State lawmakers want to give New Jersey more effective tools to manage its nonemergency Medicaid transportation network while requiring more of those directly involved with this long-criticized system of private drivers and shuttles that is essential to connecting vulnerable residents with care.
A pair of Assembly Democrats introduced legislation Monday to reform the program by requiring tighter inspections of cars and drivers, more detailed record-keeping and greater state oversight of the five-year transportation contract, which cost taxpayers $180 million last year and served some 135,000 Medicaid patients. The bill would also make it easier for the state to levy larger fines for contract violations and allow it not to pay drivers when an individual they were scheduled to transport did not receive medical services.
The state has contracted for many years with LogistiCare, a national transportation leader based in Atlanta, that operates in dozens of states; LogistiCare collects a per-person fee and subcontracts with close to 100 private cab companies, specialized shuttle groups, and individuals to drive Medicaid clients to and from medically necessary healthcare appointments.
While many involved agree LogistiCare has worked hard to try and address concerns, advocates for individuals with disabilities and mental illness said too many of their clients are still left stranded by delayed or no-show rides. Some Medicaid members have in the past reported being harassed, disrespected, or left fearful by drivers’ actions,
‘A lot of money, a lot of people who rely on this’
“We want to make sure people get to their medical appointments, and on time,” said Assemblywoman Joann Downey (D-Monmouth), who sponsored the bill with Assemblyman Nicholas Chiaravalloti (D-Hudson). The measure is scheduled for a hearing Thursday in the Assembly Human Services Commission.
“We’re talking about a lot of money and a lot of people who rely on this,” Downey said, “and when we started looking at this (issue), we saw a lot of things that needed to be strengthened to improve services and reduce cost.”
The problems have seemed to ebb and flow over the years, noted Debra Wentz, president and CEO of the New Jersey Association of Mental Health and Addiction Agencies, despite efforts to improve the system. “Dependable, reliable, on-time transportation is so critical,” she said, especially for people with multiple chronic health conditions.
Fines for contractor
A review published in March by the nonpartisan Office of the State Auditor, which operates under the Legislature, found problems with the current monitoring and reimbursement system and urged the Department of Human Services, which oversees Medicaid, to improve how it oversees this work and assesses damages. The state fined the contractor more than $900,000 between July 2014 and June 2017, or about $25,000 a month — roughly 0.17 percent of the fees the company earned each month, the auditor noted.
The auditor’s report — which echoed concerns raised in earlier reviews by state and federal officials — also caught the attention of members of the Assembly budget committee, who pressed DHS Commissioner Carole Johnson to explain how her department could do better. The issue was already on her radar, she said, and staff was working to make improvements.
“Ensuring quality and reliable transportation services for Medicaid recipients is vitally important, which is why we are implementing reforms to improve vehicle, staffing, and performance standards,” Johnson told NJ Spotlight yesterday. “We’ve also had ongoing discussions with legislators and stakeholders as we work toward a shared goal of strong oversight and accountability for this important service.”
But Downey said legislation is needed to allow the state to more effectively manage the contract and ensure compliance. The bill also spells out new requirements for LogistiCare, which she planned to meet with on Tuesday, and the independent drivers they hire.
Stricter rules for drivers
Lori Bonderowitz, vice president of LogistiCare New Jersey’s operation, told NJ Spotlight the company looked forward to discussing the bill with stakeholders. “The vast majority of what is called for in the legislation is already included in our existing non-emergency medical transportation contract with the state,” she said. “It’s important to note, the new contract has addressed many of the issues identified in the audits and has raised the bar on performance standards, mandated greater use of technology and increased state oversight.”
Among other things, the bill (A-4131) requires all drivers to arrive within 15 minutes of the scheduled pick-up time. It requires they be properly licensed, pass a criminal background check, and have properly registered and inspected vehicles that have the capacity for at least four people, including the driver. Cars or vans with more than 150,000 miles would need to pass a more rigorous inspection process to qualify.
In addition, drivers would need to receive special training on the system and protocol and to provide passengers with “appropriate and courteous treatment” and “engage in positive interactions.” This training would need to be carefully documented and drivers could be fired if the records are incomplete.
Drivers would need to document all their runs in detail, with passengers’ names, the scheduled and actual pick-up and drop-off times, and note when medical providers requested transportation or when special handicapped-accessible vehicles were used. The transportation broker, now LogistiCare, would need to keep similar records. These logs would be updated daily and shared with the DHS on request.
The legislation also calls for significant changes to the state’s oversight system, including establishing a process to verify that Medicaid members receive the needed care. It calls for the DHS to designate an employee — someone outside the Division of Medical Assistance and Health Services, which oversees the contract — to regularly audit the system and review all documented complaints.
This staffer would need to submit monthly reports to the DHS commissioner, the division director and LogistiCare, according to the bill, and could urge the commissioner to assess penalties when appropriate. These fines could be deducted from the state’s monthly payment to the broker and could ramp up over time, until the problem is resolved.
“It’s an enormous thing to oversee, in general, but that’s not an excuse,” Downey said. “We’re trying to help pull this all together.”