The Montana State Hospital is set to lose its federal reimbursement funding on Tuesday after repeated failures to meet standard health and safety conditions, the Centers for Medicare and Medicaid Services said in a letter to the state on Friday.
The letter does not say how much money the state hospital will no longer receive once the federal government stops payment for services provided to Medicare and Medicaid patients.
There were 142 patients in the main hospital as of April 4, though it’s not clear how many patients are insured by Medicare and Medicaid.
“It took many years for MSH to get to this point, and it’s going to take significant time to truly fix the problem,” state health department director Adam Meier said in an emailed statement late Sunday. “DPHHS continues to reevaluate Montana’s behavioral health system and ensure MSH is operating in a more productive, safe, efficient and effective manner.”
In February, federal inspectors put the state hospital on “immediate jeopardy” status for patient safety issues, such as operating without an infection control plan while a COVID-19 outbreak whipped through the facility, killing three patients. The hospital was also cited for not preventing patient falls — one woman died Jan. 30 after suffering a hard fall from her wheelchair; it was the 13th time she had fallen in two months.
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CMS had initially given the state hospital until March 13 to correct the issues that led to the immediate jeopardy designation, and, after the hospital had given assurances to meet those conditions, the federal agency gave the hospital an extension and additional conditions to meet. No date was ever assigned to the extension, but the concession was provided to the hospital due to its nature as a “safety net” for dementia patients who have no other place to go.
In March, hospital staff said a patient was life-flighted to a Missoula hospital after being attacked by another patient in one of the facility’s intake units. The Montana Department of Public Health and Human Services, which oversees the state hospital, confirmed the attack had drawn federal inspectors back to the facility again for another inspection.
No further information has been released about the attack, and CMS made no mention of it in Friday’s letter.
How much the Montana State Hospital relies on these federal reimbursement dollars to operate was not immediately clear Sunday. The hospital is already $7 million over budget, largely due to the paying inflated wages to contract staff to fill the gaps left by permanent workers, DPHHS said in March.
The state psychiatric hospital has been in anguish in recent months as long-term staff departed their careers in Warm Springs over “dismal” working conditions and what they referred to as an unresponsive hospital administration.
In an interview Sunday, Bernadette Franks-Ongoy, executive director of Disability Rights Montana, said her organization would do “everything in its power” to ensure patients who may have to relocate to other care settings due to the loss of funding at Montana State Hospital will get the help they need.
DRM is a federally mandated advocacy group.
“I think the state had the opportunity to prevent this from happening,” Franks-Ongoy said. “I don’t think they operated quick enough and in the best interest of the patients of the hospital and its employees.”
Friday’s letter included information for Montana State Hospital administration to assist with relocating patients. However, Franks-Ongoy said Sunday the letter does not explicitly tell the hospital to begin relocating patients.
DPHHS had sought and received applications for a contractor to move in and take over management of its facilities, with a focus on the state hospital. That contractor was originally intended to begin work in mid-February, although the state review process pushed the start date back. In a mid-March email, a department spokesperson said DPHHS had selected a vendor and the contract was being finalized.
“DPHHS has retained experts to address the immediate issues at MSH raised by CMS,” Meier said in a statement. “These efforts are ongoing and the department is making considerable progress. MSH will also benefit from the outside expertise obtained through an (request for proposals from a contractor) to conduct a comprehensive assessment of all DPHHS-operated health care facilities and develop a strategic plan to enhance quality of care and improve operations.”
An interim legislative panel that oversees the state hospital called an emergency meeting in February after the initial “immediate jeopardy” designations to request answers from the state on the hospital’s situation. Lawmakers from both parties agreed to move forward with developing legislation to ease the burden at the hospital by finding community placements for dementia patients, whose acute needs have forced staff to develop care plans for a population that, by the hospital’s own policy, were not meant to be housed there.
Rep. Mary Caferro, a Democrat from Helena on the committee, had also made a motion for the committee to issue a letter to Gov. Greg Gianforte’s administration, urging his office to release additional funding from federal COVID aid to keep staff on board and to send in the National Guard to handle low-level work. Republicans, believing the administration would appropriately attend to the situation at the state hospital, voted against sending the letter, and the motion failed.
“The Democrats have tried and tried and tried to get laser-focused on this issue, to use (American Rescue Plan Act) funds or any other funds possible to correct the problem and protect and keep the patients safe,” Caferro said Sunday. “Every step of the way we have run into roadblocks.”
Meier said in Sunday’s statement the administration was working “diligently” to address issues at the state hospital.
“I want to be clear that our commitment to serving the patients at Montana State Hospital now and reforming the facility for future generations has never been stronger,” Meier said. “The struggles at MSH have existed and remained unaddressed for far too long, spanning multiple governors. As I have said before, we must approach MSH comprehensively, strategically, and in a data-informed manner. There are no quick fixes for what MSH is currently facing.”
Current and former employees began raising the alarm late last year about the conditions at the hospital, citing an unqualified and unresponsive workforce as the driver of the fast-moving staff exodus. Employees have attended legislative hearings in recent months to urge lawmakers to get involved before more patients and employees were injured due to low staffing levels.
Hope Hollingsworth is a traveling nurse who was one of the first to raise the alarm publicly about the state hospital administration and the working conditions there. She has since left the facility.
“I do not find this development surprising, and I feel certain CMS did not arrive at this decision without thoroughly examining every alternative since MSH is a safety-net facility,” Hollingsworth said in a text late Sunday. “I remain optimistic, however, that this grim outcome was necessary to mobilize stakeholders to make the hospital a functioning and therapeutic facility the state can be proud of.”
The letter noted payments may continue for 30 calendar days for patients admitted on or before April 11.