Rhode Island is expected to recoup tens of millions of dollars in lost Medicaid funding after a review of billing practices at Eleanor Slater Hospital, but the hospital remains out of compliance with federal Medicaid rules, according to a report released Wednesday.
The state-run hospital was in compliance with Medicaid rules on the first days of April, May and December 2020, according to the report by a team at Butler Hospital, which is operated by Care New England. The team conducted a review of the hospital’s billing practices at the request of Gov. Dan McKee’s administration.
To qualify for federal Medicaid funding, the federal Centers for Medicare and Medicaid Services (CMS) requires that hospitals have fewer than half of their beds occupied by patients whose primary diagnosis is mental illness. The state has not billed CMS for Eleanor Slater’s services since August 2019, after concerns were raised about improper billing practices.
The report’s findings, confirmed by the state Medicaid office, mean that Rhode Island is now eligible to bill CMS for Eleanor Slater for that period in 2020 retroactively, state officials said.
The same review, conducted by a team from Butler Hospital and released Wednesday, also found that the hospital fell out of compliance with the federal rules in May 2021 because of its high proportion of psychiatric patients. The next review of the hospital’s patient census is scheduled for Dec. 1st.
Rhode Island Health and Human Services Secretary Womazetta Jones said demand for in-patient psychiatric beds at Eleanor Slater is a problem that needs to be addressed. “We have to create more capacity based on what our residents are in need of,’’ she said. “And that’s an area that’s definitely in need of a lot of work.”
One way to reduce the share of psychiatric patients at Eleanor Slater, Jones said, is to enroll more patients with a primary medical diagnosis. Jones said that she learned in April 2020 that the hospital had stopped admitting medical patients.
Eleanor Slater, which has campuses in Burrillville and Cranston and serves as Rhode Island’s hospital of last resort for patients with complex medical and psychiatric needs, is paid for primarily through Medicaid, the federal-state health insurance program for low-income and disabled residents. State officials have said that the lack of federal Medicaid funding for Eleanor Slater has cost the state some $200 million, a portion of which the state now hopes to recoup. Jones said it was not clear yet exactly how much federal money the state is expected to recoup, but confirmed it was in the “tens of millions” of dollars.
Eleanor Slater also is now one step closer to regaining its full accreditation, which it lost in mid-June, according to a recent letter to the hospital’s state regulator from The Joint Commission, a national nonprofit that accredits hospitals.
Health reporter Lynn Arditi can be reached at larditi@thepublicsradio.org. Follow her on Twitter @LynnArditi.
