UPDATED: See below.
Friday afternoon the blog Beyond VSH published the story that once again the feds have denied certification of Vermont State Hospital. The details are that the hospital has been decertified by CMS, the federal Centers for Medicare and Medicaid Services, almost continuously since 1993, which means that the state isn't eligible to get Medicare or Medicaid payment for the patients there. In cash terms for the budget, this decision blows an $8 million hole in the budget out of the VSH operating costs of about $23 million a year.
This is kind of a big problem, because budget writers – both in the administration of Gov. James Douglas and in the Legislature – assumed that the hospital would regain certification and be eligible for Medicaid and Medicare money in fiscal year 2011 which begins in July. Yes, we were banking on that money to make our budget next year.
It should also be a political problem for the Douglas administration because of the way they slow-walked the news to the Legislature.
The administration got the news late Thursday afternoon. Early Friday afternoon, in the course of his testimony in Senate Approps, Mental Health Commisioner Michael Hartman mentioned the loss of certification, but made no broader announcement of the decision from CMS.
A little later, around 3:00, the House was debating final passage of the budget, still with no announcement of the denial of certification until it came out on the floor.
So in other words, the Douglas Administration had the information for twenty-four hours and said nothing to the House, or to the Appropriations Committee, even though they knew this news would affect the budget that was going to be on the floor the very next day.
UPDATE: It's even worse than it sounds.
Hard to believe, but GMD has heard from Rep. Anne Donohue that the Administration's tactics went beyond just being dilatory on releasing the information. Thursday evening, after the state had the letter from CMS denying recertification, the House Democratic Caucus met to talk about voting on the budget.
Douglas's Administration Secretary Neale Lundeville and Finance Commissioner Jim Reardon came to the Democratic caucus to support Shap Smith on not delaying the budget vote. Did the caucus hear a word from Lunderville and Reardon about the decertification? Nope. They left that for the chance to sandbag Martha Heath on the floor Friday.
There's other coverage of the certification news, and why they didn't get certified, and it's definitely worth reading, but today I have a couple of other questions.
First, what the hell were they thinking? They knew they had a decision from the feds that was going to add $8 million to the state budget shortfall and they didn't go to the House, which was debating the budget, or to the House Appropriations Committee, which was presenting the budget on the floor of the House. Did they think that it just wouldn't come up? Did they really think they could slide this one by? They had to know that it woud come up before the Senate got the bill, so they'd have to deal with it anyway. Can't anybody here play this game?
Second, when is this going to start costing Douglas? The Hospital has been decertified almost continuously since 2003, or almost the entire time that Douglas has been governor, and his administration has essentially done nothing about it. At least, nothing but waste time, come up with unrealistic and unfeasible plans, and we're no closer to a replacement for VSH than we were seven years ago. You walk around the State House and legislators of all parties are openly scornful of the idea that the administration has any kind of plan to do anything, anytime.
And the cost to Vermont's taxpayers? It's hard to say, but a rough estimate of $50-80 million is probably in the ballpark. Any ideas what else we could be doing with that money if we hadn't had to take it out of the General Fund to patch the State Hospital budget?
If the total lack of leadership isn't entirely the responsibility of Douglas and his appointees, whose fault is it? As much as any other issue, Douglas owns this one. yet as far as I can tell, Douglas has been able to get away with treating this whole disaster as though he is as much a spectator as anyone else. Could the truth really be as simple as what I heard a Democratic representative say recently? People just don't care enough about VSH and the people it serves for it to make a difference?
And my last question: What are the Democratic candidates for governor going to do about it? They all spoke at a debate on mental health and substance abuse issues last Monday night (not sure if an empty chair was provided for Dubie), but we didn't have this news then. I wasn't at the debate, but I understand that nobody had a particularly compelling proposal for how they'll deal with the crisis that will still be sitting on their desk next January. It seems that this is an opportunity to demonstrate a reality-based understanding of our situation, compassion for the people who are locked up in the current facility, and a vision for the future. Those all seem like good things for a Democratic governor, don't they?
The VSH serves the most forgotten of all Vermonters. No likely voters there, I would guess.
What does it say about the “Vermont Brand” that we have failed to bring the VSH up to standards for so many years; and Douglas’ idea of a fix is to cut the budget even further?
The question is did Smith know about the problem on Thursday evening? If yes it is time for Smith to join Shumlin and pack it in. The Democratic leadership is whimpy at best.
to start is at the State Hospital.
I am not suggesting that they arrive as consultants, however, but for long term evaluation and treatment.
First, I would encourage GMD readers who couldn’t make it to watch the Mental Health, Substance Abuse and Developmental Services forum. It had a great and passionate crowd and many important issues were discussed, often at a more detailed level than more wide-ranging forums. Thanks to the VT Council and SBHS for hosting such a great discussion.
http://www.cctv.org/node/90595.
This news on the VSH, and the manner of its arrival, is extremely unfortunate but not surprising. Montpelier’s approach to the state hospital issue reflects a lack of care, commitment, and follow-through that has cost Vermont taxpayers millions of dollars, year after year. Additionally, it has badly failed the vulnerable consumers and struggling providers at the facility. Aside from the lost dollars, which are significant, this is about safety and this is about dignity.
I have dealt with and been saddened by the administration’s approach since my time in the State Senate. Once we heard about the magnitude of the problems from state employees who worried about losing their jobs if they told the truth about what was going on at the VSH, we expedited no-bid funding with a directive to just ‘get it done,’ and the administration didn’t spend the money. Further, they dropped strong partnership plans, seemingly because the politics were too difficult regarding which hospitals VSH was going to partner with. That is unacceptable. Our neighbors in New Hampshire have dealt with this issue right, and their facility and system is a model for the nation, but Vermont is not coming even close. Not fighting to make our state hospital a place we can be proud of is not only poor public policy, it does not demonstrate Vermont values or fulfill the obligation of government to work well for communities that don’t have the strongest lobbyists or deliver votes. We can do much better.
As I said last Monday at the mental health forum, the VSH will be prioritized in a Dunne administration. As with any complex issue, it requires collaboration with experts and relevant constituencies, supported by a dedication to settling on a realistic plan that solves the problem. All options should be on the table, including partnering with community institutions, teaching facilities, and if necessary, rebuilding. The key to effecting real change will be strong leadership from the Governor’s office, and I pledge to press the issue and make the VSH a priority in the first year.
Again, I would encourage all GMD readers to watch last Monday’s forum here:
http://www.cctv.org/node/90595.
The excellent question about the Vermont State Hospital from Connie Stabler of South Burlington is at 69:30, and my answer starts at 72:00.
If you or someone who cares about the VSH issue are among the 47% of Vermonters who do not have broadband speed internet allowing downloads of large videos (making Vermont dead last in the United States in that connectivity metric, which is another pressing problem that would be a year one priority for a Dunne administration), please re-post and let me know if I can clarify anything.
Jack, thank you for an excellent and much needed diary, and thanks to the GMD community for continuing to ask the tough questions.
As I said at the forum, resolving the Vermont State Hospital issue will be a priority for my administration. I start with a commitment to having a strong community system for Vermonters with mental health issues, developmental disabilities and substance abuse problems. I am currently fighting the Douglas Administration’s plans to cut community programs in the FY 2011 budget. Those cuts would be both hurtful and shortsighted.
My plan for the hospital is to try one more time to work with our local hospitals to develop a community-based hospitalization system, which would be better for patients and families throughout Vermont. However, if it becomes clear that this simply isn’t possible in Vermont, then I would aggressively pursue building a new state hospital–preferably in Waterbury–for up to 45 patients. When the new hospital is built, I will not use the federal Medicaid money as Jim Douglas has proposed. (That money is targeted for assisting low-income Vermonters through the recession.) Instead, I will do what Vermont has always done for capital construction projects–use our bonding authority.
As usual, Anne Galloway has done a great job of documenting our responses to questions at forums at vtdigger.org. You can see the answer to this question (and others) here:
http://vtdigger.org/2010/03/23…
This question is the 3rd video box down on the page, and my answer is begins at 5:52.
-Doug Racine