by Morgan True vtdigger.org The Brattleboro Retreat psychiatric hospital has reached a preliminary agreement to avoid losing its federal certification, the hospital announced Friday. The Retreat has been under increased scrutiny from state and federal authorities after two suicide attempts and a sexual assault in the past six months in the hospital’s adolescent inpatient unit. One of the patients who attempted suicide later died, and her parents say it was a direct result of her injuries at the Retreat. A notice of termination from the Centers for Medicare and Medicaid Services was issued over the summer that would have ended the Retreat’s ability to participate in those programs on Monday.
Inspectors with the Vermont Division of Licensing and Protection, acting on behalf of CMS, conducted a planned, but unannounced, survey of the hospital this week where, based on the exit conference, Retreat officials said they believe “that the Retreat remains out of compliance with one or more conditions of participation” in the federal health care programs.
With intervention from the Shumlin administration on the Retreat’s behalf, the hospital was able to enter a “Systems Improvement Agreement” with CMS, officials said Friday.
The deal will allow the hospital to avoid termination in exchange for submitting to a prolonged period of increased oversight from CMS to ensure compliance with federal regulations for patient safety and quality of care.
“The Brattleboro Retreat is a critical piece of the state’s mental health infrastructure,” said Secretary of Administration Jeb Spaulding, who noted Gov. Peter Shumlin has had direct contact with the regional director of CMS in Boston.
“The governor wants to make sure the lines of communication between CMS and the Retreat are open and that people weren’t miscommunicating so we can avoid a disastrous situation where the Retreat might lose the ability to take new patient reimbursements,” he said.
Part of the agreement requires the Retreat to hire a CMS-approved independent expert to assist with compliance. The improvement agreement could be in place for as long as two years, according to Paul Dupre, commissioner of the Department of Mental Health.
The details of the agreement are not settled, and could take several weeks to be finalized, Dupre said Friday.
CMS had expressed concern, according to Dupre, that the Retreat was addressing specific concerns about patient care as they surfaced and was not developing a sustainable quality assurance program and governance structure to prevent future incidents.
The long-term involvement of CMS in oversight is a boon to DMH in its efforts to help the Retreat improve its practices, Dupre said.
The Retreat is home to the only child and adolescent inpatient psychiatric unit in Vermont and holds several contracts with the Agency of Human Services to provide substance abuse programs and mental health services for state patients.
If the Retreat had lost federal certification, said Spaulding, “it doesn’t mean we would stop sending our patients there. It just means we wouldn’t qualify for federal funding.”
But losing federal funding would have broader consequences, he added. “It would limit access not only to state of Vermont involved psychiatric patients but also people who are voluntarily seeking help for child services and drug addiction, many of whom are not Vermonters.”
Had the Retreat lost its certification, the hospital could have continued billing Medicare and Medicaid for existing patients for up to 30 days, Dupre said. Services to new patients could not be billed to either program.
DMH has contracts with the Retreat through Vermont’s Medicaid global commitment waiver worth $8 million, Dupre said. That money would otherwise have to be paid in full from the general fund.
A total value for the Retreat’s contracts with Vermont paid for through the Medicaid waiver was not immediately available.
It was an uncomfortable few days, Dupre said, when the state was unsure what the outcome would be, but said he’s confident this agreement will ensure the Retreat remains a safe and quality environment for patients in state custody.
“The Brattleboro Retreat showed that they take this oversight very seriously, and so does the state,” Dupre said.
“Senior management and the board of trustees of the Brattleboro Retreat see these developments as a positive, collaborative step forward toward meeting the common goals of quality care and accountability,” the Retreat said in a statement.
Ann Pugh, D-South Burlington, chairwoman of the Mental Health Oversight Committee and chairwoman of the House Human Services Committee, said during a meeting last week it became abundantly clear to her that the state could do a better job in coordinating its own agencies to work better with mental health providers around Vermont.
“We need to have a system-wide plan for communication that will lead to better communication between providers, state officials and the Legislature,” she said. “That will facilitate a better quality of care.”
Editor’s note: Bob Audette of the Brattleboro Reformer contributed to this report.