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RI poised to recoup millions after Medicaid billing approval at Eleanor Slater Hospital

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eleanor slater zambarano unit in burrillville_285879

PROVIDENCE, R.I. (WPRI) — The federal government on Thursday approved a state request to restart Medicaid billing at the embattled Eleanor Slater Hospital, positioning Rhode Island to recoup millions of dollars in state money spent on services during the past year.

The U.S. Centers for Medicare & Medicaid Services approved Rhode Island’s so-called “State Plan Amendment” submitted roughly one year ago. The state had sought approval to bill the federal government for certain medical services provided through the state-run hospital system.

“We have reviewed the proposed amendment,” CMS Acting Director Rory Howe wrote in the letter. “This letter is to inform you Rhode Island is approved.”

Eleanor Slater, with units in Cranston and at its Zambarano facility in Burrillville, fell out of compliance with the federal government in the fall of 2019 and stopped billing for Medicaid reimbursement. The state has since spent more than $100 million in general revenue to pay for services that might have otherwise been covered.

It wasn’t immediately clear how much the state would recoup, but the federal approval means Rhode Island will be eligible to retroactively bill for at least some services dating back to April 1, 2020. However, state officials warned they will not likely be able to recover all of the state money spent during that time.

“The hospital is determining the fiscal impact, based upon a patient’s insurance coverage eligibility, their length of stay in the hospital, and the billable services they received,” said Randy Edgar, spokesperson for the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, which oversees Eleanor Slater.

The federal approval comes as a welcome sign to state budget-crunchers, who have watched the state-run hospital system gobble up state revenue for more than a year.

It also comes at a time when the hospital is under intense scrutiny, as Gov. Dan McKee has proposed closing two units in Cranston and building a $65 million long-term care facility on the Zambarano campus in Burrillville. State officials have also been trying to discharge some patients that they argue could be receiving similar levels of care outside of a hospital setting, which is required under federal law dating back to the 1960s.

The effort, along with governor’s proposal, has been met with pushback from advocates and union groups, who argue the hospital provides a unique set of services for people with psychiatric and complex medical needs that they wouldn’t likely find elsewhere.

Eli Sherman (esherman@wpri.com) is a Target 12 investigative reporter for WPRI 12. Connect with him on Twitter and on Facebook

Copyright 2021 Nexstar Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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