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Here's what we know about the plan to fix Eleanor Slater Hospital

Providence Journal - 11/23/2021

PROVIDENCE — Rhode Island is moving toward creating a standalone psychiatric hospital on the campus of the state-run Eleanor Slater Hospital.

Announced Tuesday, the "relicensing" decision is a key part of Gov. Dan McKee's effort to chart a new, more financially stable direction for the "last resort" hospital that has been at the vortex of a firestorm the last two years.

Spread across two campuses in Cranston and Burrillville, the hospital is home to close to 200 patients with severe medical and psychiatric disorders who have been there an average of 12½ years each. It is not yet clear what direct effect, if any, the decision to relicense the 52-bed Benton building on the Cranston campus as a standalone psychiatric hospital will have on the patients who were sent there, instead of prison, by state judges for care and treatment.

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But a statement issued by the McKee administration said:

"Benton will continue to operate as a secure facility, serving patients who are involved in the criminal justice system, while Eleanor Slater will continue to serve patients with longer-term medical and psychiatric conditions."

The decision to sever the psychiatric wing from the rest of the hospital is aimed, at least in part, at ending a years-long dispute over Rhode Island's eligibility to collect federal Medicaid dollars.

It's a complicated problem that stems from a prohibition in federal law against payment of Medicaid dollars to hospitals where more than half of the patients are classified as psychiatric.

Rhode Island has teetered near, and at times gone over, that line, as it did last spring, according to an independent review team from Butler Hospital.

And that has led to allegations that administrators of the state hospital illegally manipulated data on the patient mix to keep the federal dollars flowing. It also led the state to suspend Medicaid billing for close to two years, after insiders blew the whistle.

In his resignation letter earlier this year, the hospital's chief medical officer, Brian Daly, alleged "years and years of inappropriate billing practices" and "manipulation of patient census ratios to facilitate inappropriate billing."

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The move to create a standalone Institute for Mental Disease mirrors what some other states have done. Some have even found alternate ways to draw down federal dollars.

And it addresses the math problem: by removing the psychiatric patients at Benton -who, in most cases, are not eligible for Medicaid reimbursement now - from the Eleanor Slater Hospital patient count, there will presumably be less chance the rest of the hospital will cross the line.

It is also one of the recommendations that state Health and Human Services Secretary Womazetta Jones made in a report to the governor last June.

"We knew that it was important for BHDDH [the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals] 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 Tuesday.

The logistics:

The state agency that runs the hospital is preparing a "certificate of need application'' for relicensing the Benton building as a psychiatric hospital, for filing with the Rhode Island Department of Health in January.

"Once all steps of the approval process are complete, Benton will operate under a separate license, with Eleanor Slater still accepting some forensic patients, as needed, depending on the number of court-remanded patients," according to a statement from BHDDH.

"This is an important step for Eleanor Slater Hospital," BHDDH Director Richard Charest.

"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.

"By doing this, we provide the best-possible care to patients while also being fiscally responsible to the taxpayers."

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But it is not the only new operating license the state is seeking.

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