Cambia Hills of East Bethel, one of the few intensive mental health treatment facilities in Minnesota for high-risk adolescents, abruptly announced this week that it would shut its doors Friday.
The facility, which has struggled since opening during the start of the COVID-19 pandemic and has been cited by state regulators for licensing violations, said it had not received a requested rate increase from the Minnesota Department of Human Services to continue operations.
"We can't continue without some sort of emergency funding," said Leslie Chaplin, chief executive of the facility's parent corporation. "We did not have any other options because I can't ... pay people to work."
Cambia Hills is one of only two psychiatric residential treatment facilities licensed for children in Minnesota. It was designed to provide intensive treatment for children that bridges the gap between outpatient care and hospitalization.
"These are kids with extremely high needs," said Sue Abderholden, executive director of NAMI Minnesota. "I don't know what they expect these families to do. Once again families are left in the lurch with no options for their kids."
The closure comes as Minnesota hospitals report a surge in emergency department visits from children in psychiatric distress, partly due to the stress brought on by the pandemic.
Some are held for days or even weeks before they can be admitted to a hospital or a treatment facility.
DHS funds most of the care provided at Cambia Hills as private insurers generally do not cover most stays at the facility.
Chaplin said state payments were too low to cover treatment costs and she could not get a commitment from the agency about what its future rates would be.
Transition plans are being made for existing patients, Chaplin said.
"Some of them are going home," she said. "We were able to work with some of our local community health providers to make sure that kids have support at home."
DHS said it worked with Cambia Hills to make arrangements for the remaining residents.
Those plans will be completed before the facility closes.
"By providing only two days' notice of intent to close, Cambia Hills is violating its obligations under its license and state contract," said Gertrude Matemba-Mutasa, an assistant commissioner at DHS.
Chaplin acknowledged that Cambia Hills should have provided a 27-day notice of closure, but said that bondholders had reached the $1.5 million limit in emergency funding and would not provide any more money given the uncertainty about payment rates.
"We hoped we would have a couple of months, for sure at least one month, to do some calm and timely communication and work on some really detailed transition plans for kids," she said.
Cambia Hills was operating under a settlement agreement with DHS regulators that required ongoing monitoring of its operations.
The agreement came after the facility had been cited for several violations of state regulations.
"We certainly had a lot of mistakes," said Chaplin, who was hired after a management shake-up. "I had to clean up a lot of mistakes."
At one point last year, the Minnesota Department of Health, which also regulates the facility, threatened to stop all state and federal Medicaid funding after Cambia Hills failed to disclose that one resident had been taken to the hospital due to significant blood loss after attempting suicide.
Funding was not interrupted after Cambia agreed to adhere to reporting requirements.
It is unclear what Cambia Hill's closure will mean for the future of psychiatric residential treatment facilities for children in Minnesota.
Chaplin said the low payment rates and bureaucratic red tape makes operating such facilities difficult.
"The system that has been created by DHS is now unworkable," Chaplin said.
DHS said it hopes that new treatment facilities will be established.
"While this situation is unfortunate, it does not diminish the need for psychiatric residential treatment facilities, nor does it lessen our commitment to see this level of care become available to more Minnesota children," Matemba-Mutasa said.
Kirsten Anderson, executive director at AspireMN, an association of mental health providers, said at least two residential treatment programs are working to become licensed in the state as psychiatric treatment facilities, which require more staffing and medical direction by psychiatrists.
"The two providers who are anticipating to open are receiving daily phone calls even though they are not open to this level of care," Anderson said.
She added that there are still many gaps in Minnesota's mental health care system for children, including inpatient capacity, residential treatment and community care.
"We have a crisis in all of these levels of care," she said. "We will continue to press forward to build the continuum that we need."
Friday's closure of Cambia Hills comes after slightly more than one year of operation, ending a long road that started in 2017 when the center was first proposed and plans were made to locate in Forest Lake.
In 2018, the Forest Lake City Council rejected the proposal. Eventually the $26 million, 60-bed facility was constructed in East Bethel, but it initially opened with 35 patients due to pandemic restrictions.
Parent company Hills Youth and Family Services in Duluth operates a residential treatment program as well as a juvenile justice program, but it could face regulatory trouble for closing Cambia Hills without sufficient notice. The nonprofit's finances have also taken a hit, Chaplin said.
Glenn Howatt • 612-673-7192