August 21, 2013

MaineCare ride system favors certain patients

Because drivers can earn mileage for several at once, methadone patients almost always get rides.

By Joe Lawlor jlawlor@pressherald.com
Staff Writer

While MaineCare recipients have lodged thousands of complaints since Aug. 1 about missed rides to doctor's appointments and other problems with Maine's new nonemergency transportation system, one group has had relatively reliable service.

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Greg Curry, a volunteer driver, said he doesn’t want to be put into the position of turning down rides for MaineCare patients just because he’d lose money providing them.

Gordon Chibroski / Staff Photographer

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Methadone patients.

"The only people that are for certain getting their rides are the methadone patients," said Rita George-Roux, a volunteer driver in York County. "It's messed up."

The reason: a new reimbursement system that gives volunteers incentive to drive routes with multiple passengers.

Because of Medicaid rules, drivers in the new system can no longer be reimbursed for miles when no patient is in the car.

In the Portland area, drivers are paid 70 cents for each mile driven with a patient, and 70 cents a mile more for each additional passenger. So drivers have an incentive to accept routes with multiple passengers and turn down money-losing trips.

Seventy cents a mile doesn't make up for the many unreimbursed miles, said Sue Stimpson, a volunteer driver for the Portland-based Regional Transportation Program.

"The other day, I drove more than 40 miles, and only 10 of them were reimbursed," she said.

Dan Goodman, who coordinated volunteer drivers for the Regional Transportation Program before Aug. 1, said it's efficient to schedule rides for multiple methadone patients because large numbers go to the same place in the same time frame, and drivers have to wait only a few minutes before bringing the patients back home. Methadone clinics typically are open in the morning.

When people have doctor's appointments at scattered sites and times, scheduling rides for multiple passengers is more difficult, and impossible in some cases, said Goodman.

Stimpson said, "The drivers are scrambling for these methadone routes."

Alex Milliken, program director for the Discovery House methadone clinic in South Portland, said patients have complained about long telephone hold times while scheduling appointments, but almost all have made it to the clinic.

"They're getting here," he said. "It's much better than 90 percent."

Most of the patients are MaineCare recipients, Milliken said.

He said that if methadone patients didn't get their rides, many would go back to using heroin and engaging in dangerous activities.

"It makes it difficult for them to do well in treatment if they don't get a consistent dose every day," Milliken said. "They would be in danger of a relapse."

Since two out-of-state contractors started arranging rides for most people in the program on Aug. 1, the state has received more than 2,000 complaints. Clients have reported problems including missed rides and being on hold for hours while calling to schedule appointments.

The state adopted the system to comply with federal Medicaid rules for transparency and accountability, although it had flexibility to alter the system in other ways.

The state dropped a system in which local nonprofit groups coordinated and provided rides, and hired the contractors to arrange rides.

Coordinated Transportation Solutions of Connecticut was awarded a $28.3 million contract to cover most of the state, while Atlanta-based LogistiCare landed a $5.1 million contract for the York County area.

The new system has been beset with problems. Stories abound about seniors with cancer and other serious illnesses who cannot get to treatment and autistic children who miss therapy sessions.

In the Augusta area, the change in reimbursement for drivers caused so many problems that the agency that provides rides reverted to its previous system.

With drivers no longer reimbursed for miles without a patient in the car, they said they would lose money, especially on long rural routes.

Jim Wood, transportation director for the Kennebec Valley Community Action Program, said that when he was negotiating with Coordinated Transportation Solutions, he came up with a way to potentially alleviate some of the financial pain for the drivers.

"We were going to lose all of our drivers if we didn't do something," Wood said.

He said one way to offset their costs was to pay drivers for each patient in the vehicle. So a driver hauling four patients at 55 cents per mile in Augusta would receive $2.20 per mile when all four were in the car.

Coordinated Transportation Solutions and the state signed off on the plan, Wood said. State officials couldn't be reached for comment Tuesday despite repeated attempts.

Wood said the new reimbursement system made routes such as those for methadone patients lucrative for the volunteers, while rural routes became money-losers.

Wood said drivers were mostly losing money to volunteer, and they were quitting despite the bonus for carrying multiple patients.

Wood said his agency went back to its old system of reimbursing drivers last week. Now, drivers in the Augusta area are paid as they were before Aug. 1 -- 41 cents per mile for all miles driven.

Because of the Medicaid regulations, Wood said, his agency is being reimbursed by Coordinated Transportation Solutions under the new system, even while paying drivers under the old system.

"We're doing this blind," Wood said. "We have no idea how it's going to work out."

Wood said the paperwork is twice as time-consuming because of the workaround, and if the agency loses too much money, it won't be able to maintain the more generous reimbursement rate.

Greg Curry, a volunteer driver for the Regional Transportation Program, said he and other drivers are being put in the uncomfortable position of evaluating a patient's need when deciding whether to accept a route. He said volunteers can decline any route.

"I don't want to have to say no to a patient," Curry said. "But now, you have a reason to say, 'No, I'm not doing that.' It's not fair to the people."

Curry said he doesn't want to turn down a route, then later hear about a patient dying because there was no ride available.

"Your incentive is to give many people one ride in your car instead of carrying one person," Curry said. "But that one person, if they need dialysis, they could die if they don't get a ride."

Joe Lawlor can be contacted at 791-6376 or at:

jlawlor@pressherald.com

Twitter: @joelawlorph

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