As Western Colorado’s only psychiatric hospital approaches possible closure, its parent company, Mind Springs Health, is in arbitration over millions of dollars with Rocky Mountain Health Plans, a group that reimburses Medicaid costs. It’s inside.
The Daily Sentinel reported in mid-April that West Springs Psychiatric Hospital could close within weeks due to continued financial losses. The facility is still open, but Mind Springs Health CEO John Sheehan said it will be closed by June unless the mediation is successful or additional substantial help is received from outside sources. It is said to be closed.
Sheehan said the crisis is because RMHP is short-circuiting Medicaid reimbursement and referring Western Slope patients to the Front Range, while some state agencies refuse to provide substantial assistance. Stated.
“I would like to say that the state has provided some form of additional funding to help us get through the financial difficulties, they have not provided us with anything, it is not what we asked for,” Sheehan said. . “The idea that they’ve exhausted all their resources to help us in any way is bullshit.”
The Bureau of Behavioral Health (BHA), Department of Public Health and Environment (CDPHE), and Department of Health Policy and Financing (HCPF) deny all of Mr. Sheehan’s claims and ask Western Slope lawmakers to detail their work with RMHP. I sent a letter stating. In just one fiscal year he helped West Springs Hospital and its parent company with more than $20 million.
“The departments have exhausted their capacity to provide financial assistance to West Springs,” the letter states. “We are also concerned that Mind Springs has consistently demonstrated poor financial management and an inability to produce a transparent sustainability plan.”
But Mr Sheehan said the nearly $4 million Mind Springs received from BHA was for contracted services, essentially breaking even after taking into account the cost of providing additional services. He said the $23.8 million Mind Springs received from RMHP was an advance payment to “offset the significant cash flow issues they caused” and essentially must be repaid by Mind Springs. He added that it was nothing but a loan.
“They may say we owe them money, but actually it’s money we’re charging them and it’s being reduced every month,” he said.
In a letter to Western Slope lawmakers, the agency said that although Mind Springs received an advance payment of $21.8 million, it had provided only $15.3 million in services as of April 16. It was estimated that only. Sheehan said the final debt amount could not be calculated until the end of the 2024 fiscal year. Mind Springs received his final advance payment ($2 million) on May 1st.
The agencies added that financial assistance is the maximum they can provide within state and federal law. RMHP CEO Patrick Gordon wrote in an op-ed in the Sentinel last week that the decision to provide prepayments is a voluntary and unprecedented effort to secure mental health care in the community. .
Despite having to pay the money back, Sheehan said the advance payments are important in helping to fund care for the facility’s Medicaid patients, who make up about 65% to 70% of the facility’s patients. Having just received his final advance payment, he said he has no doubt that West Springs will be out of business by the end of May.
That is, unless Mind Springs succeeds in arbitration for $7 million and negotiates different terms in a new contract with RMHP.
arbitration
Arbitration is a less costly and less complex alternative to litigation in which a neutral third party or arbitrator decides the resolution of the dispute. The arbitration concerns $7 million that RMHP said it overpaid to Mind Springs during the 2023 fiscal year.
Sheehan said the dispute began in September 2022 when RMHP sent a letter to a majority of its members advising them not to receive treatment at Mind Springs due to complaints of non-compliance. He said this has led to a significant decrease in outpatient and inpatient admissions. -Patient volume. He added that Mind Springs has had compliance issues in the past, but that at the time RMHP sent the letter, there were no findings to support its claims.
RMHP representatives were not available to comment on the letter or the arbitration.
By the end of fiscal year 2023, RMHP notified Mind Springs that it owed approximately $7 million in upfront funds for Medicaid treatment, suggesting that declining patient volume suggested it was not provided. did. Sheehan said the money was used to maintain the facility’s infrastructure, not Medicaid care.
“I have a contract to provide care for all 10 counties on the Western Slope for a fixed amount paid monthly, so when my volume goes down, I can’t provide as much care and I don’t have as much care. “We’re not raising a lot of money,” he said. “That means I’ll be wasting some of my money, but there’s a good reason for that. I’m not firing anyone. I’m not dismantling the network. I’m not firing anybody. I’m not denying them care. I’m keeping the door open and paying for all of this.”
Larry Robinson/Daily Sentinel
West Springs Hospital is on the verge of closing due to financial difficulties. Several state agencies have refused to provide hospitals with significant aid to keep them open, writing in a letter to Colorado lawmakers that they have “found out that Mind Springs has consistently demonstrated poor financial management. “We are also concerned that it shows an inability to produce a transparent sustainability plan.”
The following month, when RMHP reduced its insurance payout to Mind Springs by $1 million to recoup the excess funds, Sheehan filed a temporary restraining order and filed a lawsuit that eventually moved to arbitration. Arbitration is ongoing, but Sheehan said he aims to reach a settlement as part of contract renegotiations, preferably by the end of May.
In a joint response to the Sentinel, BHA, HCPF and CDPHE said they could not comment on the arbitration. But they said RMHP, as a regional responsibility agency for Medicaid, acts on behalf of the state government and uses Medicaid funds, so it is required to recover excess payments from the state. They added that reimbursing facilities based on maximum capacity rather than patient numbers could be problematic for several reasons.
“A model that pays providers based on their maximum capacity, regardless of utilization, allows providers to limit hospitalizations for Medicaid members or for commercially funded patients. “It would be possible to prioritize hospital beds or keep hospital beds empty while hospitals receive payments regardless of the care provided to Medicaid members,” they said. “That model will not benefit Medicaid patients, their families, or the state or federal government.”
They noted that West Springs has historically not operated at maximum capacity and that none of RMHP’s 6,000 Medicaid behavioral health providers have previously settled or had difficulty adjusting excess payments. He added that the only provider there was Mind Springs.
Recovery of surplus funds is also a federal requirement, so if RMHP and the state ignore that requirement, Colorado’s Medicaid program will be largely disenfranchised.
fight for a solution
Although state officials said they have helped Mind Springs in almost every way to no avail, there have been some discussions at the county level.
Mesa County Commissioner Janet Rowland has been considering how Western Slope towns and counties can help West Springs, but her options are limited.
“When we looked at the breakdown of hospital usage by county and municipality, Mesa and Grand Junction had the largest share,” Rowland said. “It wouldn’t have been very helpful to ask other people for such small donations, and it probably would have been difficult for those small communities to contribute.”
She added that the money was likely a loan, and she feared it would only worsen Mind Springs’ financial woes in the long run.
In our interactions with both agencies and Sentinel, RMHP remains proactive and creative in seeking ways to support Mind Springs and the psychiatric hospital in the future, regardless of arbitration or the potential closure of West Springs. He said he would continue.
