The federal Centers for Medicare and Medicaid Services has given Nevada 10 days to correct “serious deficiencies” in its mental health discharge policies or face a loss of federal funding.
Meanwhile, Nevada state officials say they are confident they will meet the deadline and be in compliance.
The warning came in a letter sent Thursday to Rawson-Neal Psychiatric Hospital in Las Vegas, which has been under scrutiny since busing a homeless mentally ill patient to Sacramento, Calif., in February with no support services awaiting him on the other end.
The Centers for Medicare and Medicaid Services takes any concerns or allegations related to quality of care seriously, federal officials said Friday.
According to a survey by the federal agency, Rawson-Neal was found not to be in compliance in two out of 23 conditions that hospitals are required to meet in order to participate in Medicare. It found problems with lack of adequate oversight by the hospital’s governing board and discharge planning, said Rufus Arther, survey and certification branch manager for the western division.
He said he wasn’t able to discuss the specifics, but some generic corrective examples for the governing body deficiencies could include changing policies, adding members to the hospital’s leadership, further clarifying leadership roles or even changing leadership.
The discharge planning deficiencies could be addressed by changes in policies for releasing patients.
Arther wasn’t able to comment on the likelihood of the hospital losing federal funding.
However, Steven Chickering, associate regional administrator, said these kinds of actions happen 30 to 40 times a year in region nine. There are about 550 to 600 hospitals in the region, which includes California, Nevada, Arizona and Hawaii.
Most of the time, the hospitals follow up with the survey and are found to be back in compliance, he said.
Neither Arther nor Chickering were able to give an estimate of the amount of funding Rawson-Neal receives from the federal government. They said it depends on the number of patients.
Now it’s up to the hospital to submit a plan of correction, Arther said.
Dr. Tracey Green, the state’s health officer, said they have begun to implement much of the corrective plan. The plan includes changes to policy, training of staff and disciplinary action against two employees who will be reported to their licensing boards.
Green said she wasn’t able to comment when asked whether more employees are expected to be disciplined.
The two specific changes to policy include having a second doctor review a recommendation to discharge a patient that would require the state to buy an out-of-state bus ticket and then having it approved by an administrator, said Richard Whitley, administrator for the state’s Mental Health and Developmental Services Division. All clients receiving a ticket would require a chaperon.
Green said they don’t anticipate increased costs as a result of having chaperons travel with patients because the number of requests for out-of-state tickets has decreased.
And changes are designed to help identify similar cases and help prevent violations, Whitley said.
Officials say they believe they have made all the necessary changes to address the problems.
Medicare recipients at the Rawson-Neal hospital represent less than 10 percent of the hospital’s patient population, Whitley said. The hospital is primarily supported by state general funds.
“We are confident that we will be in compliance with (Centers for Medicare and Medicaid Services),” Whitley said.
California accused Nevada of dumping 500 patients on the Golden State since July 1, 2008. Nevada disputed the allegation that it dumps patients but admitted proper discharge policies weren’t followed in the case of James F. Brown.
Gov. Brian Sandoval also this week ordered the state to escort all future patients bused out of state, most often at their request so they can return home to their family and friends.
After the Brown case came to light, Nevada and the federal government launched parallel investigations. The probes were finished March 20 and found two more cases of unsafe discharges out of 30 reviewed during February.
Rawson-Neal filed a plan of corrective action to answer the state investigation. It included new safeguards to ensure out-of-state patients are discharged with full support services at their destinations. A second doctor must OK the discharge plan too.
Nevada’s corrective action plan that will be filed to the federal agency is expected to cite the same upgraded policies.
If the federal Centers for Medicare and Medicaid Services accepts the plan, Rawson-Neal’s tens of millions of dollars in federal funding will continue.
If the federal agency rejects the corrective action plan, financial consequences would kick in.
“We will notify you that we are initiating action to terminate the facility’s Medicare provider agreement,” the letter said.
The Sacramento Bee first reported Thursday on the letter.