Sunday, March 9, 2014
AUGUSTA — MaineCare’s troubled rides system, which has caused thousands of patients to miss medical appointments over the course of nearly six months, could soon be fixed, lawmakers said Thursday, if upcoming talks between the Department of Health and Human Services and local transportation providers prove fruitful.
Stefanie Nadeau, head of MaineCare Services, says the potential ride system solution could be done without law changes or getting a federal OK.
Andy Molloy/2013 Kennebec Journal file
Cindy Dow is lifted into a KV CAP bus in October at her Augusta home for a ride to a medical appointment. The troubled MaineCare rides system could be on the brink of a solution, lawmakers said.
2013 Kennebec Journal File Photo/Andy Molloy
During a legislative committee meeting on a bill that would scrap the current system and replace it with a program similar to Vermont’s, DHHS officials and representatives of nonprofit transportation agencies appeared to find common ground on a solution that would not require a new law.
The two groups will meet within the next two weeks to consider ways to fix problems that have persisted since the state replaced a system run by local transportation providers with one in which contractors arrange the rides in eight regions statewide.
“They’re going to get together and figure this all out. I know they will,” said Rep. Carol McElwee, R-Caribou.
The potential solution would give the local transportation providers a much better chance of winning state contracts to be awarded this summer.
Since Aug. 1, the state has contracted with two out-of-state companies and a nonprofit in the Bangor area to arrange rides statewide. Local transportation agencies still provide many of the rides.
Because of numerous glitches and logistical problems, thousands of low-income patients have been left without rides to and from doctor’s offices, dialysis treatments, mental health counseling and other services. About 45,000 Mainers use the $40 million-a-year program.
The state announced this month that it will not renew its six contracts with Connecticut-based Coordinated Transportation Solutions – worth a total of $28.3 million – when they expire June 30, because of the company’s poor performance.
The company also failed to take out a performance bond, as required in its contracts.
RULE CHANGE MAY BE SOLUTION
The solution discussed Thursday would change the way contracts are awarded, giving preference to local transportation providers.
It also would eliminate the “25 percent rule,” which transportation directors said discouraged them from bidding on the contracts last year. The rule prohibits ride brokers from referring more than 25 percent of the arranged rides to themselves.
Since most of the nonprofits that operated the program before Aug. 1 were local transportation agencies, the restriction would effectively make the contracts money-losers for them.
Federal officials had expressed concern that Maine’s previous system could give transportation agencies incentive to assign as many rides to themselves as possible, even perhaps rides that aren’t allowed, such as to the grocery store or the beach.
When the state switched to a flat-fee system with ride brokers, those concerns disappeared because the brokers were to be paid the same amount regardless of how many rides were given.
Stefanie Nadeau, director of MaineCare services, answered questions from the Health and Human Services Committee on Thursday, and said afterward that she has no objection to eliminating the 25 percent rule and offering bidding preferences to Maine agencies. Such changes could be made without approval from the federal government, she said.
MaineCare is funded with a blend of federal and state dollars, and the U.S. Centers for Medicare and Medicaid requires approval for major changes to state-run programs.
DETAILS STILL NEED ATTENTION
The new rules would improve the prospects for local nonprofits to win MaineCare rides contracts, officials said.
“I can tell you that if these changes are made, we would bid on the contracts,” said James Wood, transportation director for the Kennebec Valley Community Action Program. “(If we won a contract) we would be able to spend our time and resources getting people to their appointments efficiently.”
Rep. Ann Dorney, D-Norridgewock, suggested that local agencies should get higher scores in the bidding process.
Nadeau said the DHHS and the transportation providers still have to discuss the details, but she doesn’t see why the state would have any objection to adding bidding preferences for Maine agencies.
The only in-state contractor in the program now, Penquis in the Bangor region, is serving the only part of the state where patients have not complained en masse about a lack of service. Penquis officials have said the transition was seamless for them because they had run the program for many years.
DELIGHT THAT SOLUTION MAY BE NEAR
Nancee Campbell of Augusta, who uses the program, said the rides arranged by Coordinated Transportation Solutions have not been consistent, and the change would be welcome.
“Finally, DHHS is looking seriously at having local agencies give the rides to local people. I’m delighted,” Campbell said.
Wood said another major problem that arose when the system started in August – smaller mileage reimbursements for volunteer drivers – has largely been fixed with workarounds devised by the ride brokers and local transportation providers.
But Wood said the separate ride brokers still add a layer of unneeded bureaucracy. If local providers get the contracts, he said, that layer will disappear.
The committee voted to table the bill to scrap the current system to determine whether the potential solution would satisfy all parties.
“We are hearing what sounds like success,” said Margaret Craven, D-Lewiston, the committee’s Senate chair. “That sounds very nice.”
Joe Lawlor can be contacted at 791-6376 or at: