From: Priya Cloutier
Sent: Thursday, December 13, 2001 2:04 PM
To: Advocates - All Programs
Subject: YOU CAN HELP FIX MEDICAL TRANSPORTATION PROBLEMS FOR MEDICAID CLIENTS

All Medicaid clients, whether enrolled in a Medicaid HMO or under the fee-for-service Medicaid program run directly by the Department of Social Services, are entitled to appropriate medical transportation to ensure access to any medically necessary appointments covered by Medicaid (in the case of Medicaid clients under 21, any medically necessary appointments period, since there are no coverage limits under Medicaid).

Medicaid clients in the fee for service program must schedule appointments with one of DSS's two managed transportation contractors (Logisticare, Inc. in the southwest and south central parts of the state; Dyncorp, Inc. elsewhere). Medicaid HMO enrollees must schedule appointments either directly through their HMO (in the case of Community Health Network), or through its managed transportation subcontractor (Logisticare, in the case of Health Net and Anthem Blue Care; Coordinated Transportation Solutions, in the case of the (formerly Yale) Preferred One plan).

Connecticut Legal Services and New Haven Legal Assistance Association are considering litigation against DSS and/or one or more of its transportation contractors or subcontractors, with regard to some serious medical transportation access problems which clients have called to our attention over the course of the last few months. The problems that clients have identified include, among others:

1. Clients having to make appointments 48 hours in advance even for acute care appointments, and being denied transportation services if the requirement is not complied with - Imagine waiting 48 hours for someone to deal with a child's earache or an elderly person's flu.

2. Clients not being allowed to call in to schedule transportation services on evenings and weekends, while holding them to the 48-hour advance call requirement (for example, calling on Friday at noon is considered too late for a Tuesday morning appointment).

3. Clients being denied taxi service because their doctor didn't "update" their -required medical certification (required for non-bus transportation), as routinely required every two months even for folks with permanent disabilities.

4. Appointments being changed for clients by the transportation companies- The company calls the client's doctor, checks on the nature of the problem, and then changes the appointment if in ITS view the problem is "not that serious."

5. Terminating transportation to out of town doctors because they are too far away, claiming that there must be a doctor closer to where the client lives (who takes Medicaid and has a spot for you in their appointment book!), but without specifically identifying any such doctors.

6. Not sending out written notices when they terminate transportation services or change the type of service from that requested (like from taxi to bus), and sending out notices that are legally defective or untimely under federal Medicaid law (for example, notices have to go out ten days before termination of any transportation services which already begun).

THESE ISSUES ARE REALLY IMPORTANT TO OUR CLIENTS WHO HAVE ENOUGH PROBLEMS FINDING PROVIDERS WHO TAKE MEDICAID AND GETTING MEDICALLY NECESSARY TREATMENT.

If you are aware of any Medicaid clients for whom any of the above practices (or any other practices by the medical transportation contractors or subcontractors) have been a problem, we would be very interested in receiving referrals. Please also feel free to forward this message to others who may be aware of these problems or who know Medicaid recipients who may be experiencing them.

Please make all referrals to me at (860)447-0323, ext. 112, or pcloutier@connlegalservices.org, no matter where in Connecticut the Medicaid client is located.

Thank You,
Priya

Priya Sinha Cloutier
Connecticut Legal Services
153 Williams Street
New London, CT 06320
phone: 860-447-0323, ext. 112
e-mail: pcloutier@connlegalservices.org