communication has been poor and information unavailable and the impact this has on our exercise of oversight and collaboration.

 

Commissioner Mayhew reviewed the events leading to the loss of federal certification for Riverview and her view of the CMS decision.

It is the Department’s belief that the decision is not grounded in CMS’s own rules. The Department plans to appeal the decision and to apply for recertification.

It is the Department’s view that the remaining issues are those of staffing. The Commissioner believes that the quality issues have been addressed.

Ken Albert, Director of the Division of Licensing and Regulatory Services (DLRS), the state agency that serves as the CMS contractor for surveys and inspections of Riverview and other facilities testified that his staff did not find that Riverview’s conditions merited a loss of certification. However, in what he termed an unusual move, the embedded CMS investigators submitted recommendations that certification be terminated. This recommendation was the one accepted.

 

Mr. Albert also shared his belief that CMS changed their view of what constitutes a “distinct part unit”, what LD 1515 created at Riverview. Rep. Carey challenged this interpretation noting that communications in August highlighted the need for separate staffing for both units. He was especially firm on the need for adequate staffing and compensation. The Commissioner disagrees that there are too few staff.

Pressed by Rep. Rotundo to share her long term vision for Riverview the Commissioner spoke about efforts to foster culture and structural changes at the hospital.

Mr. Albert revealed that he was aware of specific language in the letter from CMS a week prior to the existence of the letter being revealed.

Mr. Albert testified that he viewed his office’s relationship with CMS as collaborative up until the unannounced visit in late September. The committees then received a copy of a letter by Mr. Albert to CMS regional staff in mid August outlining a dispute between DLRS and CMS that speaks specifically to a CMS concern that DLRS should “…monitor any bias it may have related to Riverview.”

The Commissioner intimated that there were concerns expressed by staff that the CMS decision was preordained.

 

Some Questions Asked of Commissioner Mayhew, October 9, 2013

 

  1. Do you anticipate a successful appeal leading to reimbursement retroactive to Sept. 2, 2013? Patients in care on September 2 remain eligible for reimbursement. Those admitted after September 2 will not receive reimbursement from at least some federal sources. Counsel has verbally indicated to the Commissioner that retroactive reimbursement is possible.
  2. What is the anticipated impact on patient and staff care and safety? Admissions will likely need to be directed elsewhere.
  3. Are there plans to discharge patients? No patients have been moved at this time.
  4. We have heard a cost of $20M, is this just Medicare reimbursement or is it also DSH? The vast majority of this funding is Disproportionate Share funding. 
  5. What are the costs of making the staffing and equipment changes required by CMS? The Department did not share this information.
  6. Is CMS’s concern one of separate staff or of clearly delineated reimbursement? This is disputed.
  7. Is DDPC currently certified?  What capacity does DDPC have to receive either forensic or non-forensic patients? There is no plan to move patients at this time.
  8. What is the time frame for an appeal like this? Hospitals being placed on a termination track is not unheard of nationally, though Maine has little experience with this situation. Hospitals that are terminated are typically recertified within 6 months.
  9. What is the timeline for a recertification, presuming a functioning federal government? The Department intends to submit its appeal today. The process could happen relatively quickly, in a months time, presuming a functioning federal government.  

After a brief break the Appropriations committee was joined by Commissioner Millett for information and a discussion on the impact of the federal shutdown

The Commissioner used a few words to characterize the atmosphere around the shutdown:

  •  Uncertainty
  • Complexity
  • Fluidity 

 He shared documents with the committee that address determinations of which federally funded state employees can and should continue to work and which positions will receive reimbursement or back pay.

OMB guidance

Governor’s memo to Commissioners

The three most impacted Departments are:

 

  • Veterans and Emergency Management (44- now back to work)
  • Health and Human Services (56)
  • Labor (3)

 

All layoffs at this time are 3 day layoffs. 10 day layoffs begin a process of “bumping” and are quite complex. The Administration has chosen to limit the search for funding to this quarter.

Rep. Carey raised a September 25, 2013 letter from the Social Security Administration that appears to guarantee federal reimbursement for 52 of the HHS employees noted above that provide disability determination services.

 SSA letter

Commissioner Millett is of the opinion that the administration cannot identify state funds to cover the federal funds in the short term.

Appropriations meets again on November 17th for a regularly scheduled meeting.

 

Please let me know if you have any questions,

 

Mark

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