Secretary of Administration Jeb Spaulding says that if Vermont’s need for acute psychiatric care remains high, the Shumlin administration is committed to opening the Berlin State Hospital at its full 25-bed capacity in summer 2014.
“I would be surprised if it doesn’t open with 25 beds,” he said Friday.
Spaulding’s statements come days after the Department of Mental Health informed the joint Mental Health Oversight Committee that psychiatric patients with severe disorders are waiting longer in emergency rooms and correctional facilities than they have since the 54-bed Vermont State Hospital closed (link: http://vtdigger.org/2013/08/28/after-irene-er-wait-times-for-psychiatric-patients-longer-than-ever/). Tropical Storm Irene inundated and effectively shut down the hospital two years ago.
The question of whether the new 25-bed facility will open at full capacity or with 16 beds has been floating in limbo for almost two years, and the appropriations for a full-capacity opening are not yet there.
“Did the budget for FY 2014 include staffing for the 25 beds that are going to be there ready to go?” Spaulding said. “The answer for that is no.”
Spaulding said the administration and Legislature could tweak the budget in a new budget adjustment act during the legislative session.
Typically, the federal Centers for Medicare and Medicaid Services (CMS) will not provide Medicaid funding for a psychiatric facility with more than 16 beds. But Spaulding says a new federal waiver for its Global Commitment program, which allows the state to use those funds more flexibly, would enable the administration to use Medicaid dollars to fund a 25-bed facility.
“We believe we will get funding for 25. It’s built in pods for therapeutic reasons,” he said about the hospital. “If at some point they (the Feds) say we’re only covering 16, we would have the ability to lower that number to 16 beds.”
The federal waiver for the Global Commitment program is set to expire at the end of this year, and the state and Feds are negotiating the details of a new waiver.
At the current reimbursement rate, the federal government would fund about 56 percent of the operational costs for the new hospital, and the state would be on the hook for about 44 percent of those costs. That means that a 25-bed facility would draw more from the state’s General Fund than a 16-bed facility.
Commissioner of Finance Jim Reardon points out, however, that the fixed costs of running a psychiatric hospital would make it cheaper on a per-bed basis to operate a 25-bed facility. He says this new facility will benefit Vermont financially and in terms of care.
“We’re getting a state-of-the art facility, and we’re getting federal participation that we weren’t getting at the old facility,” he said. “Building a new facility is long overdue and a very good thing for the state in terms of providing quality care for those people who need those services.”
Deputy Commissioner of Mental Health Frank Reed said that if demand for acute psychiatric care continues to far exceed the supply of services, 16 beds would not be enough.
“Our thinking is that we will likely need those 25 beds as soon as possible, but that’s a determination of the Legislature,” he said.
The budget bill that passed last legislative session charges the legislative Mental Health and Health Oversight Committees with making recommendations on psychiatric hospital numbers to the Joint Fiscal Committee and the House and Senate Committees on Appropriations by Dec. 15, 2013.
The two health committees will meet in November.
