Maine Psychiatric Hospital Deemed Compliant For Medicare

Feb 23, 2019

After nearly half a dozen years, the state's Riverview Psychiatric Center has passed federal inspection to qualify for funds under the Medicare program. Maine Public political correspondent Mal Leary joined Nora Flaherty on Maine Things Considered to look at what this all means for Maine.

NF: Mal, this sounds like good news and kind of a big deal, is it?

ML: I think it is, Norah. It's clearly good news for the patients at Riverview, because now they're getting the quality of care they should have been getting all along for the last several years. It's been a big effort in the last year to try to clean up all of these problems.

Now we have to go back to April of 2013. That's when the state lost its first certification after inspection by federal officials, and the federal officials said that Medicaid funds of almost $20 million a year should be suspended. They found some serious problems, Nora, for example, unnecessary use of restraints on patients, the use of stun guns, pepper spray by security staff on patients. The hospital was also faulted for a number of problems with staffing and tracking the care that was actually given to patients.

Federal officials say those problems have now been solved as of an inspection that was held last month, and the state can now start to draw as of January 30th, once again, draw down all that Medicare money. That's about$ 20 million a year. But the state still faces a bill from the federal government for federal money that was improperly used.

And is that a lot of money, and does the state have the money to pay that bill?

We don't know the exact size of that bill, but last month the state auditor went before the Appropriations Committee and said at that time the bill had reached $70 million. Remember, this goes back nearly six years in which the LePage administration continued to draw on federal Medicaid, excuse me, Medicare funds without authorization.

So it's all added up, and in 2017 the LePage administration got a letter saying the bill then was up to $51 million, and that the state was shut off from drawing down any more money without authorization. Now the Appropriations Committee looked at that, I would characterize it as a rather blistering letter from the feds, and put language in the budget that you're reserving $65 million from the states rainy day fund to pay what finally may be owed. So we may be looking at a $5 million bill or something different.

OK so this happened the federal funds were cut off. How has Riverview stayed open and paid its bills during this time?

Under the LePage administration they started to use transfers from the Mainecare surplus to pay the bills. Now you got to remember, Mainecare, which is the state's name for Medicaid, is paid for by both the state and federal government. Maine picks up roughly a third, the federal government roughly two thirds so that overall when Maine care expenditures are down, which they have been, the state has a surplus in the account of state money that they can use for other purposes. They've been using that to keep Riverview afloat since that 2017 letter from the federal government that said 'no more Medicare money for you.'

So what's next here? Will the state be sending a big check to the feds?

Well, we don't know yet, because we don't know the size of the bill. You see Nora, there are state appeals pending on some of the past findings of inspections at the hospital that could, maybe, mitigate what the feds want back for the state. This has happened in the past. The state violated the law for Temporary Assistance to Needy Families. They were hit with a big fine. And the state's - the federal government later mitigated that back to a much smaller amount. But clearly it's an issue as the Appropriations Committee works on the state budget, and the panel wants to clean up this funding issue in this budget and not let it drag on any further.

Originally published 5:42 p.m. Feb. 22, 2019