PROVIDENCE, R.I. (WPRI) – The R.I. Health Services Council has approved a plan to create a standalone psychiatric facility in Cranston, granting a key regulatory victory to the state agency overseeing Eleanor Slater Hospital.
The R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals – or BHDDH, which runs the publicly funded hospital – presented a plan to carve out an existing 52-bed psychiatric facility and name it the “Rhode Island State Psychiatric Hospital.”
“This is really a once-in-a-generation opportunity for Rhode Island,” Health Services Council Chairperson Victoria Almeida said in explaining her support of the proposal.
Under the plan, Eleanor Slater’s existing Benton unit – which already serves psychiatric patients ordered into the state-run hospital via the courts system – would be relicensed as the new standalone facility. BHDDH Director Richard Charest successfully made the case that the cost of operating the new facility – about $30 million per year – would be roughly the same as the current cost of operating Benton.
The only addition, he added, would be new executive staff to run the standalone facility. The jobs must receive General Assembly approval, and are included in Gov. Dan McKee’s proposed 2022-23 state budget.
“The employees who currently work at the Benton facility will continue to work at the Benton facility,” he told the council. “I don’t imagine any more staff than what we have today.”
State officials decided to pursue the model of creating a standalone psychiatric hospital – which is already used in every other state in the nation – beginning last year after a long-term failure to comply with federal regulations cost state taxpayers tens of millions of dollars.
To qualify for federal funding for hospital services, Eleanor Slater must maintain more medical patients than psychiatric patients. The rule is known as the Institution of Mental Diseases exemption, or the “IMD mix,” and the hospital has exceeded the ratio multiple times in recent years.
Eleanor Slater, comprising Zambarano in Burrillville and three units in Cranston, currently provides behavioral, psychiatric and long-term care to about 200 patients. The annual cost per patient is upward of $500,000, with some estimating the cost is on track to balloon above $700,000.
For years, the federal government footed about half the cost of those operations. But the state stopped billing the federal government in 2019 after a group of state workers raised compliance concerns internally. Meanwhile, the demand for psychiatric services has soared, especially among court-ordered patients, also known as “forensic patients.”
“The continuous growth of the court ordered forensic psychiatric patients has resulted in the hospital’s failure to adhere to said ratio and therefore the hospital has become ineligible for federal matching funds,” state officials wrote in their proposal. “The lack of reimbursement has resulted in a significant financial burden to the state.”
The state must cover the lion’s share of costs at the hospital when its IMD mix goes too high. According to a Target 12 analysis of data presented by Charest to the Health Services Council, the state would miss out on about $40.8 million in federal support over the course of a single non-compliant year.
By removing 52 psychiatric patients from the broader Eleanor Slater umbrella, however, Charest argued that it would be far easier for the rest of the state-run hospital to comply with the IMD mix requirement.
Rhode Island Mental Health Advocate Megan Clingham, who attended the Health Services Council hearing, said she was in support of the plan. But she questioned whether the beds at Benton would be sufficient considering the nationwide rise in demand for mental-health services.
“Is 52 beds enough capacity for these patients?” she asked.
Charest acknowledged the rising demand, but said he thought the new Benton hospital would be sufficient for the purposes of resolving the IMD mix and other regulatory challenges, including approval from The Joint Commission, a national accrediting nonprofit. The director said Benton should “fare well” under Joint Commission scrutiny, but that he’s “less confident about other buildings.”
Charest also said the state is working toward creating an outpatient clinic to treat misdemeanor criminal charges involving offenders who are denied bail due to mental health issues. In a pinch, he added, the hospital could always come back to the council and ask for more beds.
“At this moment, we’re not quite ready for that,” he said.
The council’s decision will now go to Dr. James McDonald, interim director of the R.I. Department of Health, for final approval. He is expected to sign off on the plan.