Monday, March 10, 2014
KENNEBUNK — A volunteer driver protest about reimbursement rates is a major reason why patients were missing rides from the MaineCare non-emergency transportation program, officials with a company that coordinates rides said Wednesday.
Pamela Tardiff cries while telling the story of her frustrations with the new ride scheduling system on Friday in Augusta. Tardiff uses an powered wheelchair and has had trouble getting rides to doctors appointments.
Staff photo by Joe Phelan
LogistiCare officials met with the Portland Press Herald on Wednesday for an interview and a tour of its new Kennebunk call center.
More than 2,000 Maine residents have complained that they have missed rides to doctor’s appointments and other medical services since Atlanta-based LogistiCare won a contract to serve the York County region and Coordinated Transportation Solutions of Connecticut took over coordinating rides for most of the state starting Aug. 1, according to the Maine Department of Health and Human Services.
Hundreds of volunteer drivers make up the backbone of the state’s MaineCare rides system, especially in rural regions. Many drivers became upset when Medicaid changed driver reimbursement rates so that drivers would no longer be reimbursed when a patient wasn’t in the car. Drivers said they were losing money to volunteer, especially on rural routes when they had to drive many unreimbursed miles to get to a patient’s house.
“So many volunteer drivers walked,” said Robert Harrison, LogistiCare’s senior vice president for operations. “Suddenly we were down 40 to 45 drivers.”
At York County Community Action Agency — the largest provider of drivers for LogistiCare — the number of volunteer drivers dipped from about 110 to 60 at the same time that LogistiCare was going through the typical growing pains of a start-up operation, Harrison said.
Drivers became so scarce, he said, that LogistiCare took the unusual step of purchasing eight vans and hiring eight drivers, although LogistiCare doesn’t expect to have the drivers and vans long-term.
However, Harrison said LogistiCare’s service has improved dramatically since the first week.
Pam Lee, a York County activist for MaineCare patients who has given her phone number to disgruntled LogistiCare patients since the controversy erupted, said the calls have eased up over the past week, but she suspects many gave up requesting rides.
“I’m still getting calls, but they’re not as frequent. It was like a gold rush at the beginning,” Lee said.
The Press Herald also has received fewer LogistiCare complaints this week.
Over the past week, the York County and Augusta regions have returned to the previous driver reimbursement system, with the goal of retaining and luring back drivers who had quit because they were losing money. York County and Augusta have devised workarounds to comply with Medicaid rules but still reimburse drivers for all miles driven.
Both regions now reimburse drivers 41 cents per mile for all miles driven, even when patients are not in the car.
Many states have gone to a similar system of brokering rides for Medicaid patients, Harrison said, and LogistiCare operates in 43 states.
LogistiCare won a $5.1 million contract with the state to arrange rides in the York County area, while CTS landed a $28.3 million contract for most of the rest of the state.
The state overhauled the system in response to Medicaid rules requiring greater transparency and accountability of rides, although the state had flexibility in how to meet the standards.
“This is our core business,” said Steven Linowes, a LogistiCare executive vice president. “We have a high degree of satisfaction in many states.”
However, Linowes and Harrison declined to reveal official complaint numbers that they filed with Maine, saying that’s the duty of state officials. The state so far has not released official numbers to the public, except for providing the 2,000 estimate.
Mary Mayhew, Maine’s health and human services commissioner, said last week that the state was investigating discrepancies in complaint numbers and delaying releasing the figures until the state could be sure they were accurate.
State officials did not return calls and emails today asking when the complaint numbers would be released.
The call center occupies a former dentist’s office in Kennebunk, where 12 employees take calls and plan routes for patients.
Employees on Wednesday sat in cubicles answering calls in an otherwise quiet room.
A display screen of call wait times at the center showed all zeros, which meant that callers were getting through without delay. If there’s a rush of calls, the calls can be routed to other call centers in other states, Harrison said.
Previously, local nonprofit agencies dispatched and provided the rides to MaineCare residents with few problems, patients have said.
The nonprofits had to lay off employees, although both LogistiCare and CTS hired Maine workers for its call centers.
Harrison said every complaint is important.
“You need data to evaluate effectively,” he said. “We want to know about complaints, because that’s the way we correct the problems.”
Responding to criticisms over the past week about brokers such as LogistiCare having a motive to limit ride service to earn higher profits, Harrison and Linowes dismissed that notion. LogistiCare and CTS receive a flat fee based on the number of transportation patients it serves. Critics say the fewer rides they provide, the more money they make, giving the companies an incentive to turn down patients.
Even so, Harrison said there’s a “moral imperative” and a federal requirement to provide rides to people in need. The state also has numerous performance standards that LogistiCare and CTS must meet.
Harrison said it’s true that some people don’t really need the rides, and it’s part of LogistiCare’s job to weed people out so that the government is not unnecessarily providing service. Harrison said he’s heard stories in other states where people were getting free Medicaid-provided rides to the beach and the casino.
“That’s one way we save states money,” Harrison said. “We get rid of trips that shouldn’t be run.”
Maine has not predicted that the contractors will save the state money.
Still, Linowes said employees care deeply about the patients and provide good service to those in need.
“You have to be good stewards of the taxpayer money and provide high quality levels of service,” Linowes said. “That’s the balance that we hit every day.”
However, Lee said she’s uncomfortable with call center employees from a private company making life-altering decisions for patients.
“Who at LogistiCare is qualified to make those decisions?” Lee said.