Monday, December 9, 2013
Maine has wide latitude to cancel the contracts with the companies at the center of the MaineCare transportation controversy, but the state official in charge of the program said she's not ready to broach that topic yet.
Rebecca Lee, 27, of Kennebunkport, missed a few appointments for her neuroligcal therapy in Portland because of logistical problems with MaineCare rides.
Gordon Chibroski / Staff Photorapher
Hazel Clarke, of Westbrook, said she's been unable to schedule rides because she's been put on hold for hours at a time when she calls MaineCare.
John Ewing / Staff Photographer
"We're 14 days in. It's too early to talk about how long we'll give them," Stefanie Nadeau, director of MaineCare Services, told the Press Herald on Wednesday, when asked whether the state was considering canceling the companies' contracts. "We expect progress to be made."
But Nadeau also said the state "is committed to making this brokerage system succeed."
The MaineCare ride program is responsible for providing transportation for thousands of low-income Medicaid patients, some seriously ill, to appointments with doctors and for treatments such as dialysis and chemotherapy.
The state Department of Health and Human Services, which oversees the MaineCare ride program, has reported that it received more than 2,000 complaints in the past couple of weeks from patients whose rides have not showed up, or who had trouble contacting the contractors in charge of the service. Coordinated Transportation Solutions of Connecticut and Atlanta-based LogistiCare took over coordinating the rides on Aug. 1.
The Connecticut firm is being paid $28 million for contracts to serve most of the state, and LogistiCare landed a $5.1 million contract for the York County region.
Previously, the rides were organized by local nonprofit agencies with few problems, numerous patients have told the Press Herald.
The transportation program costs about $40 million a year and serves about 45,000 patients. The federal government reimburses the state for the majority of the costs.
Nadeau said the state is "holding the brokers accountable" to provide much-improved service. She said DHHS has had discussions with company officials to express their concerns.
"Any missed ride is unacceptable," Nadeau said.
But activists say the state should cancel contracts and go back to a system that worked.
"The state should put things back the way that they were and give people some peace," said Rita George-Roux, a volunteer driver in York County. "Let us do what we were doing, and doing very well."
Pam Lee, of Kennebunkport, an advocate who has been fielding calls from those who have missed rides, said the state should admit it was wrong and undo the new system.
"It's been a nightmare, and it's not getting better," Lee said. "The state is taking the easy way out."
The state was told in 2010 that its existing MaineCare transportation system did not comply with Medicaid rules, according to DHHS. One problem was that the nonprofit agencies were operating the ride service without a formal contract with the state.
The state was given options to bring the program into compliance and chose to have regional contractors coordinate the rides. But the state could also have designed a localized system that would have been similar to the one that had been in place, a national Medicaid expert has said.
Officials with Coordinated Transportation Solutions couldn't be reached for comment Wednesday. LogistiCare issued a written statement.
"We have increased our capacity since starting operations this month," wrote LogistiCare spokesman Todd DeFeo. "As a result, the complaint rate has dropped dramatically, even as the number of scheduled trips has increased. We expect the rate will continue to decrease moving forward."
State Rep. Richard Farnsworth, D-Portland, chairman of the Legislature's Health and Human Services committee, said that from conversations he's had with state officials, he believes the contractors will be given at least a month to resolve the problems.
Adrienne Bennett, spokeswoman for Gov. Paul LePage, said state officials are frequently briefing the governor on the problems.
"We acknowledge this is a problem, and we're doing what we can to fix it up," Bennett said.
According to the terms of the brokers' contracts, they can be terminated "whenever for any reason" that ending the agreements is "in the best interest of the department."
One of the stumbling blocks in the new system has been volunteer drivers quitting in large numbers over reimbursement issues, state officials have said.
Because of Medicaid reimbursement rules, drivers can no longer be reimbursed for miles driven when a patient is not in the vehicle. So even though the mileage rate increased from 41 cents per mile to 55 cents per mile, it hasn't been enough to make up for not being reimbursed for mileage to and from a patient's house, especially in more rural areas of the state.
Charlotte England of Oxford said she used to be a MaineCare volunteer driver, but she quit this summer when she heard about the pending reduction in reimbursement rates. She said she would have lost money to volunteer because she would often only be reimbursed for about 10 miles of a 40-mile trip.
"I don't mind volunteering, but if I have to pay to volunteer, that's another story," England said.
Nadeau noted that under the state contracts, the new ride brokers have the flexibility to increase the reimbursement rate for miles driven with the patient to higher than 55 cents, which would help maintain the volunteer driver force.
Farnsworth said he believes the contractors were surprised at how much Maine relied on volunteer drivers to provide the MaineCare service. Other states rely more on paid drivers.
Switching to a higher reimbursement rate appears to be already happening.
Jack DeBeradinis, executive director of Portland's Regional Transportation Program ride service, is still providing rides, although the ride coordination is now being handled by Coordinated Transportation Solutions.
He said he's been told by the company that the reimbursement rate is going to increase to 68 cents per mile to better retain the volunteer drivers, and he believes that will apply in all the regions the company covers.
George-Roux said she has heard that an improved reimbursement system will also kick in for volunteer drivers in York County, which is served by LogistiCare.
Dozens of calls and emails complaining of missed rides and other logistical snafus were received by the Press Herald on Wednesday.
Valerie Enos of Freeport said she's missed chiropractor appointments to treat fibromyalgia and other medical problems.
"I have a very delicate system," Enos said. "I have anxiety issues. I thought my anxiety was under control, but when something like this happens it comes back."
Adam Adams of Skowhegan, who suffers from a degenerative disc disease, said he's missed two appointments and he's been on hold for several hours trying to set up rides.
"The whole system is a joke," Adams said.
Nadeau said the state is temporarily helping the brokers by having state employees take overflow calls and email or fax appointments to the brokers.
But ultimately, Nadeau said, the brokers are responsible for making the contract work.
Joe Lawlor can be contacted at 791-6376 or at: