Archive for January 9th, 2014

Democratic Senators Jackson and Lachowicz Introduce Bills Addressing Ongoing MaineCare Ride Issues

Posted on January 9, 2014. Filed under: Uncategorized | Tags: , , , , , , , |

The Health and Human Services Committee held public hearings on two measures to fix the flawed MaineCare Rides system today. Senate Majority Leader Troy Jackson is sponsoring a bill, to cancel the current contract with Coordinated Transportation Solutions (CTS), the least responsive transportation broker and the broker with the most egregious errors, and Senator Colleen Lachowicz is sponsoring a bill to create a more reliable and efficient transportation system.

PPH reported in October that CTS had documented only 160 complaints for August when the company’s complaint line actually received 3,662 calls. Not only has CTS failed to meet the current terms of its contract, but they have requested additional funds, with no specifics as to how the money would be used.

Before the hearing, it was announced that the company’s contract will not be renewed by DHHS– Senator Jackson veered off of his prepared remarks to address his concerns regarding the now more urgent need for his bill’s swift passage.
Senator Colleen Lachowicz (D-Waterville) addressed the committee first:

Her testimony to the committee as prepared:

      Testimony of Senator Lachowicz Introducing LD 1636, “An Act to Provide a More Efficient
      and Reliable System of Nonemergency Transportation for MaineCare Members” Thursday,
      January 9, 2014

    Good afternoon Senator Craven, Representative Farnsworth and fellow members of the Health and Human Services Committee. I am Senator Colleen Lachowicz, representing Senate District 25, which includes the towns of Waterville, Winslow, Albion, Benton, Clinton, Pittsfield, Detroit and Unity Township. I want to thank you for the opportunity to speak before you and I ask for your support of LD 1636, “An Act to Provide a More Efficient and Reliable System of Nonemergency Transportation for MaineCare Members.”

    Senator Colleen Lachowicz (Kennebec) testifies before HHS Committee on LD 1636.

    Senator Colleen Lachowicz (Kennebec) testifies before HHS Committee on LD 1636.

    In addition to being a senator I am also a Licensed Clinical Social Worker. In my work for the past 2 decades, I’ve had an up close and personal view of how transportation to medical appointments is provided to MaineCare members. I’ve sat with children and families as they’ve waited for their ride to pick them up. I’ve helped clients arrange transportation for themselves or family members. In a rural state such as ours, this isn’t always an easy task- for the client, transportation provider or the medical provider. When I looked into the changes in how we provide transportation for MaineCare members, I became concerned. So many people in our communities worked hard every day to make this system work. What would happen when it changed?

    I’ve heard a lot of talk that you have to let a new system work out the bugs. I suppose that’s true. I’ve worked in healthcare long enough to see new models and systems come and go. Some have worked; some have not. But here’s the thing: providing transportation for people to medical appointments is a big deal. Sometimes it is for scheduled vaccinations or a possible ear infection- things that can likely be rescheduled with little repercussions, but sometimes it is for chemotherapy for a cancer patient, or dialysis or critical tests and procedures for people with heart disease. Sometimes that appointment is for someone who is close to a psychiatric crisis. Other times it is simply for a person to get to their jobs so they can pay their bills. That’s why this is a big deal.

    We can look at the human costs and the monetary costs, but either way I think our current system that began in August is not working and the cost is too high. Too high for the patients and too high for the taxpayers. I ask of you, if it was you or your loved one that missed an appointment for life saving chemotherapy for cancer, chemotherapy that is specifically scheduled to best beat back that cancer so you can survive, would waiting to let the bugs be worked out be good enough for you? What if it was your child who was having more meltdowns and becoming more dangerous to himself and his family and you couldn’t get in to see the psychiatrist for another 3-4 weeks after your ride didn’t show up? Would that be acceptable to you? Or what if it was your elderly mother who had recently broken a bone in a fall and was in pain? How would you feel about a system that failed to get her to her doctor? I could spend the next hour or so telling this committee the stories I have heard from people who have been harmed by this flawed new system, but I know there are plenty of people here to do just that today. I and others on this committee have also already heard many of these stories in our monthly meetings we held in between the legislative sessions.

    In August of last year when the new system for MaineCare transportation first went live, we all began to hear the stories of the missed rides, unanswered calls for rides and more. Like many of you, I received numerous calls from constituents about the problem. To be honest, I couldn’t keep up with it. Many patients reported having missed appointments because rides were delayed, or failed to show up completely.

    The bottom line is we have given the new system a chance to work and it is not working. Taxpayers of Maine are paying $28M for services that are not being delivered. At a time of scarce resources, we cannot afford to be paying for something we’re not getting. This problem needs to be addressed immediately.

    We had a system that worked well for a rural state with an older population than many other states. Yes, the federal government had wanted our state to make changes, but we had other options. I think the broker system would work well in a more urban state with many competing transportation providers. But that’s not what we have. We have never had a system like that. We are rural. Our population is spread out. We never had multiple transportation providers competing for the privilege to transport patients to their appointments. We had a system where different regions had different transportation providers that had built up a network that worked well for the unique characteristics of that region. Some depended more on volunteer drivers than others. It’s quite different to drive someone from Ashland to Bangor than it is to drive someone from Westbrook to Portland. I thought we needed a system that worked for us and would meet the federal requirements. So I started looking into this. I talked with MaineCare members, transportation providers and medical and behavioral health providers. I also looked to see what other states had done. Maine wasn’t unique in having to make changes.

    By talking with legislators and administrators in Vermont, I discovered that they had considered making the same change we had when faced with the same dilemma. I asked questions. I discovered that Vermont is similar in many ways- rural, spread out, older population, but certainly not as big as Maine. But that state has decided that the brokerage system would not work as well in their state, so they crafted something different that met their needs and met federal guidelines.

    LD 1636 will create a more reliable and efficient system based on the Vermont model. Vermont satisfied federal requirements but maintained a system that relies on local nonprofits arranging and delivering rides, similar to our system before the Aug. 1 change.

    This bill would require the Department of Health and Human Services to contract with transportation providers in each region to provide transportation for MaineCare members. The Department would negotiate on a per member per month basis. It would not be the old fee for service model. Transportation providers and the Department of Health and Human Services would have to work together to consider the amount of MaineCare members in a region, fuel costs, the logistics of travel in a particular region and other factors. Transportation providers would have to develop the systems required to meet reporting requirements. The Department would set performance standards much like they do now.

    In closing, I ask you to give this bill your full consideration. I believe that MaineCare members and the taxpayers of Maine deserve something better than what we are getting now. We can build on what we have, make it meet our needs as a rural state and meet federal guidelines and keep more of our tax dollars in our own state.

    Thank you.

Then it was Senate Majority Leader Troy Jackson (D-Allagash)’s turn:

Here is his prepared testimony:

      Testimony from Senator Troy Jackson in Support of L.D. 1663 Resolve, To Terminate a MaineCare Transportation Contract

    Senator Craven, Representative Farnsworth, and members of the Joint Standing Committee on Health and Human Services, I am Senator Troy Jackson from Aroostook County, and I am here today to ask for your support of my bill, Resolve, To Terminate a MaineCare Transportation Contract.

    Senate Majority Leader Troy Jackson (D-Allagash) testifies before the HHS Committee on his bill, LD 1663.

    Senate Majority Leader Troy Jackson (D-Allagash) testifies before the HHS Committee on his bill, LD 1663.

    The purpose of this bill is to cancel the current MaineCare rides contract with Coordinated Transportation Solutions (CTS) that began in August of last year. The MaineCare rides system services about 45,000 people a month and since the change to a new ride system, there has been mounting frustration with ongoing customer service problems. These problems have left our most vulnerable friends and neighbors without access to the critical care that they need. Of the three brokers, CTS has been the most aggregious in the mishandling of their services.

    While it is true that each transition can come with its’ share of bumps – these problems go beyond simple growing pains.
    Since the change, countless clients have had difficulty booking rides. According to Stefanie Nadeau, the director of MaineCare services of DHHS, 58 percent of callers hung up in frustration before reaching a live caller. In one notable case, a caller was put on hold for 21 hours waiting for help. Even in cases where their calls got through, the rides have often been seriously delayed or have failed to show up completely. In rural districts like mine in Aroostook County, there is often no other option for public transportation for those who need it.

    December 1 was the deadline for CTS to either meet their objectives or show progress toward meeting goals. There has been no evidence that this has happened, and the taxpayers of Maine have been left on the hook for $28 million dollars in exchange for services that aren’t being delivered.

    Perhaps the most troubling aspect of the new rides broker is the failure to secure a performance bond. This represents an extreme mismanagement, and makes throwing any more money towards the current brokers’ an irresponsible risk.

    As if this wasn’t enough, CTS has requested additional funds after failing to meet the terms of their contract.

    We’ve given the new system a chance to work and it hasn’t. Our friends and neighbors can’t wait for dialysis while the brokers get their act together, not to mention those who depend on these rides to get to their jobs. This is why my colleague Senator Lachowicz has introduced a measure to replace this system with a program based on the Vermont model which is much more similar to the system Maine has used effectively for years. This plan has been tested to be more efficient and effective, and is a system that has met the requirements of the federal government.

    In the case that the contract with CTS is cancelled, but the new system has not been implemented, two brokers have said they are willing to step in. American Medical Response and MTM are two well-funded, national non-emergency transportation providers that are willing to take up the task of providing services. In other states, these providers have stepped in for CTS where they have fallen short.

    We should be moving forward with this proposal, and cancel the existing contract with CTS to avoid further hardship for our citizens and further costs to the taxpayers.

    I would like to thank the Health and Human Services committee for their time and consideration.

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Mainers Urge Lawmakers to Expand Medicare (Pix, Video)

Posted on January 9, 2014. Filed under: Uncategorized | Tags: , , , , , , , , , , , , |

Yesterday the 126th Maine Legislature reconvened to begin the second half of the legislative session. At the same time, hundreds of people from around the state came to Augusta to hold a rally organized by Maine People’s Alliance coalition members, hear the life stories of almost two dozen fellow citizens, and urge lawmakers to support expansion of Medicare for 70,000 Mainers as part of the Health Care First initiative.

Almost two dozen came to the mic to speak at the rally; here is a full clip from the event held in the State House’s Hall of Flags.

    “As a nurse, many of the patients I see every day wait until they are so sick that we can’t help them the way that we should and their health deteriorates even more,” said Jessie Mellott, a Registered Nurse from Bangor, introducing the speakers. “They lose limbs. They may never get back to their previous health due to lack of access to care. A lot of the time, these are easy things to fix if they were addressed in time. I urge the legislature to help me care for my patients and take the important step of expanding Medicaid services for 70,000 Maine people.”

    gina“I am a veteran of the U.S. Navy and lost my MaineCare coverage on December 31st,” said Thomas Ptacek of Portland. “My family has a history of multiple sclerosis and I worry that I, too, may have it someday. But my VA benefits are limited and will not cover the cost of preventative care or any treatment for the disease. I need MaineCare for that.”

    “When I found out I had seriously aggressive cancer I was able to access MaineCare and that was life-saving for me,” said Laura Tasheiko of Northport. “I was dropped and left without coverage as I continue my recovery from the ongoing and debilitating effects of cancer, surgery, and chemotherapy treatment. MaineCare is essential for the monitoring and care needed to avoid a medical crisis from medication complications, or even death, in the event of the cancer coming back.”

    “Without MaineCare, my injuries will just keep getting worse and worse. I’ll just keep going until I can’t go anymore and then they’ll throw you to the wolves, I guess,” said Richard Holt, a lobsterman and carpenter living in South Portland, “I need it to make sure I can stay healthy enough to keep working for at least another 4 years before I qualify for Medicare.”

More quotes from Bangor Daily News:

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    One of those speakers was Gail MacLean, who boards horses at her stable in Gray. MacLean said she has been on Medicaid for three years, but lost her coverage on Dec. 31 as a result of the state not expanding the program, known as MaineCare in the state.

    “Now I’m tip-toeing around the farm, hoping I don’t hurt myself,” she said. “My fear is that if something happens, I’ll lose what I’ve worked so hard for.”

    Another man, Tom Bennie, a farmer and handyman from Whitefield, said MaineCare paid for his full hip replacement in 2010, and helped his wife recover from a heart attack shortly thereafter.

    “If it weren’t for MaineCare, I wouldn’t be able to stand here today,” he said. “My health is all I have. That’s the most important thing. MaineCare gave me a sense of security.”

    Rep. Jeffrey Evangelos, I-Friendship, is co-sponsor of Eves’ Medicaid expansion bill, which legislative Republicans and LePage have vowed to defeat again this year. He called on the governor to follow the example of other GOP executives, such as New Jersey Gov. Chris Christie and Arizona Gov. Jan Brewer, who in their states accepted Medicaid expansion as allowed by President Barack Obama’s Affordable Care Act.

    He called the showing by MPA “impressive.”

    “I think it’s a real statement to the moderate Republicans to get on board,” he said. “If Gov. LePage vetoes this bill again, I expect them to support us in overriding.”

Later after the end of the beginning day of session, Senate President Justin Alfond and Speaker of the House Mark Eves spoke to those assembled:

    “Today in the halls of the State House, we heard why expanding health care to tens of thousands of Mainers is a top priority. The stakes are high—people’s lives and well-being are on the line,” said Senate President Justin Alfond of Portland. “Expanding healthcare is the right thing to do morally and it’s the right economic decision. Making sure folks have access to healthcare without the fear of going bankrupt is something we all value and it’s something we will continue fighting for.”

    “We are so grateful to the people who came today to talk to lawmakers about the importance of this life-saving health care,” said Speaker of the House Mark Eves of North Berwick, who is sponsoring a new measure to accept federal Medicaid dollars under the Affordable Care Act. “What we heard today is what we hear from our neighbors at home: people want and need life-saving health care. They don’t understand why politics and ideology are holding up common sense care.”

A public hearing will be held by the HHS Committee (Cross Building Rm 209) on January 15 regarding Speaker Eves’ and Senate Majority Leader Troy Jackson’s Medicaid expansion proposals. More pictures from yesterday can be found here.

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