Medicare won’t pay for patients at one of West Virginia’s two state-run psychiatric hospitals, as of today, according to a termination notice from the federal Department of Health and Human Services.
The notice states that, “The Centers for Medicare & Medicaid Services has determined that the William R. Sharpe, Jr. Hospital is not in compliance with the Medicare requirements for a psychiatric hospital.”
Medicare, the federal health insurance program for people 65 and older, will not make payment for beneficiaries who are admitted to the Weston hospital on or after today, according to the notice. It will continue to make payments for up to 30 days for beneficiaries admitted before today, the notice states.
Allison Adler, spokeswoman for the state Department of Health and Human Resources, which runs Sharpe Hospital, confirmed Wednesday that the DHHR had been notified that Sharpe “no longer meets the requirements for participation as a provider of services in Medicare.”
“The main reasons for the decision were due to inadequate documentation and insufficient treatment plans and follow up,” she said. “Secretary [Bill] Crouch continues to work with CMS regarding this issue in regards to the final determination.”
She added, “The health and well-being of the patients will remain our priority.”
The termination letter does not specify the requirements with which Sharpe Hospital did not comply.
According to the CMS website, termination can occur if it is determined that a health care provider:
n Is not complying substantially with the terms of the agreement, the provisions of title XVIII of the Social Security Act or regulations promulgated thereunder;
n Has failed to supply information necessary to determine whether payments are or were due and the amounts of such payments;
n Refuses to permit examination of fiscal and other records (including medical records) necessary for the verification of information furnished as a basis for claiming payment under the Medicare program; or
n Refuses to permit photocopying of any records or other information necessary to determine or verify compliance with participation requirements.
CMS documents also indicate that termination generally occurs 90 days after notification of noncompliance with one or more conditions of coverage, if the provider fails to correct those issues, although regional CMS offices may terminate more quickly, if all required procedures have been completed.
CMS did not respond to a request for additional information about the Sharpe Hospital termination Wednesday.
Sharpe Hospital, a 150-bed acute-care psychiatric hospital, opened in 1994. Mildred Mitchell-Bateman Hospital in Huntington is West Virginia’s only other state-run psychiatric hospital.
In 2015, the West Virginia Supreme Court upheld a circuit court order directing Sharpe administrators to address staffing shortages and patient care issues.