CMS Tells Nevada Mental Health Facility To Alter Discharge Policies

Last week, CMS sent a letter to a Nevada mental health facility urging officials to correct "serious deficiencies" at the hospital or potentially lose millions of dollars in federal Medicare funding, the AP/Washington Post reports (AP/Washington Post, 4/26).

Rufus Arther, Medicare's regional director for hospital operations, sent the letter to Rawson-Neal Psychiatric Hospital in Las Vegas (Phillips, Wall Street Journal, 4/26).

Details of Rawson Neal's Alleged Practices

According to a Sacramento Bee review of bus receipts kept by the Nevada Division of Mental Health and Developmental Services, the facility has put numerous patients with mental illnesses on buses and sent them to cities in California and other states.

The review found that the number of patients with mental illnesses sent by the psychiatric hospital to other cities via Greyhound bus increased by 66% from 2009 to 2012.

The Bee found that Rawson-Neal has sent more than 1,500 patients to other cities since July 2008.

According to the review, about one-third of such individuals traveled to California, including:

• 200 who arrived in Los Angeles County;
• 70 who arrived in San Diego County; and
• 19 who arrived in Sacramento.

Last week, city attorneys for Los Angeles and San Francisco announced formal investigations into Rawson Neal's practices.

In response to the probes, Nevada health officials said that the majority of patients sent to other cities by bus were returning home and had family or treatment programs waiting for them.

In addition, Nevada Gov. Brian Sandoval (R) said there are no systemic problems related to patient dumping at Rawson-Neal (California Healthline, 4/25).

Details of Letter

On March 20, CMS conducted a survey of Rawson-Neal after the Bee reported that one of the facility's patients was improperly discharged to Sacramento without any arrangements made for housing or treatment.

According to the letter, CMS' survey found that the facility was not in compliance with federal regulations for discharge procedures and governance (Hubert, Sacramento Bee, 4/26).

The letter said that Nevada officials have 10 days to "address what they are going to do to correct those deficiencies" (Wall Street Journal, 4/26).

According to the Bee, CMS likely will conduct another survey after 10 days.

The letter states that if corrective action is not sufficient, "we will notify you that we are initiating action to terminate the facility's Medicare provider agreement" (Sacramento Bee, 4/26).

Nevada's Response

Last week, Sandoval said that after Nevada officials conducted investigations of discharge policies, they implemented disciplinary actions and enacted a new policy to strengthen oversight of the process.

According to the AP/Post, Nevada now requires two physicians instead of one to approve a discharge order for a patient. In addition, the discharge of a patient now must be approved by a hospital administrator (AP/Washington Post, 4/26).

Last week, Nevada health officials also said that, effective immediately, a chaperone must accompany any patient with a mental illness discharged from state facilities "for whom the state is paying transportation costs" to locations outside of Nevada (California Healthline, 4/25).