ALFRED — One client, who had a confirmation number for his ride, missed vascular surgery because no one showed up to take him to the hospital. Others missed medical appointments because of no-show drivers. Two people living in the same location had appointments at the same time, in the same place, on the same day; the driver took one, but not the other.

These incidents ”“ and others ”“ happened to MaineCare clients in York County between Aug. 1 and about Aug. 22.

And despite efforts to make it better, it is still happening. For some, it has been a rough road, and it is still bumpy.

Jen Ouellette, clinical director at York County Shelter Programs, said she’s seen no improvement in the number of delays and no-show drivers since Logisticare began brokering calls for non-emergency MaineCare rides Aug. 1. Her staff makes appointments for shelter residents or those who live in apartment units owned by the shelter.

She said there have been more incidents of late and no-show drivers, and in one recent case, a female client was given a ride to her doctor’s office in a vehicle with an intoxicated male MaineCare client. Ouellette said her client was extremely uncomfortable with the situation.

STATE RESPONSE

Stefanie Nadeau, the director of the Office of MaineCare Services at the Department of Health and Human Services, said Logisticare is responding.

“We have seen, over the last week or so, movement in the right direction,” said Nadeau in a telephone interview Wednesday. “We’re seeing calls answered more quickly and more rides delivered.”

Still, she said, “one missed ride is one too many,” and the state is looking for quick a resolution to the issues here and in other parts of the state.

“We’re focused on weeks and days and how quickly these issues can be resolved,” said Nadeau. “We’re focusing on the next few weeks and how much progress can be made.”

Ouellette estimated 80 percent of rides scheduled for clients have resulted in late service or no shows.

“There’s been no improvement,” she said.

WHY THE SYSTEM CHANGED

Until Aug. 1 in Region 8, which includes York County and part of Oxford County, non-emergency transportation for MaineCare clients was arranged by staff at York County Community Action Corporation and largely provided by them. YCCAC Transportation Director Connie Garber said rides were scheduled on agency buses or through an army of 100 volunteer drivers or in cabs. Referrals to wheelchair van providers were made for clients who needed that service. YCCAC also administered the program that reimburses friends and family of MaineCare clients if they transport a client to a pre-approved medical appointment. Community action programs or other nonprofit entities provided the same services in other parts of the state.

That changed, Nadeau said, because the federal Center for Medicaid Services raised conflict of interest concerns. As well, CMS objected to the state reimbursing volunteers when the client was not in the vehicle ”“ which meant volunteers who had to travel to pick up a client wouldn’t be reimbursed for those miles. Had the state not made changes, $6 million in Medicaid reimbursements was in jeopardy, she said.

“The Center for Medicaid Services offered four solutions, and we went with a pre-paid brokerage system,” said Nadeau.

In York County, Logisticare submitted a bid of $10.33 million for two years.

Since Logisticare began arranging non-emergency rides for MaineCare patients Aug. 1 ”“ and Coordinated Transportation Solutions, Inc. began providing brokerage services for most of the rest of the state ”“ reports of no-shows and other transportation-related mishaps have appeared in numerous news reports.

Sen. John Tuttle, D-Sanford, said it had been his understanding that the change to a brokered system was a federal mandate. Tuttle had submitted bills earlier this year that would have allowed the state to seek a waiver, but the bills went nowhere.

Now, he said he’s finding out the brokerage system itself wasn’t a mandate. He said he wants to see some resolution to the problems within a month or two.

PROBLEMS

Logisticare, based in Atlanta, Ga., opened a Maine office in Kennebunk, where 16 call takers take requests for transportation to medical appointments.

Logisticare Vice President of Operations Robert Harrison agreed there have been bumps in the road. Harrison said York County Community Action lost volunteer drivers when the news that mileage wouldn’t be reimbursed when a client was not in the vehicle. Garber, at YCCAC, estimated about 40 volunteers quit when that happened. Now, that position has been reversed and drivers are now being reimbursed for those miles again, but in the meantime, Harrison said Logisticare responded by buying eight vehicles, leasing six others and bringing in drivers from their offices in other states to provide rides.

“It did happen, there were quite a few no-shows at the beginning,” said Harrison, which he attributed to the decrease in volunteer drivers.

Now that the reimbursement system has been repaired, some volunteers have returned ”“ but many are idle because Logisticare is continuing to provide the service itself, Garber said. YCCAC provided 40 percent fewer rides in the first two weeks of 2013 than they did the previous year, she said.

Harrison on Wednesday said YCCAC asked Logisticare to provide rides only for standing orders ”“ regular reoccurring dialysis appointments and the like ”“ and not individual appointments. He said he doesn’t expect that to continue long term.

“It depends on when YCCAC wants more volume,” he said.

Garber said that scenario was supposed to be short-term. YCCAC made that request, at the behest of the state, only for Aug. 1-4, she said.

Compounding the problems are a computer interface between the two entities that doesn’t work well and the ensuing upheaval as a result of those issues and others has been difficult for clients, volunteer drivers ”“ everyone involved.

“It’s frustrating,” said Garber. “There are continuing problems that affect the amount of service available to riders and affecting Community Action’s ability to ”¦ cover our costs.”

Harrison, of Logisticare, said complaints have recently “dramatically decreased,” though he declined to provide numbers, saying those are reported to the state. He said some likely go unreported because only complaints taken on a specific toll-free telephone line are counted. That number is 877-659-1302. The number to arrange transportation is 877-659-1302. Calls should be made two days in advance of an appointment.

”˜I TOLD YOU SO’

Tuttle, the state senator for Sanford and several inland York County towns, raised a red flag about the brokerage system in February, before it was implemented, and provided copies of news stories to the Journal Tribune outlining similar difficulties experienced by clients in Wisconsin when Logisticare operated there. According to the Milwaukee-based Journal Sentinel, Logisticare terminated its $38 million annual contract with Wisconsin in November, citing ride volume. Logisticare had been losing money, wrote reporter Gitte Laasby, because the state had failed to supply accurate ridership data.

Nadeau said in Maine, Logisticare is showing they’re trying to improve the situation.

“We feel they’ve shown an effort and a responsiveness to the states’ needs,” said Nadeau.

Tuttle remains wary and said there has to be some resolution “in the next month or two.” He said MaineCare clients are suffering.

“I hate to say ”˜I told you so,’ but I told you so,” he concluded.

— Senior Staff Writer Tammy Wells can be contacted at 324-4444 (local call in Sanford) or 282-1535, ext. 327 or twells@journaltribune.com.