Address Hospital Overstays and Emergency Room Backlogs

There are several simple steps that the Maryland General Assembly can take that will address both hospital inpatient overstays as well as the mental health patient burden on the State’s emergency rooms. As we think about overstays, it is important to stress two points, 1) parents and families should not have to relinquish custody to the State for youth to access care, and 2) adults should not lose their civil liberties by being unduly held on inpatient units. While Sheppard Pratt is actively participating with the Maryland Hospital Association and the Department of Health on tracking youth inpatient overstays, the problem runs deeper than just youth—extending to adults and a lack of invested resources. Recommended steps include:

• Address Residential Treatment Center (RTC) reimbursement. The number of in-state RTCs has decreased from eleven to just four in the past couple of years. This can be singularly attributed to reimbursement rates that do not meet the cost of care. The State needs to eliminate the current RTC reimbursement model and instead cover adequate services on a per diem basis. Without an adequate number of in-state RTCs, the State must pay the additional cost and families bear the emotional burden of sending young Marylanders out of state for this specialized and necessary care.
• Address Youth and Adult Overstays. The State needs to address the overstays, which lead to increased time on inpatient units. This overstay problem is the direct result of a lack of step-down facilities in the State as well as a lack of coordination between governmental agencies. In addition, the State should not penalize providers with administrative days for issues outside of the providers’ control. Administrative days simply equate to a reduced reimbursement rate for the same amount of inpatient care and effort. It is a punishment for which providers have no control.
• Expand Community Services. Sheppard Pratt is ready to assist the State, but some reasonable steps are needed. For example, the State should 1) create a system for timely and efficient approval of crisis beds; 2) eliminate core service agency delays for residential rehab program beds; 3) expand regional access to crisis services, which Sheppard Pratt can provide; and 4) eliminate any willing provider and hold providers accountable to the community and patients.
• Utilize Sheppard Pratt Resources with the 9-8-8 Rollout. The State should assist in the funding of Sheppard Pratt’s new call center. A key objective of Sheppard Pratt Care Connect will be to provide urgent assessments as an alternative to emergency room visits. We want to connect Marylanders with the behavioral health services they need— when and where they need them—before reaching a crisis point that necessitates a visit to local emergency departments. The system will function as a single-entry point to services across Sheppard Pratt and community-service providers, with one toll-free number for persons in need to access 24/7 behavioral health services, 24/7. Well-trained “care finders” will help callers promptly find community providers, navigate services, and schedule appointments including same-day urgent assessments.
• Improve Workforce. Workforce challenges are affecting all in the health care industry. Sheppard Pratt and other behavioral health providers are particularly vulnerable and unable to compete for staffing due to our reimbursement levels coupled with the degree of patients we serve.
• Create Capacity. The State should create bed capacity within State hospitals specifically for the most vulnerable adjudicated youth. These are patients, who because of their involvement in the judicial system and complex treatment requirements, bottleneck the system.
• Address other fixes. These “other” fixes are mentioned elsewhere in this letter include:
  • Increase the number of Certified Community Behavioral Health Clinics (CCBHCs) in the State.
  • Eliminate barriers for placement in an IMD and treat IMD expenses as an entitlement.