Wednesday, March 12, 2014
The MaineCare rides contractor under fire for subpar performance is hiring more taxi companies to deliver rides to low-income patients, and may require its network of transportation providers to shoulder more of the workload, according to documents released by the Maine Department of Health and Human Services.
Mark Goggins stands next to his KVCAP bus in Waterville in September. KVCAP used to provide between 900 and 1,000 rides a day to MaineCare patients.
Morning Sentinel file photo/Michael G. Seamans
While the documents do not reveal how many more rides are being given by taxis, 16 taxi companies with 68 vehicles were added to the list of potential or approved transportation providers for Connecticut-based Coordinated Transportation Solutions, according to the records.
The state on Aug. 1 switched to a regional broker system for arranging nonemergency MaineCare rides for about 45,000 patients, but the program has since been beset with logistical problems. Thousands of patients have missed rides to doctor’s offices, cancer therapy and dialysis treatments, and other medical appointments.
The potential reliance on taxis is not going to work for the long term, said Rep. Richard Farnsworth, D-Portland, House chairman of the Legislature’s Health and Human Services Committee.
“How are they going to keep from going broke?” said Farnsworth, referring to CTS. “If they have to use taxis, I don’t think they are going to have the financial means to keep going.”
CTS, which is on the equivalent of state probation for mishandling thousands of rides for patients to medical appointments, submitted a corrective action plan in October as a requirement to maintain its $28.3 million state contract. CTS – which serves most of Maine, excluding the York County and Bangor regions – is being evaluated by Maine DHHS officials to see whether enough progress was made by Dec. 1. If not, the state could cancel the CTS contract. State officials have not indicated when a decision will be made.
John Martins, the DHHS spokesman, wrote in an email response to questions that CTS is still being evaluated, but that the action plan is an important benchmark.
“We worked with CTS from the point of its initial submission to improve the corrective action plan to ensure that it addressed, in detail, a wide array of concerns. We have accepted the plan and are evaluating the broker’s performance according to its many elements,” Martins wrote.
Previously, before the disastrous rollout of the new MaineCare rides program on Aug. 1, the $40 million system relied on mostly volunteers working with nonprofit transportation companies to drive patients to medical appointments.
Changes in the way drivers were reimbursed under the new system caused many volunteers to quit because they were making less money. But even after reimbursement rates were subsequently increased, officials at the transportation companies said it’s been difficult to rebuild the network of volunteer drivers.
Legislators asked for a copy of CTS’ corrective action plan for weeks, but they said they were ignored until the Press Herald asked for a copy last week. The state released the documents to the newspaper and legislators on Thursday.
Brian Dodge, president of Windham Taxi, which has been driving patients for CTS for more than two months, said CTS pays the taxi company a $2 flat fee for each ride plus $2 per mile.
The amount that volunteer drivers with nonprofit ride providers are reimbursed varies. In Portland, drivers with the nonprofit Regional Transportation Program receive 45 cents per mile, and CTS also pays the program a $3.75 administrative fee for each trip.
CTS President David White, who couldn’t be reached for comment on Friday, has said the company is improving its performance.
Jack DeBerardinis, president of RTP, the Portland transportation provider, indicated that things are slightly better now but are still far from perfect.
“I’m starting to see some signs of improvement. Are folks still missing rides and have late rides? Yes, that’s still happening,” he said.
According to the Corrective Action Plan, CTS may soon ask its nonprofit partners to shoulder more of the workload.
The plan seems to indicate that CTS will ask transportation providers to take on some scheduling and dispatching duties being performed by CTS, and to notify patients if vehicles are running late or will not arrive for an appointment.
Farnsworth asked why, if more work is dumped on the nonprofits, should the state be paying CTS $28.3 million.
DeBerardinis said that while CTS is so far not asking RTP to schedule rides, the system is inefficient and a lot of staff time is required to make it work.
“This has been far more staff-intensive than we ever imagined,” DeBerardinis said. His agency had to lay off dispatchers when CTS took over on Aug. 1.
Dan Donovan, executive director of the Aroostook Regional Transportation System, said that it’s already taking a lot of staff time, although CTS has not given the system more duties recently.
“We’re doing more work than we expected we would have to be doing,” Donovan said.
Dodge of Windham Taxi said he’s noticed fewer riders are complaining.
“It’s going really well,” Dodge said. “CTS is slowly but surely putting things back together again. They’re getting the right drivers out there, and I think CTS is doing a pretty good job.”
The action plan also said that CTS could require underperforming transportation providers to submit a corrective action plan to CTS.
Donovan said if CTS tried to require his organization to submit such a plan, there’s a “fat chance” it would comply with such an order.
The CTS action plan pointed to faulty data provided by the state and not having enough drivers and workers as some of the reasons for the troubled program. In addition to bringing the taxi companies on board, CTS hired more employees for its Lewiston call center.
The state vastly underestimated the number of wheelchair rides needed, according to the plan. The wheelchair rides require specialized vans for transportation, which are not as easy to come by.
Martins wrote that part of the problem with the previous system was the lack of data collected on rides, which made it difficult to predict how many rides were needed.
While the state selected the regional broker system, the federal government gives states wide latitude in devising systems to comply with new federal rules designed to cut back on the potential for fraud and abuse. In January, the Legislature will consider a bill that would force DHHS to switch to a Vermont-style system. Vermont satisfied federal requirements but maintained a system that relies on local nonprofits arranging and delivering rides, similar to Maine’s system before the Aug. 1 change.
The CTS plan also touted the reduction in calls to its complaint line from August, when 3,667 calls came in. In September, 1,299 calls were made to the CTS complaint line. Some critics have said that people are giving up and not bothering to complain any more.
Joe Lawlor can be contacted at 791-6376 or at: