In October, we urged the Maine Department of Health and Human Services to hold a non-emergency medical transportation broker accountable for failure to do its job. Coordinated Transportation Services, which arranges rides to medical appointments for MaineCare recipients in six of the state’s eight transportation regions, had not performed according to its contract. It had failed to secure an adequate network of transportation providers and to provide prompt and competent service at its call center, resulting in thousands of missed and late rides.
Last week, the Office of MaineCare Services continued its efforts to try to hold the company accountable and announced it would not continue its contracts with CTS when they expire on June 30. This decision is appropriate. CTS has improved its performance, and the time between now and June 30 will allow other companies to prepare to take its place. Also, CTS did not obtain a performance bond as its contract mandated, meaning funding is not available to help cover state costs to find a new broker.
Outrage is appropriate here. CTS failed to originally submit a bid that accurately accounted for the needs it would face. The state awarded a bid to an unprepared company. Many people suffered, such as one person who missed her dialysis treatment and landed in the hospital.
Lawmakers have understandably responded with great concern. They have heard from their constituents who have not been picked up, were left stranded, or spent hours on the phone on hold. But the Legislature is at risk of overstepping. Sen. Troy Jackson, D-Allagash, has proposed to terminate the state’s contracts with CTS immediately, and Sen. Colleen Lachowicz, D-Waterville, is sponsoring a bill to revert to the previous system where local agencies both arranged rides and transported people.
While both proposals aim to help, they could actually cause more damage. Jackson’s bill doesn’t specify what the state should do after it ends CTS’ contract immediately, but one would hope a different company, or several companies, would have to step in. However, assuming CTS didn’t appeal the decision, it would take months for the state to complete its request for proposals process and for companies to prepare and take over successfully. The time isn’t there.
And returning to the former model, which was out of compliance with federal rules to begin with, would be time-consuming and complicated. The state likely wouldn’t be able to revert quickly, as it would need approval by the federal government. And if it did manage to get approval, at least $6 million in federal funding would be in jeopardy. In addition to logistical and financial issues, there are also issues of system quality. Under the old system, the transportation providers were not required to offer ride services on evenings and weekends; they are required to now.
The current brokerage system, recommended by the federal government because it reduces the risk of conflicts of interest and improves payment transparency, works in other states. And two other brokers in Maine — Logisticare and Penquis Community Action Program — are now meeting and exceeding their performance standards. It is possible for the model to work, as long as brokers have the appropriate level of staffing to provide services and a strong technological infrastructure that allows information to flow seamlessly.
There are many reasons to want the state’s relationship with CTS to end sooner rather than later. But the state’s options are limited, and altering the rides system now could prompt new problems. It’s good for lawmakers to be frustrated by CTS, but they shouldn’t let that frustration worsen the odds of getting MaineCare transportation services back on track.