Thursday, December 5, 2013
BY JOE LAWLOR
Portland Press Herald
The state is on the brink of canceling a contract with a company it hired for $28.3 million in taxpayer funds to arrange medical appointments for thousands of MaineCare patients, according to a memo released Wednesday by the Department of Health and Human Services.
However, the agency is also giving the company two additional months to fix the problems.
Connecticut-based Coordinated Transportation Solutions -- which serves six of eight transportation regions in the state -- has been put on the equivalent of probation for failing to provide adequate services, according to a Sept. 30 memo signed by Stephanie Nadeau, DHHS director of MaineCare services.
The rides system has been in turmoil since the state switched from a system in which local nonprofits arranged the rides to a new system in which regional brokers connect patients with the transportation providers. DHHS made the change to comply with federal rules requiring more accountability and transparency.
Thousands of patients have missed rides to doctor's appointments, therapies, counseling and other medical services.
CTS must submit a "corrective action" report to the state by Monday and make "significant measurable" improvement by Dec. 1 or the company could lose its contract, according to Nadeau. The state also could recover money set aside by CTS in a performance bond for failing to deliver services, the memo said.
"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, among other things. CTS's performance failures also have a ripple effect throughout the state, causing caretakers to miss work and causing medical providers to lose revenue," Nadeau's memo said.
Nadeau also wrote to the two other ride providers, LogistiCare for the York County region and Penquis Community Action for Bangor. While mentioning issues that need to be improved, the other two contractors were not put on probation and were not threatened with having their contracts revoked.
The rides are given to MaineCare patients who otherwise don't have access to transportation, and is a service required by the federal government.
DHHS has refused multiple requests by the Portland Press Herald to release complaint numbers. However, the Sept. 30 memo says that since Aug. 1, CTS "has received over 3,300 complaints from members, and this does not include the numerous complaints received separately by the Department."
Nadeau's memo to CTS belies the largely upbeat tone of an official memo DHHS submitted Wednesday to the Legislature's Appropriations Committee.
In the memo, released by the office of DHHS Commissioner Mary Mayhew, CTS was lauded for its performance in September "demonstrating improvement in problem areas they saw in August."
The weekly average of missed trips by CTS patients declined from 824 in August to 394 in September, according to Mayhew's memo. CTS has missed providing rides for more than 4,000 patients through mid-September, out of about 160,000 trips scheduled, the memo said.
"We have made significant progress," CTS President David White told the Press Herald in an interview Wednesday. "It's been a very significant improvement. We are in a very different place than we were in August."
White also pointed out that in the state-released memo, the average time people calling the center spent on hold has decreased from more than 7 minutes to about 3 1/2 minutes.
But Nadeau, the MaineCare program official, wrote that call wait times are still not adequate, and that the contract requires average call wait times to be less than a minute.
Nadeau also wrote that caller abandonment, or people hanging up in frustration, should be 5 percent or less, while callers gave up on CTS between 15 percent and 58 percent of the time.
Overall, the improvement in services has not been enough, according to Nadeau's memo to CTS.
"While there has been some improvement over the last few weeks, information provided to the Department demonstrates that CTS has not responded quickly enough to identified deficiencies, and has not provided sufficient resources to remedy the deficiencies," Nadeau wrote.
Others jumped in to criticize CTS on Wednesday.
Marylou Dyer, managing director for the Maine Association for Community Service Providers, said the data DHHS is using will never "show what's happening on the ground." She described the 10-week experience as a disaster and that any hint of an improvement had "flat-lined."
Dyer also said that the companies were making it hard for people to file complaints for missed or delayed rides.
"You have to be very pushy to get an official complaint number with the broker," she said. "It's ludicrous."
A memo signed by Paul Murphy, president of the Maine Transit Association, representing the nonprofit ride providers, casts doubt on the system put in place by the state, and he suggests a complete overhaul.
"I would like to report that things are improving and that we have faith in the brokers and DHHS to make this system work. Unfortunately , I cannot. The number and the significance of the problems we are encountering lead us to question whether this system will ever work," Murphy wrote.
Sen. Patrick Flood, R-Winthrop, a member of the Appropriations Committee, said he was encouraged that DHHS had indicated that "one ride missed was one too many." However, Flood said, the Dec. 1 deadline to correct the problems seemed "weak."
Rep. Richard Farnsworth, D-Portland, chairman of the Health and Human Services Committee, said in a phone interview that he would not give CTS another two months to fix problems when many of the logistical issues should have been ironed out by now.
"We should have given them two weeks, not two months. Now we're going to give them another two months?" Farnsworth said.
Jack DeBeradinis, who heads up Portland-based Regional Transportation Program, a local nonprofit that provides rides, said in an interview that the CTS system is cumbersome and has not improved much since August. He said RTP often doesn't receive the list of upcoming rides until the afternoon before the rides needs to be delivered, rather than a week before,which would allow for better planning.
He also said CTS's computer software still does not interface with RTP's software, bogging down the system.
"We have to work with this ponderous system," he said. "Our riders have had 40 to 50 percent less efficient service compared to before Aug. 1."
DeBeradinis said the state inserted a "middleman" that's gumming up the system, and he doesn't believe it will ever be as efficient as it was before the companies took over.
Glen Herbert has a 27-year-old daughter with Down syndrome, Sheena Patel. He said she relies on the MaineCare rides system for transportation to a sheltered work environment, and he's still leery of CTS, despite some improvements. Herbert, of South Portland, said he circumvents CTS as much as possible.
"I'm not supposed to call RTP for a ride, but I've been calling RTP on the day of the ride to make sure that Sheena is getting her rides," Herbert said. "We're still not confident in CTS."
The state also is threatening to recover funds put up by CTS in a performance bond for failing to provide adequate service, although the amount available for the state to claim was not immediately available on Wednesday, and CTS declined to reveal the amount.
"Upon issuance of this notice, the department shall also put CTS's bond holder on notice of its performance failures," Nadeau's Sept. 30 memo says.