In a new report, University of Vermont Health Network administrators say they haven’t decided on the size of a psychiatric hospital to be built in Berlin. But they say federal limitations on Medicaid money for mental health care mean the facility won’t be able to house the estimated 29 to 35 beds the state needs.
“We do have a limitation on the number of beds we can build,” said Anna Tempesta Noonan, president and chief operating officer of Central Vermont Medical Center.
However, Noonan said the health network continues to move forward on a project that is supposed to reduce the number of psychiatric patients who are enduring long waits in hospital emergency rooms.
“As a network, we are committed to this,” Noonan said. “We are committed to being part of the solution for this issue.”
Vermont’s overburdened mental health system is failing to keep up with the number of psychiatric patients as well as the severity of their illnesses. One prominent manifestation of that is the growing number of patients who are stuck in medical hospitals because no psychiatric beds are available.
Hospitals have added staff and made physical changes to try to accommodate more mental health patients. But they remain ill-equipped to handle that population, leading to numerous regulatory problems involving mistreatment and safety concerns.
“One of the things we’re most concerned about is the notion that really no Vermonter should wait for those extended periods of time in our emergency departments due to that lack of a therapeutic inpatient psychiatric bed,” Noonan said.
There are multiple potential solutions, including building more inpatient beds. Last year, the Green Mountain Care Board sought to expedite that process by ordering University of Vermont Medical Center to dedicate $21 million in excess revenue from fiscal year 2017 to “measurably increase inpatient mental health capacity in Vermont.”
UVM Health Network has identified Central Vermont Medical Center’s campus as an ideal spot for a new adult inpatient psychiatric treatment facility. The hospital is centrally located in the state, has available space “on or very near its campus,” and already has 15 psychiatric beds.
As part of its planning process, the network also has produced a report saying Vermont needs 29 to 35 more inpatient beds to meet current and future demand.
But in a new report to the Green Mountain Care Board, network administrators say federal Medicaid funding is a barrier to building a project of that size.
Federal Medicaid money cannot be used for adults in “institutions for mental disease,” a statutory term that refers to standalone psychiatric hospitals with more than 16 inpatient beds. Vermont has a waiver to get around the restriction on so-called “IMD” funding, but that waiver will be phased out between 2021 and 2025.
So, in order to not jeopardize Central Vermont Medical Center’s Medicaid funding, health network administrators say they need to make sure that any new mental health project doesn’t lead to the federal government declaring the entire facility an institution for mental disease.
It’s a tricky equation. The network’s new report notes that “even facilities not expressly licensed as psychiatric hospitals could be designated as IMDs if their ‘overall character’ suggests they are primarily for psychiatric care.”
In an interview, Noonan said the hospital’s risk related to federal regulations “is something that we are trying to very carefully balance” with the need for more mental health beds.
“We’re just starting to understand the nuances of those regulations,” she said. “We are seeking some outside expertise to help us really interpret and understand that.”
One thing is certain: The federal rules will have an impact on the new facility in Berlin. “We can already say with confidence that the IMD rules will limit the number of additional beds that can be built on the (Central Vermont) campus to fewer than the 29-35 beds needed statewide,” the health network’s report to regulators says.
The federal government has offered the possibility of a new waiver that could preserve some psychiatric inpatient funding for states like Vermont. State Agency of Human Services officials are seeking legislative permission to pursue that waiver, but it’s not clear whether Vermont will receive the waiver or what its long-term implications will be.
Noonan said health network administrators are “considering all of that in total as we really tease out the true implications of the IMD rule for this particular project.”
The network also has a lot of other issues to consider, including the kinds of programming and staffing the new psychiatric facility will need. And once those questions are answered, design and permitting processes will follow.
So any construction is still years away. Noonan said the health network is “moving through the process as quickly as we can,” but she also said it’s important to get preliminary planning right.
To that end, network administrators have been consulting with state officials, care providers and a committee
