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Other health care providers want even stronger conditions than what the Oregon Health Authority outlined in its draft recommendation.

FILE PHOTO - Legacy Health, which helps run the Unity Center for Behavioral Health in Portland, wants the Oregon Health Authority to impose further conditions for the development of a psychiatric hospital in Wilsonville.

Universal Health Services strongly opposes many of the conditions for the tentative approval of the proposed for-profit psychiatric hospital it wants to build on Day Road in north Wilsonville.

At the same time, competitors in the field are asking for even more stringent requirements. 

The Oregon Health Authority recently issued a draft recommendation, which may pave the way for official approval of the new hospital, and held a public hearing Monday, Sept. 20, to hear comments from Universal Health, which is a multi-billion dollar company with 400 hospitals, as well as other providers like Providence and Legacy Health. 

At the hearing, Universal Health asked the OHA to rescind many of its recommendations and stated that building the facility under current obligations may not be financially feasible. 

Two of OHA's most notable changes to Universal Health's original proposal stipulated that the hospital have 60 rather than the requested 100 beds and that 45% of the beds go to persons who have court determination of mental illness, have been placed in emergency custody or are awaiting a hearing for detention or diversion. In the recommendation, the health authority cited the proliferation of emergency room boarding for mental health patients and the lack of beds for involuntarily committed patients as reasons it may greenlight the facility even though it rejected a previous application from Universal Health. 

According to Mental Health of America, Oregon is ranked 49th out of 50 states and the District of Columbia in terms of the prevalence of mental health issues and access to care for adults. 

Universal Health representatives said 60 beds wouldn't be enough to meet the need in the area and that the project may not pencil out financially if OHA doesn't allow the expansion to 100 beds after two years. 

"UHS agrees operating up to 60 beds in the first two years is reasonable to facilitate a gradual ramp up, but the ability of the new facility to add beds after that point is critical to ensure the viability of the project as a freestanding psychiatric hospital," said Ron Escarda, the Universal Health director of product operations and implementation, at the public hearing. 

The OHA previously told Pamplin Media Group that the 45% condition was made to ensure that the hospital serves vulnerable populations who don't have financial resources or connections with systems of care. Escarda described this condition as "unnecessary, operationally unworkable and unfairly applied to UHS only."

On the other side, Legacy Health and Providence, which have long opposed the project, want further stipulations to ensure Universal Health is addressing needs.

Lynnea Lindsey, the director of behavioral health services for Legacy, requested that OHA mandate that the 27 beds for the aforementioned populations (with a court determination of mental illness, in custody or awaiting detention or diversion) be designed and staffed to accommodate those persons, that that the certificate of need issuance is evaluated quarterly rather than annually and for findings to be made public to ensure that Universal Health doesn't breach requirements. Legacy also wants the consequences of breaching requirements to be explicitly stated. 

"While Legacy does not believe a certificate of need is appropriately issued to UHS, OHA's vision is a vast improvement on the project proposed by UHS," Lindsey said. "If OHA does issue a proposed decision granting OHA a full certificate of need for a 60-bed facility over the objections of Legacy, Providence and others, Legacy respectfully requests the conditions in the draft recommendation be expanded to ensure there is one, clarity, two, transparency, and three, accountability." 

Robin Henderson, with Providence, also found Universal Health's proposal that 12.5% of patients be on Medicaid to be inconsistent with the 45% requirement, as a high proportion of patients falling under those categories qualify for Medicaid or are uninsured. Universal Health has struggled to serve Medicaid patients because some coordinated care organizations have refused to work with them. 

Representative Frank Fox said Universal Health has tried to work with these organizations — including Health Share, the largest coordinated care organization in Oregon. Fox noted that competitors Legacy Health and Providence are among the organizations that govern Health Share. Universal Health previously paid $127 million to settle a U.S. Department of Justice civil investigation regarding its Medicare and Medicaid billing practices. 

"Without these CCO (coordinated care organization) contracts, UHS is hindered in serving Medicaid and involuntary civil commitment patients as some of those CCOs refuse to pay for service or admit members. Importantly, the lack of CCO contracts is not a reflection of UHS's willingness and desire to serve this population and meet the demonstrated need, but instead a direct result of the CCOs refusal to contract," Fox said. 

Chris Bouneff, the executive director for National Alliance on Mental Illness Oregon, posited at the hearing that adding inpatient beds is not the solution to the mental health problems in Oregon. He said that, currently, patients who are waiting for civil commitment or are under guardianship, and in need of short-term care, are sitting in mental health institutions for more than 100 days — thus leading to a shortage of beds for others who, in turn, wind up in emergency departments. He wanted more options for patients who don't need long-term admittance into a psychiatric hospital but need more help than counseling and other outpatient services. 

"What's not being addressed anywhere in this application and not being addressed anywhere in this conversation are the levels of care that are missing," Bouneff said. "More and more, we are dealing with families where their loved ones have been in inpatient psychiatric care for an excess of 200 days for no other reason than no other level of care exists in the Portland metropolitan area."

The public comment period for the draft recommendation ends on Sept. 30. After that, OHA will have 10 days to issue a proposed decision. Then, a contested hearing may be requested by affected parties within 60 days. If no hearing is requested, the proposed decision becomes final. 


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