Frew and Medical Transportation on a Collision Course

On May 28^th, 2009, Appropriations Committee Chairman Jim Pitts, R-Waxahachie, was laying out the appropriations bill at the end of legislative session. Rep. Warren Chisum, R-Pampa, a senior and respected member of the Texas House, stands at the back microphone and inquires about Rider 55 -- the broker pilot amendment. Part of the actual conversation is embedded in this Rep. Senfronia Thompson’s Attorney General request. See Report Here.

What kind of impact will this rider have on the Frew lawsuit and the settlement agreement? None, that he knows of, Pitts replies. Are you sure? Chisum is unconvinced. Pitts maintains the state has nothing to fear. Chisum walks away from the back microphone and says, “I guess we’ll see.”

Fast forward to the Medical Transportation Program public hearing, October 29, 2012 – nearly eight months after the broker pilots became operational. The public hearing is populated with transit folks, brokers and many, many employees from HHSC.

A transit representative stands and asks the question: “Who from HHSC is monitoring whether the brokers in the pilot regions are complying with the Frew lawsuit settlement agreement?”

Silence. Not sure. We’ll get back to you. A good indication that no one is watching. If no one is watching and the brokers are self-reporting without much oversight, then “Frew – The Sequel” should be in the State’s foreseeable future.

Frew vs. Hawkins  -- this class action lawsuit was originally filed in 1993 and alleged numerous, serious failings in the State's efforts to ensure all children already enrolled in Medicaid were receiving appropriate preventive and specialty care services available to them through the federally-required Early Periodic Screening Diagnosis and Treatment Act (EPSDT). Access and therefore medical transportation was a major component of the suit, the settlement agreement, the consent decree and the corrective action plans. A brief history of the Frew lawsuit can be found here: History of Frew Lawsuit

It took 14 years for Frew to wind its way through the legal labyrinth culminating in Texas coughing up $707 million in general revenue in 2007. The Frew Version #1 was the result of benign neglect not a nefarious plot to deny children their medical care. But full-risk brokers use various time-honored techniques to discourage rides and therefore deny access, like long hold times or being discourteous to clients. Policymakers have been warned repeatedly about brokers and their methods.

The next trip to the courthouse will not take 14 years because everyone (no exaggeration here – everyone) involved has been duly informed and warned. In fact, here is a letter to the Texas House Committee on Transportation by Susan Zinn, the plaintiff attorney on Frew. Ms. Zinn offers one suggestion to the committee; let the broker model “die a peaceful death.” See Zinn Letter 8/17//10

Some interesting points:

• Logisticare has reported about 6000 complaints in 7 months. It is reasonable to assume some of these complaints involve children. See Fox News Video here

• Brazos Transit District, the MTP provider in Bryan / College Station area, had 5 complaints. Two of those complaints involved incidents where the driver arrived TOO EARLY.

• STAR Transit, a MTP subcontractor to Logisticare, is reporting an 80% reduction in providing rides to children over the previous year (calculated month to month).

Brokers claim their program is all about managing risk. In short order, we feel the broker model will have lawmakers reaching for their wallets (well – taxpayer money) once an enterprising attorney figures it out.