CRANSTON, R.I. (WPRI) — The state agency that oversees Eleanor Slater Hospital on Tuesday announced a plan to seek a new license for a standalone psychiatric hospital, a long-anticipated move that could potentially alleviate some of the regulatory and financial headaches that have plagued the facility for years.
The R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals said it would seek the new license in an effort to separate out Eleanor Slater’s Benton facility in Cranston. If approved, Benton would become a 52-bed standalone psychiatric hospital for so-called “forensic patients,” the term for people ordered into the hospital, typically through the criminal court system.
Eleanor Slater’s other units — including Zambarano in Burrillville — would continue under its existing license as a long-term acute care hospital, according to state officials.
“This is an important step for Eleanor Slater Hospital,” BHDDH Director Richard Charest said in a statement. “We know that Rhode Island has to treat its forensic patients, and we know the state needs a long-term acute care hospital, so it is important that we find a model that best serves patients while maximizing opportunities with our federal partners.”
Benton already serves as a de facto mental-health facility for forensic patients, but it’s technically licensed under the broader umbrella of Eleanor Slater.
Rhode Island is the only state in the country with no state-run standalone psychiatric hospital.
The existing licensing structure for Eleanor Slater has for decades allowed Rhode Island to seek tens of millions of dollars in annual federal Medicaid reimbursements for the hospital because of its medical patients, helping to offset the high cost of care associated with psychiatric patients, who are ineligible for federal support.
But that funding scheme blew up in 2019 after multiple state workers raised concerns that the hospital was in violation of several federal requirements, including one that mandates the hospital must always have more medical patients than psychiatric patients to remain in compliance with Medicaid rules.
That requirement — known as the Institutions for Mental Disease, or IMD, exclusion — has since cost the state tens of millions of dollars. The state currently remains out of compliance with the IMD rule, which will be reviewed again next month.
By creating a standalone psychiatric hospital, Eleanor Slater could likely avoid violating the IMD in the future, since forensic patients would no longer be counted as part of the hospital’s overall patient mix.
State officials also argue the new license could help with accreditation, as The Joint Commission would no longer survey conditions at Benton in reviewing the long-term acute care hospital. The national agency has threatened to revoke the hospital’s accreditation the last two times it surveyed Eleanor Slater, in 2017 and this year, and Benton has been cited for a variety of problems.
“By doing this, we provide the best-possible care to patients while also being fiscally responsible to the taxpayers,” Charest said.
The proposal could pose new financial challenges, however. Rhode Island taxpayers will likely have to foot the entire bill of a standalone psychiatric hospital without much federal support. It’s also unclear how having two separate facilities might affect overhead costs, and the unions that staff those facilities may also push back to ensure their livelihoods are not disrupted by the change.
Obtaining a new license also requires clearing a series of regulatory hurdles, beginning with a Certificate of Need application to relicense Benton that BHDDH will need to submit to the R.I. Department of Health. The state agency laid out a plan to first submit a letter of intent to the Health Department by Friday, followed by the full application in January.
“They would eventually present the proposal to the Health Services Council,” Health Department spokesperson Joseph Wendelken said in an email.
The major areas of review include looking at the track record of the applicant, whether there is a public need for the facility, financial implications and how it would affect health disparities, Wendelken explained.
“The Council makes a recommendation to the Director of Health, who makes the final decision,” he added.
The idea of relicensing Benton as a standalone psychiatric facility has been discussed for years, emerging as a proposal in a litany of reviews that have been commissioned to examine the facility. The latest came from Health and Human Services Secretary Womazetta Jones, who issued a report earlier this year saying the licensing needed to be reviewed.
“We knew that it was important for BHDDH to reevaluate Eleanor Slater Hospital’s licensing, and by investigating licensing options, the Department has identified an important step to be taken as we move forward,” Jones said in a statement. “I am pleased with the work that has been done on this issue and I look forward to more progress.”