A roughly decade-long billing disagreement between Park County commissioners and the Powell and Cody hospitals will continue for at least another two weeks.

Closed-door meetings with hospital officials on Tuesday yielded no agreements on how much the county owes the hospitals for indigent patients committed against their will.

Commissioners met with officials from West Park Hospital for about an hour-and-a-half and with those from Powell Valley Healthcare for about a half-hour, all without attorneys.

Commission Chairman Tim French had previously said he expected agreements to be finalized at Tuesday’s meeting, but now thinks deals should be in place by the commission’s June 19 meeting.

“We’re very close. We’re just trying to tweak it a little bit,” French said.

The emergency detentions in question take place when individuals are deemed by a law enforcement officer or mental health professional to be a danger to themselves or others because of mental illness. Title 25 of Wyoming law says that within 72 hours of being committed, excepting holidays and weekends, an individual must be given a hearing before a judge to determine whether they should continue to be detained.

Counties come into the equation because Title 25 requires them to pick up the cost of an individual’s care prior to that first hearing if the patient can’t pay for it.

Powell Valley Healthcare presented commissioners a proposal approved unanimously by the PVHC board at its May 29 meeting.

The proposed agreement calls for the county to pay the hospital a lump sum of $275,000 to cover bills dating back to 2002.

PVHC Chief Executive Officer Bill Patten said the county’s outstanding bill from Powell Valley Healthcare now stands at more than $500,000.

In the future, Powell Valley Healthcare would bill the county $1,000 daily for involuntary hospitalizations, with a $3,000 maximum per episode of care through Title 25. Costs incurred for treating those patients’ medical conditions, as allowed by Wyoming statute, would be billed in addition to the flat rate, the proposal says.

Under the proposed agreement, Powell Valley Healthcare would waive claims to bills for additional days of services for holidays and weekends beyond the first 72 hours of service.

The agreement would last for at least three years, at which point it could be re-negotiated.

The proposal includes a method for resolving disputes over future Title 25 bills.

West Park Hospital trustees haven’t voted on a proposal in open session, WPH Chief Executive Officer Doug McMillan said Wednesday, and no details on what that hospital is seeking were available.

Commissioners declined to offer any specifics when asked by the Tribune to identify which portions of Powell Valley Healthcare proposal they don’t agree with.

“We discussed it. That’s about all we can say,” said Commissioner Dave Burke.

Patten listed several points under negotiation.

Patten said out-of-state residents are not covered under Title 25 and the commission would like PVHC officials to consider putting that in the agreement as well.

Patten said another concern commissioners had centered over negotiating separately with the two hospitals to reach an agreement with each hospital. He said their concern is that treating the hospitals differently could lead to perceptions of favoritism.

But, without commissioners’ permission, the hospitals can’t meet to come up with a mutual agreement, Patten said, because that could be considered price fixing.

“I asked that question — do they want us to negotiate with each other? But I haven’t gotten an answer yet,” he said.

Patten said he advised the commission that any changes in the agreement would have to be approved by the PVHC board. Unless proposed changes are available for discussion during a special meeting on June 14, they would have to wait for the board’s regular meeting on June 26, he said.

Commissioners don’t dispute that they owe West Park Hospital and Powell Valley Healthcare for hundreds of commitments over the past decade, but they dispute how much they owe.

One of the biggest areas of disagreement for the county is whether it should have to pay for all the care a patient receives will committed at a hospital or only things directly relating to their mental health.

“Was it (a cost) truly related to Title 25, an involuntary commitment? Or were you kind of treating a side set of problems? So there’s a real gray area,” said commissioner French. He said that while hospitals have the goal of trying to treat people and get them out the door, commissioners are trying to stick to state law.

Patten said commissioners asked Powell Valley Healthcare officials to review each of the 120 bills in dispute to make sure charges not related to Title 25 have been removed.

Commissioners do want an agreement that has a set amount per patient, per day, so that things can move forward in an orderly fashion, French said.

“We’ll pay in a timely fashion and move on, so we don’t get in a situation that we’ve been in the last number of years, fighting over every bill,” French said. “We don’t want to fight over the bills anymore.”