HealthVest

- 
August 3, 2018 

AUG 3 2018
Karen Nidermayer, Analyst
Certi?cate Of Need Program CERTIFICATE or NEED PROGRAM
Department of Health DEPARTMENT OF HEALTH

111 Israel Road SE
Tumwater, WA 98501

Dear Karen:

Vest Whatcom, LLC has had the opportunity to review the public record on our application
proposing to establish a new 70 bed hospital in Bellingham, Whatcom County. The
public support for our project was signi?cant, compelling and widespread. A review of the
public record confirms that our project meets all applicable certificate of need criteria.

Thank you for the opportunity to provide this ?nal comment. We have appreciated the
Certi?cate of Needs support throughout this process, and look forward to working with you to
make this much needed project a reality.

Sincerely,

Martina 826%
Chief Development Officer

32 East 57th Street
17th Floor
New York, New York 10022
212.243.5565 - 212.243.1099


REBUTTAL
TO
CERTIFICATE OF NEED APPLICATION
PROPOSING TO
ESTABLISH A 70 BED PSYCHIATRIC HOSPITAL
IN
WHATCOM COUNTY
August 3, 2018

 1. Introduction, Context and Affected Persons:
In June 2017, US HealthVest (USHV) submitted a certificate of need application to address the
demonstrated unmet need for psychiatric beds in Whatcom and Skagit Counties. The application
proposes a 70-bed psychiatric hospital which will be located in Bellingham. The hospital, which
will be named Whatcom Behavioral Health, will serve residents of Whatcom and Skagit
Counties age 5+. It is scheduled to open in January 2020.
The application was declared complete and placed under review in May 2018. A public hearing
was requested and held on July 19, 2018. Consistent with WAC, this document provides
UHSV’s final rebuttal.
The public record contains nearly 60, largely personalized letters of support. All but a very few
are in strong support of the new hospital. Many tell personal stories of efforts to secure needed
treatment for a family member. Others are from professionals and social service providers
expressing near exasperation about the lack of resources in the County, and the impact that lack
has on the families they serve.
In addition, more than 80 persons signed in at the public hearing. Only three persons signed in as
“opposed”. Two of these individuals identified their addresses as Renton and Seattle; well
outside of the service area. Both of these individuals are employed by SEIU 1199; one Edon
Misgina as a Union Organizer and the other, Rachel Ersted as a Research Analyst. Copies of
their LinkedIn profiles are included as Attachment 1. Finally, a letter of opposition was
submitted by Christina Perry, a former Smokey Point employee, regarding concerns related to
staff and patient safety. These issues were resolved following the March 2018 Department of
Health survey.
Thirty-two persons testified at the hearing, with the vast majority overwhelmingly in support of
the new hospital. One testifier, representing the Whatcom County Health Department identified
great need, but sought assurance from the CN Program that the State’s Medicaid funding for the
proposed hospital will not jeopardize funding for their proposed Evaluation and Treatment
(ENT) facility. The Health Department requested that the Department communicate with the
Governor’s Office to assure consistency with the Governor’s vision of psychiatric services. For
the record, USHV reminds the CN Program that in July of 2017, only 12 months ago, Governor
Inslee was the keynote speaker at the opening of our Smokey Point Behavioral Hospital opening.
Governor Inslee is a strong supporter of our model and its role in the delivery system. A
YouTube video of his comment can be viewed at
https://www.youtube.com/watch?v=MgdNjkI6qoM

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 The only other substantive opposition came from SEIU 1199NW. Here, the record must reflect
that SEIU’s likely motivation is to advance its organizing effort at our Smokey Point hospital.
SEIU orchestrated an employee complaint that triggered a complaint survey in March 2018.
100% of the issues raised in the survey were addressed to the satisfaction of state surveyors, and,
since opening, Smokey Point has, at all times, followed all federal and state requirements. The
record should also reflect that SEIU is targeting behavioral health hospitals. Its on-line blog
includes a photo of it picketing at Navos. Navos is a King County safety net provider, dedicated
to caring largely for the Medicaid population. A copy of the blog page can be found at
Attachment 2.
Per WAC, rebuttal is limited to affected persons. SEIU does not meet the definition of an
affected party (nor an interested party). Any rebuttal comment it submits must be rejected.
WAC 246-310-160 guides the regular review process and states:
(1) The regular review process shall not exceed ninety days from the beginning of the
review period and shall be conducted in accordance with this section unless the review period is
extended in accordance with the provisions of subsection (2) of this section.
(a) The public comment period shall be limited to forty-five days. The first thirty-five
days of the public comment period shall be reserved for receiving public comments and
conducting a public hearing, if requested. The remaining ten days shall be reserved for the
applicant to provide rebuttal statements to written or oral statements submitted during the first
thirty-five day period. Any affected person shall also be provided the opportunity to provide
rebuttal statements to written or oral statements submitted during the first thirty-five day
period.
Under WAC 246-310-010(34), an “interested person” is defined to include only certain persons,
including competing health care facilities in the service area, residents of the area served, and
persons who regularly use health care facilities in the area served. “Affected persons” are a
subset of interested persons who are located or reside in the service area, testify or submit
evidence during the public hearing and comment period, and request to be informed of the
resulting decision, per WAC 246-310-010(2). Interested and affected persons do not include
individuals who are merely employed by providers within the service area; nor do they include
organizations such as labor unions that represent such employees. SEIU 1199NW is not a
healthcare provider or other qualifying interested or affected person as defined in WAC 246-310010.

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 2. The Project Enjoys Exceptionally Strong and Widespread Support
The project received nearly 60 personalized and compelling letters describing the magnitude and
the extent of the unmet need in the service area. Support came from patients and families,
physicians and mid-level providers, mental health providers (MSWs, LICSW, PhD, LMHA,
CMHS, MAs), Bellingham Whatcom County Housing Authorities, Sea Mar Community Health
Centers, a number of school districts, Nooksack and Stillaguamish Indian Tribes, the City of
Bellingham Mayor, NAMI, Skagit Regional Health, religious organizations, skilled nursing
providers and Whatcom Community College. Excerpts from the letters are included below:
I am writing on behalf of Associates in Mental Health. Our group was
founded in 1993 and currently consists of 25 masters and PhD level
therapists. We are proud to be serving Bellingham and the surrounding
area, and feel we have a great sense of the mental health needs within our
region. There is much support for a local inpatient psychiatric hospital,
both as a resource and a partner in meeting the mental health needs of
our citizens.
We were interested to hear about US HealthVest's plan to expand
behavioral health services in our area by opening a new hospital in
Bellingham. We are supporting this application for a certificate of need
because of the lack of access to inpatient behavioral health care in om
community. There is a necessity to expand behavioral health services in
Whatcom County, especially inpatient and crisis services, and we would
welcome this hospital in our community.
Associates in Mental Health, June 12, 2018 letter signed by 25 members

When I first moved to Bellingham there was an inpatient facility, the Martin Center,
where I had hoped to work, and it closed as well. I worked instead at the Whatcom
County Triage Center, a short term option…. Frequently, there were situations where
clients would have preferred a voluntary inpatient hospitalization, but the beds and
resources are not available in Whatcom County. We also experienced situations where
the triage center was used as an alternative for inpatient hospitalization, although we
did not have the staffing or extent of resources many of these clients needed.
Currently, in my private practice setting, I have received referrals from Peace Health
for adolescents following serious suicide attempts and discharge from the ER, when an
inpatient hospitalization would have helped them to stabilize more quickly and receive
the 24 support that was needed at the time. An inpatient psychiatric hospital in
Bellingham would strengthen our community mental health resources, and I believe it
would be utilized by residents not only from Whatcom and Skagit County, but from
communities throughout the state.
Barbara Overson MS, LMHC, CMHS, BCB
Associates in Mental Health

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 Building this hospital in Whatcom county would be a step in the right direction
and it's time to do the right thing for the people here in Northwestern
Washington. This proposed hospital would include services for children as young
as 5 years old, which would allow their families to be close by to aid in their
recovery, something that is much harder to do from hundreds of miles away. As
well as serving the youth population, this proposed center would also meet the
unique and specialized needs of women and the geriatric population. In addition,
Whatcom county and the surrounding areas are in great need of Substance Abuse
support and Whatcom Behavioral Hospital would be an integral tool in
stabilizing folks with addiction and psychiatric issues so they can get the help
they need.
It is for all these reasons that I support the proposal to build Whatcom
Behavioral Hospital.
Brandie Lourenco MA LMCHA
I am writing in support of US HealthVest's plan to expand behavioral health
services…..
As a provider of affordable housing for lower income households we see the
evidence of unmet treatment needs every day, both among too many of our
residents and among our homeless population. Untreated mental health and
substance abuse issues are a primary cause of housing instability and
homelessness. It's heartbreaking to watch folks who are struggling to hold their
lives together without access to adequate support spiral downwards, often losing
their children and their homes.
Brien Thane, Director Asset Development, Bellingham Whatcom County Housing
Authorities
I am supporting this application because I see critical need for psychiatric care.
Families in our community experiencing mental health crisis have difficulty
getting the help they need. Local treatment is too often deferred or denied, or
families must travel far to access care. Convenient access to inpatient mental
health care in the region is critically important for the overall health and
wellbeing of any community. The provision of accessible inpatient psychiatric
inpatient beds in the area is of vital importance without which, would negatively
impact the continuity of care patients receive with local healthcare providers and
law enforcement.
Christin McCausland, Case Manager, Sea Mar Behavioral Health

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 Over the past several years, our school district and others in the region have
seen an increase in the number of elementary-age children with serious
behavioral and emotional issues in our classrooms. Often times these children
come to us with a history of multiple adverse childhood experiences and act
out in ways that threaten the safety of staff and other students. The lack of
accessible mental health resources to stabilize, diagnose, and plan for these
children's needs leads to a cycle of exclusion and escalation.
Carl Bruner, Ed.D, Superintendent
I am writing in support of US HealthVest's Certificate of Need
application to expand behavioral health services in Whatcom
County….
We have found the Behavior Hospital at Smokey Point to be a great
resource for our community as it is local and can serve as an
outpatient facility as well. This facility has served our community
from its inception. We look forward to having an additional facility
in Whatcom County and one able to accept younger patients.
Dr. Lloy Schaaf
Assistant Superintendent, Stanwood Camano School District
I have worked within the behavioral health system for the past 10 years and have been a
psychiatric nurse practitioner in the state of Washington for the past five years, working
for both inpatient and outpatient organizations. I have worked with individuals in
inpatient care who have had to travel five hours for psychiatric stabilization, removing
the person from close vicinity to their families and friends who are the closest support to
the individual. Majority of the time, individuals are placed in emergency departments
and waiting to be assessed for several hours, which further creates distress for the
individual, but also the emergency department staff. Establishing a psychiatric hospital
north of Snohomish County would create quicker access to mental health care and
minimizing the gaps for treatment.
I urge you to approve this certificate of need application. Thank you for addressing the
issues of access to care for people in our community who need inpatient psychiatric
and/or substance use disorder services.
Edward Ebert, ARNP

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 I have been in practice since 2007, seeing clients in both Island and Whatcom
counties. We are in desperate need of inpatient beds and IOP services, particularly
for youth and marginalized populations. At the moment, the closest behavioral
hospital is in Smokey Point, which is over an hour drive away from Bellingham,
where my practice is now. Smokey Point Behavioral Hospital is an amazing facility
and was needed desperately - AND it's still not enough. Clients from Whatcom are
unable to participate in family treatment, as the drive is prohibitive, both due to time
and cost, including lost wages. Lake Whatcom house, which is closer, is often not
reachable. They do not answer phone calls or return messages and clients with
presumed bed dates show up only to be turned away and told they have no beds. They
are overwhelmed.
I have sent clients all over the state of Washington, and to Oregon and Idaho to
substance abuse treatment and trauma-informed co-occurring programs. I've seen
clients lose pets, housing, jobs, vehicles, and more due to needing treatment that
requires them to be out of state. Their lives are further interrupted and thus recovery is
that much harder when support and services are not available in their home counties
and towns. This increases the likelihood of relapse and therefore harm to clients.
Heather MC Brown, LMHC Green Light Counseling
I am encouraged to hear about USHealthVest's plan to expand behavioral health
services by building a new behavioral hospital in Bellingham, WA. I support the
expansion of these services because of the lack of access to quality inpatient
behavioral health care in our community. We have been working with
PeaceHealth to ensure a continuum of mental health services to our residents and
support additional options.
There are currently only five beds in Whatcom County's Crisis Triage Center to
serve clients facing acute mental health concerns with plans to increase to 16
beds, which is still sorely inadequate for a community of our size. Increased
capacity for behavioral health services will allow local law enforcement and
healthcare personnel to offer more options to individuals they encounter who have
acute behavioral health concerns, providing a better alternative than
incarceration and linking those individuals to appropriate care…..
Kelli Linville, Mayor, City of Bellingham
….There is a necessity to expand behavioral health services in Whatcom County and I
would welcome this hospital in our community.
As a family member of a young adult who needed 9 weeks inpatient treatment at the
age of 12 I understand the difficulties, both financial and emotional, involved whe11
a child's only access to treatment is 100 miles away. In my case, I had to make the
decision to leave the family residence and another school-aged child at home so I
could support in my daughter's treatment in Seattle.

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 As a NAMI Family Support Group facilitator and NAMI Family-to-Family teacher, I
have heard too many times about the difficulty of obtaining treatment in Whatcom
county. Not all families have the resources to travel and support loved ones who are
hospitalized out of the county. This deprives individuals who are sick and suffering of
the supp01t that they need to get well.
Kim Sauter, Director, NAMI Whatcom
I have practiced in Bellingham for over 36 years as a clinical psychologist with the
community psychiatric clinic (Whatcom Counseling and Psychiatnc Clinic prior to it
being Compass Health) and then independently. For 16 years I was the CEO of
Associates in Mental Health, the longest established group of mental health
professionals in Whatcom County. It has been an extremely frustrating experience
trying to place mental health patients in local, hospital based inpatient treatment
centers because of the limited psychiatric beds available. Almost all of my referrals are
sent to Seattle, 100 miles away, when there is a bed available, which puts undue stress
on the patients' families because of the cost of travel and the need to take off of work to
visit patients. Currently there are no local facilities for children to be treated for mental
health disorders. My area of specialization for over 40 years has been eating disorders
often co-morbid with anxiety, OCD and depression and to receive inpatient treatment
for this my patients are often referred out of State.
Richard Spitzer, Ph.D, Clinical Psychologist
I am writing in support of US HealthVest's Certificate of Need application to expand
behavioral health services in Whatcom County…
It has been almost one year since their facility in Smokey Point opened up and they
have been a real positive assist [asset] to our community. We meet and collaborate
with them regularly and they have helped to take care of the mental health population
in our area which has been previously underserved.
Michelle Sand, MSN, RN, NEA·BC, VP /CNO, Skagit Regional Health
Our church deals with more and more people who need advanced mental health care.
A recent influx in calls for care, help and intervention have shown us the critical
shortage for this need. CTK fully supports the need for this critical service.
Pastor Grant Fishbook, Lead Teaching Pastor, Christ the King Church

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 I moved to Bellingham almost two years ago and work in the role of Director of Nursing
Services; I have been stunned by the lack of mental health services available in
Whatcom County. The extremely limited number of geriatric psychiatric beds is
detrimental to the community I serve. I am aware of many instances when our fragile,
elderly residents are kept in the emergency department, of the only hospital in
Bellingham, due to a lack of geriatric psychiatric beds. Psychiatric services are not
provided while they are in the emergency department and we receive phone calls almost
daily attempting to transfer them back to the facility without any medical intervention to
stabilize them. If a geriatric psych bed is located it is often down south an hour or
greater driving distance which is a hardship for loved ones; many spouses of our
residents are elderly and fragile themselves.
Patricia K, Kimmel, RN Director of Nursing Services St. Francis of Bellingham
I've been in private practice working with children and adults In What.com County
for approximately 4 years. In that time, I have sent numerous clients to the ER or
had their parents accompany them to the ER for suicidal ideation and/or gestures
as they were a threat to themselves and sometimes others. In every single instance,
clients and their families were told by ER workers, DMHPs or hospital social
workers, that there were no beds available for Inpatient psychiatric services that
would support their crisis level of need. in at least 3 instances, this "wait it out"
approach to teen suicidal gestures/ideation has ended in a loss of rapport between
this therapist and the client due to an inability to support the level of need and an
overall dissatisfaction with crisis mental health services in Whatcom county. Loss
of support during a crisis can not only be detrimental but potentially deadly.
Despite brainstorming with onsite ER staff, in every instance, no accommodations
were offered because all beds were filled statewide. Thankfully, to my knowledge,
none of the lives of my clients have been lost but it is simply a matter of time as
the need for crisis services is not being met in our community or even in nearby
communities. For my most vulnerable clients, I have worked diligently to connect
them with residential care out of state, so that their needs can best be met.
Tracie Smith, LMHC, ATR-BC, CCTP Licensed Mental Health Counselor Board
Certified Art Therapist Certified Clinical Trauma Professional, Private Practice
The proposed 70-bed psychiatric hospital will help provide much-needed psychiatric
services in our community. WCC is pleased with US HealthVest's stated commitment to
serve those in need regardless of ability to pay.

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 National research indicates that mental illness is on the rise on college campuses.
Communities such as ours lack appropriate levels of resources and services to address
mental health needs of students. At Whatcom, our Behavioral Intervention Team refers
students in crisis to the PeaceHealth St. Joseph emergency room, or psychiatric
assessment several times a year (3-9 students per year is typical). Regularly, students
are sent home under dire circumstances, and told to contact a non-emergency provider
because they are not in immediate danger of harming themselves. Having additional
psychiatric services would greatly improve our community's ability to care for
individuals needing urgent assistance, here in their own community.
WCC understands the increasing need for behavioral health services. In 2017, the
College began a chemical dependency professional certification program for licensed
professionals currently working in the mental health field. In the fall of 2018, the
College will begin to offer a Chemical Dependency Professional Associate in Science
(AS) degree and certificate program. WCC hopes that Whatcom Behavioral Health will
become a valued partner as a clinical site for our students, as a partner on college
advisory committees and supporter of our programs.
Dr. Kathi Hiyane-Brown, Ed.D, President
Mental Health Treatment in this community is lacking. Our community will reap the
benefits of the proposed facility. This 70-bed hospital will only skim the surface of
Whatcom Counties mental health needs, but it is a start. Without mental health hospitals
and treatment facilities people will continue to suffer, suicide rates will rise,
unemployment will surge, the homeless community will increase, and our jails will
continue to be overcrowded with people who don't belong there. The proposed hospital is
a ray of hope to assist a population that is unfortunately rapidly growing in our
community.
Robyn Gustafson
Our son was 17 and a senior in high school when he had his first psychotic break. In
order to receive an evaluation and initial treatment, he was sent to Fairfax Hospital
in Kirkland, an hour and 45 minute drive from our home. When he was released we
were unable to locate a youth psychiatrist in our area for continuing care.
A second break occurred about 10 months later, when our son was 18 but did not have
a diagnosis yet. While attempting to have him evaluated at the only current local
hospital he acted up and an emergency room technician called the police and he was
arrested. While in custody his condition deteriorated and a judge ordered a mental
evaluation and treatment, to which the prosecutor added that he was not to leave
Whatcom County for treatment. As the same local hospital that provides emergency
care has limited behavioral health care and didn't have any beds available, our son
spent 2 weeks locked in a cell until he could be released.
David Parker and Valerie Lyon-Parker Members of NAMI Whatcom

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 Throughout the past 8 years working in this community we have experienced a massive
shortage of beds when our youth and adults are in need of a higher level of behavioral
health care treatment. Currently, our resources are not adequate and the break downs
within the fabric of our system are a huge liability and safety concern.
One example, is that when we have had suicidal youth they have often been told they
have to travel to Yakima to get inpatient services when they are acutely suicidal. Most
families do not have the economic resources to travel there or to the Seattle area to
access the higher level of care they need. Many cannot afford the gas nor do they have
vehicles that can make it long distances; furthermore, our public transportation system
is inadequate. Often, the resources (i.e., adolescent inpatient facilities) in the Seattle
area have told us "we have one bed left but we are saving it for someone in our
county," even after begging that they admit the acutely suicidal youth we are calling
with. The youth in our county do not have inpatient access to behavioral health services
when they require a higher level of care. Very often they go without the treatment they
need and deserve. With rising suicidal ideation, intent and plans we are in the middle of
a behavioral health crisis, state of emergency and impending youth suicide epidemic if
something does not change immediately.
Dr. Erika Creydt, MA, PsyD, LMHC, Clinical Director, Touchstone
Behavioral Health
I have been providing mental health services in Whatcom and Skagit Counties since the
late 90's and I have witnessed first-hand how connecting with emergency psychiatric
care or substance abuse care for my patients is quite challenging at best. St. Joseph's
Hospital is often full and many of my patients have had to wait for hours in the ER to be
evaluated and then turned away for lack of available beds, They do their best to
accommodate the vast needs but unfortunately the needs often outweigh the availability
of inpatient services here in Whatcom County.
There have been times when my patients have been discharged and sent home which
was clearly a poor clinical decision. There was even one time when one of my patients
agreed to be transported from my therapy office to the ER by a kind Law Enforcement
Officer, unfortunately it was 12 hours later that I finally connected with the physician
who was in King County and had not ever seen him, but she determined that my patient
was "embellishing" and “malingering” was clearly not the issue. Needless to say, I had
quite a spirited discussion with this physician who clearly did not have the best interest
of my patient in mind. I advocated for him whom I had worked with for years. He was a
Veteran and I knew at his symptoms were authentic and he was truly in a very serious
decline psychiatrically. Thankfully the doctor heard my plea and finally relented. My
patient was hospitalized for two weeks for stabilization due to the severity of his mental
health issues. This was the correct clinical decision.
Bridget C. Cantrell, Ph.D, Cantrell Counseling & Associates, Inc.

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 I have been working in the Mental Health field in Snohomish County for over 30
years. Just as in Whatcom County, our area was also very short on resources of
hospitalization for psychiatric needs. The HealthVest facility that was opened ln
Snohomish County has filled a huge void by providing the crucial services they are
now hoping to replicate in Whatcom County. Representatives from HealthVest
worked with myself and others from a local Native Tribe where I previously worked.
They were willing to listen and implement culturally appropriate recommendations.
It was an interactive, respectful and responsive experience. The availability of this
resource in the local area has been invaluable for a long unmet need. In addition,
having a resource so local has improved client care as many people do not want to
go so far from home or their community that family is unable to visit. The Tribal
community is very connected locally and as such having a local resource has
increased the access to appropriate quality care.
Lori Hartelius MS LMHC CMHS MHP Director of Health Services Stlllaguamish, Tribe
of Indians

3. The Health Department’s Comments are Misguided: This Project is
Consistent with Policy Intent and will Support and Enhance the
Delivery System.
In its public comments, the Whatcom County Health Department raises several concerns
involving the availability of public funding for psychiatric services. Those concerns are mistaken
and misguided. Washington’s mental health system faces a variety of challenges presently and in
the years ahead, including the need to expand access to both institutional and community-based
care. The need for a multi-pronged approach to improving care and access for patients in the
Whatcom-Skagit service area does not provide any basis for delaying or blocking a project that
will serve the undeniable need for inpatient services in the region.
As an initial matter, the Health Department expresses concerns about the classification of
Whatcom Behavioral Health as an Institution for Mental Diseases (IMD), which will restrict the
availability of certain federal funding. The Health Department is correct that Section 1905(a)(B)
of the Social Security Act prohibits certain federal “payments with respect to care or services for
any individual who has not attained 65 years of age and who is a patient in an institution for
mental diseases” except for “individuals under age 21.” That restriction is nothing new; the IMD
exclusion dates to the advent of Medicaid in 1965. The CN Program has never used the IMD
exclusion as a reason to block inpatient psychiatric hospital projects. Nor should it: while small
facilities have certain areas of strength, larger psychiatric hospitals have a number of advantages
over smaller facilities, including both programmatic advantages (for instance, the ability to
maintain separate specialized programs, more tailored group therapy sessions, etc.) and
economies of scale (for instance, lower administrative costs per patient, the ability to have
specialized staff for various patient populations, etc.). While the source of patient payments is
clearly germane to a CN application, USHV has already fully explained the expected payor
sources for its services at Whatcom Behavioral Health, including the expected portion of
Medicaid revenues.

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 The Health Department’s comments also obscure the availability of Medicaid services for many
patients age 21 to 64 through Medicaid managed care. The Legislature properly budgets for state
dollars to fund appropriate services in psychiatric facilities classified as IMDs, through the
regional behavioral health organizations (BHOs) contracted to administer those programs. 1 In
fact the state is actively seeking to expand such services, and federal funding for those services,
through the Medicaid waiver program. 2 Long term civil inpatient services will also be integrated
into the managed care Medicaid model beginning in 2020 in a manner that maximizes the
available federal funds. 3 The State’s expanding reliance on managed Medicaid helps to reduce
the burden of inflexible federal rules such as the IMD exclusion, thus ensuring access to care for
all Medicaid recipients across the entire continuum of care.
In fact, USHV’s existing hospital at Smokey Point is serving a larger Medicaid patient
population than we had projected, pointing to both the striking need for such services and the
availability of funding to meet the need. USHV has demonstrated an ongoing commitment to
provide quality care to vulnerable patient populations including persons with mental illness
generally as well as children, seniors, veterans, and low-income individuals in particular.
The Health Department’s stated concern that Whatcom Behavioral Health will require state
funding for its ITA services is particularly counterproductive. The statewide need for ITA
services has been well-recognized for several years, and is well attested in the record. Whatcom
service area patients are often held in community beds awaiting available ITA placement, and
transferred long distances outside the service area for involuntary stays. The State’s duty and
commitment to provide proper treatment to involuntarily detained persons does of course require
that adequate resources be made available for those services. There is no evidence to support the
Health Department’s speculation that ITA services will come at the expense of other mental
health funding. USHV’s application fully supports that ITA services will be provided in a
manner that meets CN criteria.
The Health Department also raises a concern that USHV’s construction of a new psychiatric
hospital might interfere with the County’s planned construction of 16-bed units in a triage
facility. Funding for “new crisis triage or stabilization centers” has been funded by the
Legislature through a mix of state and federal dollars. 4 USHV’s private funding for the
construction of Whatcom Behavioral Health will not interfere with the availability of state
funding. Nor is expanding access to services a zero-sum game: to the extent that the Legislature
may need to expand Medicaid funding in future biennia to ensure full funding for the utilization
of services, that need simply reflects the current crisis in which residents have no access to the
services they need. Given that the State is currently seeking to expand access in IMDs, smaller
facilities, and community-based care, there is no reason to believe that the Medicaid program’s
funding will not be adjusted accordingly when those new services come online.

1

See Laws of 2017, 3d sp.s. c 1 (SSB 5883, 2017-19 Operating Budget), §204(1)(f) and (g).
Laws of 2018 c 299 (ESSB 6032, 2018 Supplemental Operating Budget), §204(1)(e).
3
Laws of 2017, 3d sp.s. c 1 (SSB 5883, 2017-19 Operating Budget), §130(9).
4
Laws of 2017, 3d sp.s. c 1 (SSB 5883, 2017-19 Operating Budget), §204(1)(e).
2

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 The Health Department notes recent policy proposals around smaller behavioral health facilities.
But contrary to the basic thrust of those comments, the public policy of Washington is in fact to
support the expansion of access to inpatient and residential treatment in IMDs. Earlier this year
the Washington Health Care Authority applied for an amended waiver for its Medicaid
Transformation Project specifically for the purpose of expanding access to IMDs to treat
substance abuse. 5 As HCA stated in the cover letter to its amendment request, “Medicaid
beneficiaries need more access to residential and inpatient treatment, not less,” and the State’s
goal is thus to “encourage expansion of bed capacity[.]” Those public policy goals are fully in
line with USHV’s application.
Finally, the Health Department expresses concern that Whatcom Behavioral Health will add to
the need for mental health jobs in the area. Given the statewide need for expanded access to
mental health services, staffing new facilities is an inevitable challenge. However, USHV’s
application adequately addresses staffing and the plans to attract and train staff to provide the
necessary care. Those plans were further buttressed by the public comments, which emphasized
both the ability of USHV to attract talent from outside the state and the ability of local
educational institutions to provide training to the local workforce (see earlier excerpt from the
letter of support from Kathi Hiyane-Brown, President of Whatcom Community College).
Whatcom Community College has established a certification program for chemical dependency
professionals and will add an associate degree and certification program in the fall. Those
programs will provide additional sources of qualified local personnel for Whatcom Behavioral
Health.

4. SEIU’s Issues Relate Solely to its Intent to Organize USHV’s Smokey
Point Behavioral Hospital. Many of the issues raised by SEIU were
inaccurate.6 The Issues from the Complaint Survey that SEIU
Orchestrated have been Addressed. Patients Were Never at Risk.
SEIU’s concerns can be categorized as falling into three areas: a recent state and federal survey,
financial issues, and employee issues.
 Survey and Plan of Correction
As SEIU notes, in March 2018, a Department of Health survey team conducted a simultaneous
federal Medicare survey and state health and safety licensing survey at USHV’s existing facility
in Washington, Smokey Point Behavioral Hospital. That survey was Smokey Point’s first annual
survey, and also included an assessment of an anonymous complaint. The surveyors issued two
findings of immediate jeopardy, both of which were resolved and removed prior to survey exit.

5

Healthier Washington Medicaid Transformation Section 1115 Waiver Amendment Request (March 2, 2018),
online at https://www.medicaid.gov/Medicaid-CHIP-Program-Information/ByTopics/Waivers/1115/downloads/wa/wa-medicaid-transformation-pa2.pdf.
6
Notably, the complaints footnoted on pages 6-7 (Footnote #10: Case 2018-2627, Footnote #12: 2018-4525,
Footnote #13: 2018-2841, Footnote #19: 2018-2823) have not been received by Smokey Point Behavioral Hospital
and were not placed in the record by SEIU.

14   P a g e

 The survey was completed on March 15. State and federal Form 2567 statements of alleged
deficiencies were issued on April 12.
On April 20, Smokey Point completed and submitted its plan of correction addressing each of the
alleged deficiencies, detailing how each deficiency would be resolved and how future
compliance with state and federal regulations would be monitored to prevent recurrence. The
Department and the Centers for Medicare and Medicaid Services accepted Smokey Point’s plan
of correction. The plan was fully implemented and all alleged deficiencies fully resolved by
May 23, 2018. At the date of writing, Smokey Point’s license is in good standing and the hospital
is in substantial compliance with all state and federal regulatory requirements.
 Financial issues
SEIU raised issues related to financial reporting. As the CN Program is aware, Smokey Point
Behavioral Hospital opened just over a year ago. As such, the hospital is in the process of
finalizing all year end reporting to the Department of Health including quarterly and year end
filings. In addition, related to the rate of cost to charges referenced in the SEIU public comment
submittal, USHV notes for the record that two of the five hospitals referenced are very highly
Medicaid and a 3rd has both detox and psychiatric beds. The most comparable hospital to
Smokey Point is Fairfax Hospital and its cost to charge ratio is lower than Smokey Point’s.
USHV will be filing its reports and intends to be fully transparent. Finally, Smokey Point did
agree to a charity care condition on its certificate of need and is following its Department of
Health approved charity care policy. USHV believes that the CN Program will conclude that
these arguments have no merit.
 Employee issues
On page 6 of its comments (Issue #7), SEIU alleges that NLRB “is investigating [Smokey Point]
for the wrongful termination of three . . . employees.” We respectfully disagree with the
allegations and SEIU’s description thereof. However, US HealthVest notes that it has reached a
settlement agreement with the three named employees. These employees accepted a monetary
payment in lieu of reinstatement to their positions.

5. Closing
USHV believes that upon review of the all of the materials, in particular, the letters of support
submitted to date, the CN Program will conclude that need for the proposed Whatcom
Behavioral Hospital has been demonstrated and that USHV is best positioned to meet this need.
In fact, USHV’s proposal will meet or exceed all CN requirements. Furthermore, is prepared, as
it has done in other community’s to etablish a community advisory board.

15   P a g e

 Attachment 1
LinkedIn profiles for Edon Misgina and Rachel Ersted

Eden Misgina
Lead Organizer at SEIU Healthcare 1199NW

Summary
N/A

Experience
Organizer at SEIU Healthcare 1199NW

Page 1

 El H.

Lead Organizer at SEIU Healthcare 1199NW

Linked 

Contact Eden on Linkedln

Page 2

Rachel Ersted
Treasury at Stripe

Summary
Treasury Analyst, Stripe   UC Berkeley '14, BA Economics   2013 NCAA Division I Varsity 8+
National Champion   2013 First-Team All-American   Three-Time PAC-10/PAC-12 Individual and
Team Champion

Experience
Treasury Analyst at Stripe
May 2018  -  Present
Senior Treasury Analyst at Box
September 2015  -  May 2018 (2 years 9 months)
Part of a team of two that monitored Box’s cash, foreign exchange movements, and capital
structure. I was responsible for managing our global bank accounts, cash management banking
relationships, and related international expansion activities.
Projects:
~ Draft and implement FY19 investment strategy
~ Manage global corporate card program
~ Pricing and FX related risk monitoring for new online sales currencies
~ Implemented new payment processor internationally
~ Monthly and quarterly SOX and debt compliance activities
~ Daily cash positioning and automation
~ Manage global travel for 1800+ employees, recognizing 10% in annual savings
Promoted to Senior Treasury Analyst, April 2017
Technical Sourcer & Recruiter at Box
June 2013  -  September 2015 (2 years 4 months)
Technical Sourcer & Recruiter: June 2014 - September 2015
Recruiting Intern: June 2013 - May 2014

Page 1

 Education

University of California, Berkeley
BA, Economics, 2010 - 2014
Activities and Societies: Cal Varsity Women's Rowing Team, Alpha Chi Omega
Palo Alto High School
2006 - 2010

Honors and Awards

Varsity Coxswain, Cal Varsity Women's Rowing, Coxswain, NorCal Crew Team

Page 2

 Rlid??l

Treasury at Stripe

 

Linked 

Contact Rachel on Linkedln

Page 3

Attachment 2
Image from SEIU 1199NW Blog

 SEIUHea/thcarem Ports-L
Umted for Quality Care