Hold Medicaid rides broker accountable for failure to do its job

Mary Putansu, left, of Belfast, heads to work in August at Little River Apparel after getting a ride there by Waldo County Transportation driver Winnie Fowler.
Abigail Curtis | BDN
Mary Putansu, left, of Belfast, heads to work in August at Little River Apparel after getting a ride there by Waldo County Transportation driver Winnie Fowler. Buy Photo
Posted Oct. 10, 2013, at 1:15 p.m.

Since Aug. 1, thousands of Maine residents have missed or been late to their doctors appointments, counseling and other treatment services because of the major unpreparedness of a new transportation coordinator chosen by the state.

The company, Coordinated Transportation Solutions, should not require the two months the Department of Health and Human Services has granted it to competently arrange transport for low-income patients who may be blind, elderly or have developmental disabilities or brain injuries. It needs to fix the problems immediately.

The Connecticut-based company, with a center in Lewiston, is responsible for getting MaineCare members in six of Maine’s eight transportation regions to their medical appointments. About 340,000 Maine people are eligible for MaineCare — the state’s version of Medicaid — and 75,000-80,000 receive the nonemergency transportation services.

The broker can arrange rides in a variety of ways — by providing fare for public transportation, setting up rides with a volunteer or agency, or scheduling a wheelchair van for those with special medical needs. Though the rides are not used in emergencies, failing to get a ride to the doctor can create an emergency later.

Rep. Peggy Rotundo of Lewiston, House chair of the Appropriations Committee, said she has heard from constituents who have waited as long as an hour for someone at the call center scheduling rides to pick up. Sometimes calls are dropped. Other times no one shows up to bring them to their appointment. One woman who didn’t get to her dialysis treatment ended up in the hospital. Others have stopped calling for rides because their calling cards ran out, or they gave up.

The potential harm is obvious. Providers also suffer when patients don’t show up because they don’t get reimbursed.

MaineCare Services Director Stefanie Nadeau leveled an appropriate amount of fury at the company in a Sept. 30 memo. “CTS has failed in its service to MaineCare members by: failing to secure an adequate transportation network, failing to provide prompt and competent service at its call center. As a result, thousands of MaineCare members have missed, or been late, for appointments and, in some instances, gone without necessary medical services.”

The memo states CTS has missed more than 4,000 trips, per the company’s self-reported data. Additionally, up to 58 percent of callers between Aug. 1 and Sept. 14 hung up before they could get an answer; the contract allows no more than 5 percent. The company has received more than 3,300 complaints, while DHHS has received hundreds of additional complaints. The company is paid about $28 million annually.

Nadeau wrote, “CTS has not provided transportation services as required by the Contract. … CTS has not responded quickly enough to identified deficiencies, and has not provided sufficient resources to remedy the deficiencies.”

She demanded a plan within five days that outlined the cause of each problem, a remedy and a timeline for improvement. She requested the company show “significant measurable improvement” by Dec. 1 or face financial penalties or the termination of the contract.

The company did submit the corrective plan on time. Nadeau said Wednesday the department is reviewing it and is not yet prepared to publicly release it. However, she said, the company has hired more call center staff, and the call abandonment rate has improved. In August, the company missed an average of 824 rides per week. In September it missed an average of 394 per week. The number should be zero.

CTS is not the only new vendor. After a competitive bidding process, Logisticare now serves the York County area; and Penquis Community Action Program continues to serve the Bangor area. All companies have missed rides as they’ve switched to a new delivery system, and the department has sent letters to all of them to pinpoint necessary improvements. CTS was the only company required to complete a corrective plan, however.

The state created the new MaineCare transportation system in response to federal concerns about data collection and accountability, Nadeau said. (It wasn’t about saving money; the total cost is still $35-40 million.) Prior to Aug. 1, local agencies both arranged rides and transported people, leading the federal government to express concern about potential conflicts of interest and a lack of payment transparency. If the state didn’t fix the problems, federal matching funds were on the line.

DHHS should maintain a strong backbone: It should develop an alternative plan, while it keeps the pressure on CTS to deliver — fast. People in need shouldn’t have to live through two more months of uncertainty about whether they’ll get to the doctor.

http://bangordailynews.com/2013/10/10/opinion/hold-medicaid-rides-broker-accountable-for-failure-to-do-its-job/ printed on July 30, 2014