NJAMDC In the News

Revised legislation addresses driver courtesy, vehicle reliability, patient safety and pickup schedules

For some vulnerable New Jersey residents who depend on publicly subsidized transportation, a trip to the doctor can take up the better part of the day. Others may end up at the wrong place, or never be picked up at all.

New Jersey lawmakers are once again seeking to address these and other long-standing complaints about the state’s system of nonemergency medical transportation, which provided more than 4.7 million rides to poor, elderly and disabled residents in 2022 alone. A bill first introduced in 2018 to overhaul how the state contracts with private companies that oversee and dispatch drivers was unanimously approved by an Assembly committee Thursday.

Medicaid, which covers more than 2 million low-income residents in New Jersey, is required to cover transportation costs for nonemergency health services like doctor’s appointments, physical therapy and counseling. For more than a decade New Jersey has paid Modivcare — a Colorado-based company formerly known as Logisticare — $179 million a year to recruit drivers and run the program, something it does in dozens of states.

But passengers and medical providers — who lose money when patients don’t arrive — have called for reforms for years. Drivers are frequently late or get lost, they said, while some are rude and dismissive of passengers with disabilities. Modivcare generated more than 800,000 complaint calls in 2020, advocates for change told lawmakers last week.

Left waiting in the cold

“Sometimes these seniors are waiting outside in the cold (for hours). Sometimes they don’t get picked up at all due to lack of drivers,” Joan Marie Granato, president of the New Jersey Adult Medical Day Services Coalition, told lawmakers last week. “But if you talk to my clients on a daily basis that have taken the service, they would say, ‘Why complain anymore? I don’t call to complain anymore.’ So there are probably thousands of more complaints that don’t get called in or go unnoticed,” she said.

The state Department of Human Services, which oversees Medicaid, fined Modivcare $360,000 in 2022 alone, according to a representative. The company was assessed more than $1 million in penalties between 2013 and 2017, the state has said.

Proposed legislation would increase state oversight and makes it easier for people to file formal complaints.

Modivcare officials said in an emailed statement that 99.4% of the rides it coordinates for Medicaid members are “complaint free,” adding: “Our overarching mission is to improve access to care for those in need and we look forward to working with the Legislature regarding this bill as it moves forward.”

The legislation (A-2878), sponsored by Assemblyman Daniel Benson (D-Mercer) and several Democratic colleagues, requires all pickups and drop-offs to be within 15 minutes of the scheduled time. It also increases state oversight of the operations and makes it easier for people to file formal complaints. The bill requires several additional votes in the Assembly and Senate before it could be signed into law by the governor.

Amendments approved Thursday would also allow the state to bring in a second vendor for this work, if one was not sufficient, something providers of adult medical day-services embraced. These programs, which offer meals, activities and medical monitoring during the day, must arrange their own transportation for participants, instead of relying on Modivcare. They are now seeking to expand this part of their operation and provide rides to other locations.

“We need change. We need another vendor. We need to allow adult medical day care services to engage directly in this process” — contracting with the state as a transportation provider, said Granato, who owns a trio of adult day-service facilities in New Jersey. “We know what we’re doing. We know our clients. We know what makes sense.”

Penalties for poor performance

The state signed a five-year contract with Modivcare in September 2017 and agreed to a one-year extension in August, according to DHS. The contract allows for two additional one-year extensions. The department also amended the contract in July to increase the standards and penalties for several performance metrics, officials said.

“To effectively serve our seniors and disabled population we need at least two high-quality vendors to meet the demands of this special population,” said Carol Gable, a lobbyist for the adult day-services coalition, which helped craft the amendments. “You’ll find the criteria (in the bill) represent best practices throughout the industry,” she said, while acknowledging that ensuring compliance will remain a challenge.

‘Additional accountability and oversight for reliable and safe transportation are always welcome, especially for those who are most vulnerable.’ — Deborah Wentz, New Jersey Association of Mental Health and Addiction Agencies

Modivcare is the state vendor for this service, but the actual transportation of clients is done by a network of subcontractors — small bus companies, nonemergency ambulance services and local livery drivers — who are dispatched depending on the client’s location and needs.

The amended legislation, sponsored in the Senate by Sen. Joe Vitale (D-Middlesex), would eliminate the use of private cars for these rides and require all transport to involve commercial or livery vehicles, with full insurance and at least four seats. Drivers would need a license, background check, workers’ compensation coverage and special training — with biennial refresher courses — in how to appropriately serve special-needs clients and be courteous in the process. Vehicles with more than 150,000 miles would require additional screening.

Requiring careful records

The bill would also require vendors to maintain careful logbooks with daily entries on the rides they provide, with scheduled and actual pickup and drop-off times noted. Further, operators would need to record if any patient waited more than 15 minutes for their ride. State officials would need to conduct annual audits of the program and review any complaint within five days, or one day if it involved a health and safety risk to the passenger. The department could also withhold penalties from the monthly contractual payments under the bill.

The reforms are welcome news to Debra Wentz, president and CEO of the New Jersey Association of Mental Health and Addiction Agencies, whose members have long been frustrated by the challenges their clients face in getting to appointments. The issue is a particular challenge to people with complex medical, behavioral and developmental conditions, she said.

“Additional accountability and oversight for reliable and safe transportation are always welcome, especially for those who are most vulnerable,” Wentz said. “All efforts must be taken to ensure they can leave and return home safely. As in the past, problems seem to ebb and flow so it is imperative to take additional measures for quality improvement such as this legislation prescribes.”