Montana State Hospital gets an extension to fix problems tied to deaths

The Centers for Medicare and Medicaid Services holds facilities like the state hospital to certain conditions in order to receive federal reimbursement dollars. CMS initially gave the state's only psychiatric hospital until March 13 to present a plan of correction and address the noncompliance issues inspectors uncovered in February, when the federal agency placed the hospital on "immediate jeopardy" status.

Montana Department of Public Health and Human Services Director Adam Meier presented some proposed fixes to lawmakers who called an emergency meeting earlier this month to address the problem. However, CMS issued a letter to Montana State Hospital administrator Kyle Fouts on Friday stating it was extending that deadline as it considers entering a new agreement with the hospital, in light "of the significant access to care issues for psychiatric hospital services" in Montana.

A new deadline has not been set as the agency considers a new plan, called a Systems Improvement Agreement, would require the state to contract with a third party to assist with developing and implementing corrections to those deficiencies. A CMS spokesperson said in an email Monday that Systems Improvement Agreements are not common, but are considered in cases where "access to care may be limited and there is a commitment from the facility to take the necessary steps to come into compliance."

The SIA would also require the state hospital to conduct a "root cause analysis" of all areas leading to the facility's noncompliance. 

The proposal is fortuitous for DPHHS, which began searching for a contractor to take over executive management of all of its health care facilities, with a focus on the Montana State Hospital. 

"DPHHS is very supportive of this approach, as it aligns with current efforts at MSH to leverage outside expertise to help analyze and address immediate needs and longstanding issues," DPHHS spokesperson Jon Ebelt said in an email Monday. "We have selected a vendor, and the contract is being finalized between two parties."

Ebelt said discussion that led to extending the state's deadline to correct course in Warm Springs included the facility's role as a "safety net" for patients with acute mental health needs who have nowhere else to go. The state hospital's own policy states it does not treat patients with dementia, being a facility for severe psychiatric disorders like schizophrenia. Still, a 2020 report found dementia patients have been committed to the hospital by judges around the state, and the Warm Springs facility cannot turn them away.

Mary Windecker, executive director at Behavioral Health Alliance of Montana, said Monday the CMS proposal is a fairly new oversight tool that allows the hospital to continue providing services while the federal government closely monitors the facility's implementation of corrective actions. 

"Rather than saying, 'OK, we're going to close you down,' there's a benefit to fixing the problems and keeping you open with the help of a consultant who can fix the problem," Windecker said of the arrangement.

State lawmakers this month agreed to move forward on drafting legislation to begin removing dementia patients from Montana State Hospital and finding them community placements. While the Children, Families, Health and Human Services Interim Committee may work toward a bill draft this year, the Legislature cannot take any action on it until the 2023 legislative session. 

Windecker, whose organization advocates for community-based mental health services, said Monday patients are always best served closer to friends and family, rather than isolated settings like the state hospital. But, she said, the Legislature may need to put its money where its mouth is to find community placements for dementia patients who had nowhere to go in the first place. 

Roy Toavs of Wolf Point told the Montana State News Bureau in February he wished he could have found the services his wife needed in their small Hi-Line community before he was placed at the state hospital. Instead, Kathy Toavs fell 13 times over the course of two months with inconsistent care to prevent those falls at the state hospital. She suffered a subdural hematoma in the last fall, and died Jan. 30.

"It's a harder thing to do than to say," Windecker said of finding community placements. "It's very expensive to take care of these patients anywhere, so they're going to have to be willing to reimburse providers more to take care of these people in nursing homes or wherever they have them."

The Children, Families, Health and Human Services Interim Committee meets again Tuesday at 8 a.m.