- Associated Press - Thursday, January 23, 2014

LAS VEGAS (AP) - A walk-in mental health clinic that opened in Las Vegas over the summer as a way to steer psychiatric patients away from overcrowded emergency rooms is closing after a federal review, Nevada health officials announced Thursday.

The federal Centers for Medicare and Medicaid Services contended the center was handling enough serious cases that it qualified as an emergency room, and it would thus need to offer a full range of medical services to meet ER standards.

Southern Nevada Adult Mental Health Services officials said the clinic can’t reach that bar, so it’s closing by the end of the business day Friday to avoid losing Medicare certification for both itself and Rawson-Neal Psychiatric Hospital.

“This is a setback and very saddening to us,” said Dr. Tracey Green, the state’s chief medical officer. She added that employees who worked at the clinic - fewer than 20 - will be absorbed in other mental health positions, and patients will still have other places to go for care.

The behavioral health clinic, which is physically connected to Rawson-Neal, opened in July 2013 and was trumpeted as a proactive effort to ease overcrowding in Las Vegas emergency rooms. Patients with issues that were too serious for an outpatient psychiatric clinic but not of a physical nature could go to the clinic, where staff would triage them, stabilizing some on-site and referring others to inpatient mental health care.

But when Centers for Medicare and Medicaid Services inspectors checked out the facility after an undisclosed complaint, they determined the clinic sometimes exceeded a key threshold that bumped it to emergency-room status - more than one-third of the patients who came in needed to go to a hospital.

Rufus Arther, director of hospital operations at the Centers for Medicare and Medicaid Services, said the standard is in place to ensure patients get quality care. Medicare funding isn’t available to urgent care-style clinics like the Las Vegas psychiatric clinic, and Arther said he wasn’t aware of efforts to change the rule to add the intermediate category.

Green said the clinic never intended to be an emergency room and wasn’t aware it would fall under stricter ER guidelines until the inspection. She also contends that while the center exceeds the one-third threshold on certain days, it doesn’t when the month is averaged out.

“Clearly, this was somewhat of a shock to us,” she said.

Green said the state is still interested in developing psychiatric alternatives to ERs, perhaps outside the umbrella of the Centers for Medicare and Medicaid Services. But for now, patients who used the clinic’s services - about 16 people a day in January - will be back to using ERs.

The closure is the latest setback for the region’s mental health services agency.

Earlier this month, the Centers for Medicare and Medicaid Services sent a letter threatening to cut Rawson-Neal’s Medicare funding by April 7 based on findings of a November inspection.

Agency officials said Rawson-Neal was not meeting requirements related to its governing body, nursing services and Quality Assurance and Performance Improvement program. The hospital is also out of compliance with fire codes, the letter said.

State health officials said they have corrected deficiencies by a Tuesday deadline and are in compliance with regulations. The Centers for Medicare and Medicaid Services plans to make an unannounced visit in coming weeks to verify whether the hospital is up to par.

Rawson-Neal has faced scrutiny since The Sacramento Bee reported last spring about a patient who was bused to California without a follow-up care plan. The newspaper found more than 1,000 patients were provided bus tickets out of state upon discharge, although the state says proper procedures were followed in all but a handful of those cases.

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