The state department that administers Colorado’s Medicaid program failed to provide proper oversight of its contracted transportation service, and didn’t report incidents that could have involved mistreatment of at-risk adults, according to audit results published Monday.
Some of the 32 unreported incidents potentially involved drivers “not safely securing (Medicaid) recipients into vehicles, resulting in recipients falling out of their seats,” Stefanie Winzeler, team leader at the state auditor’s office, told state lawmakers on the Legislative Audit Committee. “This could be caretaker neglect due to the provider not securing or providing adequate physical care to the recipient.”
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The Department of Health Care Policy and Financing administers Colorado’s Medicaid program, which provides health care coverage to 1.5 million low-income people and people with disabilities. The state is required to provide non-emergent medical transportation, or NEMT, to Medicaid recipients who need help getting to their scheduled appointments. The federal government reimburses Colorado 50 cents for every $1 the state spends on NEMT services.
From July 2020 to August 2021, the department contracted with the broker IntelliRide to run the NEMT program statewide. This included coordinating transportation for Medicaid recipients, paying transportation providers, and billing the department for reimbursement, according to the audit report released Monday. IntelliRide, which is part of the global public transportation company Transdev, was paid $2.9 million to administer the program.
After each of the 32 instances of potential passenger mistreatment, the health care policy department should have reported what happened to Adult Protective Services or law enforcement, according to the audit report. All of the incidents occurred during the audit period of July 2020 to February 2021 when IntelliRide was the statewide contractor.
Some incidents involved injuries, Winzeler told lawmakers, and some involved a driver speeding or running red lights with the Medicaid recipient in the vehicle — which “could also be considered caretaker neglect if the caretaker created a hostile or fearful environment,” Winzeler said.
During the audit period, 35,423 Coloradans covered by Medicaid received approximately 640,500 non-emergency rides to medical appointments, for a monthly average of 80,100 rides.
“Unfortunately, it was not surprising, but really concerning,” Julie Reiskin, executive director of the Colorado Cross-Disability Coalition, said of the unreported incidents of potential mistreatment. Reiskin, who uses a wheelchair and has spent years advocating for people with disabilities, said that most of the transportation-related safety concerns she hears involve cab drivers.
Reiskin believes having more people at the health care policy department help to oversee the NEMT program could have helped with that issue. “Given everything, (the staff member) did a great job, but they had one person doing this for the whole state,” she said. The department has since assigned another full-time equivalent staff member to NEMT, according to the audit report.
For people mistreated by someone driving them to an appointment, Reiskin recommends filing a complaint with Medicaid as well as with the Public Utilities Commission, if the driver worked for a cab company. They should also involve an outside advocate such as the Cross-Disability Coalition or Disability Law Colorado, she said.
The attorney general’s office also takes complaints about abuse, neglect and exploitation through its Medicaid Fraud Control Unit.
Millions paid for ‘noncompliant claims’
The department paid IntelliRide $33.2 million to reimburse it for transportation services provided during the audit period. But auditors found that $291,600 of that money went to pay claims “that did not comply with federal and state requirements.” Some claims that IntelliRide submitted for reimbursement, and which the department paid, did not include details supporting that the rides were actually provided, while other claims were overpaid, and some claims requested reimbursement for rides that didn’t take people to medical appointments.
Another $5.18 million — approximately 16% of what the Department of Health Care Policy and Financing paid IntelliRide for services during the audit period — went to “potentially noncompliant” claims, such as taxi rides that may have been reimbursed at the wrong rates, according to the report.
Meanwhile, many Medicaid recipients who raised concerns about IntelliRide were essentially ignored.
More than two-thirds of the complaints Medicaid recipients filed with IntelliRide about the medical transportation service were not resolved, the audit found, including 75 complaints about health or safety risks that IntelliRide never investigated or reported to the department.
“The report was just released this morning and we are still in the process (of) reviewing all items very carefully,” Mitun Seguin, vice president of marketing and communications for IntelliRide, told Newsline in a Monday email. “From a high level, we agree with the findings and have already been taking corrective actions on many of these items already. We have also been seeing good progress in several areas. We take all feedback very seriously and will be ensuring corrective action in all the areas of concern.”
Changes to non-emergency transportation
As of this month, IntelliRide is no longer the statewide NEMT administrator. The Department of Health Care Policy and Financing moved to have IntelliRide administer NEMT for just nine Front Range counties — Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson, Larimer and Weld — while Medicaid recipients in the remaining 55 counties must contact transportation providers directly to schedule appointments.
“By moving to this hybrid model, we received some positive initial feedback from advocates and stakeholders,” Kim Bimestefer, director of the department, told lawmakers during the Monday hearing.
Reiskin agreed the new model might be for the best.
“When you build these statewide contracts, they often don’t work well in rural areas,” Reiskin said. She pointed out that coordinating medical transportation in smaller communities requires building relationships with providers, including those that may not necessarily be technologically savvy.
But the real problem, according to Reiskin, is that there are areas of the state that don’t have any transportation providers.
“I think telemedicine is helping to some extent with that,” she said, adding that in-person visits are sometimes necessary.
Medicaid should also make sure that people who need to travel long distances to appointments receive adequate funds to cover food and lodging, Reiskin said.
“So you have a critically ill child and you’re having to already take time off work — you know, most of these folks are paid hourly — it would be nice to at least give them enough to stay somewhere safe and eat while they’re with their child,” she explained.
The department agreed with how auditors said it should improve NEMT services, and said it would make the recommended changes. Those included:
- Implement information technology to pay medical transportation claims in line with state and federal Medicaid requirements, improve documentation of services, recover payments for claims that did not comply with requirements, and investigate potentially noncompliant claims.
- Ensure the NEMT contractor meets requirements for reliable transportation and customer service, and establish a process to assess Medicaid recipients’ satisfaction with their transportation services.
- Ensure the medical transportation contractor pays local providers accurately, and that it “tracks, resolves, and reports complaints and incidents.”
- Report incidents of potential neglect or mistreatment of at-risk adults to law enforcement and Adult Protective Services.
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