PROVIDENCE, R.I. (WPRI) — Rhode Island lawmakers grilled state leaders Thursday over ongoing money woes and an unusually skewed patient mix at Eleanor Slater Hospital, the state-run medical facility that hasn’t billed the federal government for health care services since August 2019.
Senate Finance Committee members expressed clear frustration with Health and Human Services Secretary Womazetta Jones and members of her department that oversee Eleanor Slater. The senators chastised them for still not having a handle on the hospital’s financial and patient-mix issues more than 18 months after it first became a problem.
“In almost a two-year period, we have been going ’round and ’round on this issue,” Finance Chairman Ryan Pearson, a Cumberland Democrat, said during a hearing that lasted several hours.
Rhode Island stopped billing the U.S. Centers for Medicare and Medicaid Services (CMS) for hospital services at Slater in 2019 after concerns were raised that the state wasn’t in compliance with federal regulations requiring the hospital to have more medical patients than psychiatric patients, among other things.
Fast forward to May 2021, and the state still hasn’t started billing again, a dynamic further complicated by a new report that suggests the hospital has far more psychiatric patients than medical patients.
The lack of federal reimbursements — once a steady and consistent stream of funding for the state — has cost Rhode Island more than $100 million in state money over the last two fiscal years. Pearson said the shortfall has required the legislature to continually “alter our budgets by tens of millions of dollars.”
“From an accountability standpoint, from my eyes, this sits with the secretariat’s office,” Pearson said to Jones, whose office has overseen Eleanor Slater and its parent agency during the time period in question. “Roles and responsibilities and accountability start right from the top.”
Jones said she would not dodge responsibility and explained to lawmakers the chain of events that led to the financial and operational quagmire surrounding Eleanor Slater today. After billing stopped in 2019, Jones explained, the state submitted an amended plan within a few months to the federal government that redefined what was and was not allowed in terms of reimbursements.
But CMS didn’t end up approving that plan for more than a year, which was much longer than state officials expected, she said. Finally in March, the federal government approved the revised billing plan, suggesting Rhode Island would get to recoup a significant amount of money retroactively, and Gov. Dan McKee’s office announced an initial plan to bill CMS for nearly $10 million.
But the billing was put on hold again after Eleanor Slater staff raised compliance concerns similar to the ones highlighted in 2019. Meanwhile, a separate report came out showing that the mix between medical patients and psychiatric patients had fallen rapidly out-of-whack, raising eyebrows among lawmakers.
“The patients have been there for decades,” Sen. Lou DiPalma, D-Middletown, said during the hearing. “Yes, their diagnosis might change over time. But I suspect it doesn’t change that much [so quickly].”
As Target 12 first reported earlier this month, the hospital in December reported 50% of its patients were psychiatric and 50% of its patients were medical, meaning the state was just barely in compliance with the federal law known as the Institutes for Mental Disease (IMD) exclusion.
By May, the share of psychiatric patients soared to 79%, according to a report that’s now done twice per year.
“What changed?” Pearson asked.
“I don’t know,” state Medicaid director Ben Shaffer responded, adding that he had some theories, but that he didn’t want to guess.
Instead, he noted the state is in the process of hiring an outside consultant to review the hospital’s IMD reporting, both in May and twice during 2020.
“Certainly, I agree and lament that this has taken so long with the many twists and turns,” Shaffer said.
Jones did not offer an explanation for why the patient mix had become skewed so quickly, but she agreed that the sudden shift begged more questions.
“That’s the primary reason why we are engaging in a third-party review,” Jones said.
Sen. Jessica de la Cruz, R-Burrillville, likewise scrutinized why so many patients at Zambarano — a hospital unit in her district — could have suddenly been designated psychiatric when the facility hadn’t recorded any new admissions since last year. She also asked if people would be held accountable if it turned out that anyone was manipulating medical or reporting records.
“If it’s found that the behaviors or accusations were false and or attributed to an ulterior motive, of course they are going to be held accountable,” Jones said.
DiPalma — who has clashed with Jones over access to legal documents tied to the hospital and its patient mix — criticized the administration for not making available the hospital’s chief medical officer and chief financial officer to answer questions about what was happening at the hospital.
He suggested they could have easily responded to many of unanswered questions raised during the hearing. Jones said she brought the people she thought would be in the best position to answer the committee’s inquiries.
The state hospital system, which provides psychiatric and medical care through Zambarano and three more units in Cranston, has dominated headlines for issues related to finances, workforce and building conditions. R.I. Attorney General Peter Neronha is investigating the hospital, examining issues related to patient care and finances, and legislative oversight committees are leading separate inquiries into the various problems.
McKee on Wednesday nominated Richard Charest to become the next director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, which oversees Eleanor Slater.
Charest, the retired longtime executive of Landmark Medical Center, will take over for Jones who had been serving in the position in an interim capacity since April. His biggest challenge will likely be to bring some stability to Eleanor Slater, though already at least one House lawmaker has raised issue with the nomination.
Pearson remains concerned about the department’s overall inability to solve its underlying financial and operational issues. And it appears his patience is running thin.
“We have given you plenty of room over the course of two years to get your hands around this and we haven’t been able to do it,” he said. “I don’t understand why.”