Best Practices Around the Nation “United We Ride Effort”

1. Best Practices Around the Nation“United We Ride Effort” Presented by Jo Ann Hutchinson Human Services Transportation Planning SummitAtlanta, GeorgiaJune 1, 2007

2. Today I Will Cover:Overview of United We RideWhy Coordination? How Some States Define and Require CoordinationA Best Practice in FloridaAvailable Technical Assistance Resources

3. United We Ride and more…. • An initiative in 2003 resulting from Presidential Executive Order • Directed Federal agencies to develop coordination policies and to work together to better coordinate human service and public transportation services (Coordinating Council on Access and Mobility) • Five States received national leadership awards (Florida, Washington State, North Carolina, Ohio and Maryland)

4. United We Ride and more…. • UWR Grants provided to States and communities to further transportation coordination (planning, coordinating councils/committees, technology, etc.) • UWR technical assistance programs have assisted States and communities with planning and achieving coordination goals • National Transportation Coordination Institute created and began bringing State and community teams together in the Nation’s capital to further coordination goals

5. United We Ride and more… • SAFETEA-LU (Federal Transportation Act) reauthorized and includes strong coordination planning and funding components to further coordination goals • National Resource Center for Human Services Transportation Coordination (NRC) created and led by CTAA also included in SAFETEA-LU • As part of the NRC, five additional Coordination Ambassadors (for a total of ten) are now in place thereby offering expanded technical assistance, training and other opportunities for States and communities to achieve their coordination goals

6. Why Coordination?

7. The Best Reason: • Coordination Brings People Together: Resulting in Increased Mobility, Improved Efficiencies and Improved Lives Independence......Empowerment

8. A Journey Worth Traveling… • Coordination is not a “one time” event or process • Coordination can be best achieved through the efforts of experienced transportation and planning entities, human service agencies and others like yourself • Coordination is more achievable today due to available resources and flexibility in program funding • Coordination is not always easy but it is achievable through trust, teamwork and cooperation • Coordination is a journey - not necessarily a destination

9. How Some Neighboring States Define Coordination • Florida • North Carolina • Kentucky

10. Florida: To ensure the availability of efficient, cost-effective and quality transportation services for transportation disadvantaged persons (Commission for the Transportation Disadvantaged-set by Florida Statutes).

11. North Carolina • To provide leadership, maximize funds, ensure safe, efficient & effective transportation. Coordination ultimately means communication. Coordination occurs when two or more parties plan, share and implement activities in concert with one another….. (NDOT/NHHS Coordinating Council)

12. Kentucky • To ensure individual recipients of the human service transportation delivery programs have accessible, safe, available and accountable transportation to medical services, employment, vocational training and leisure activities. Taxpayer and cost concerns will be considered in all deliberations. Committed to engaging in a collaborative and mutually respectful process to accomplish our goals. (Kentucky Transportation Cabinet)

13. How These States Require Coordination • These States require coordination by State law. See National Conference of State Legislatures Report on all States (www.unitedweride.gov) • Florida (Florida Statute 427.011-018) • Kentucky (Kentucky Statute 281.870) • North Carolina (Executive Order 21)

14. Florida is Considered as One of the Best Practices Having Received National and State Leadership Awards for Transportation Coordination

15. Florida Data • Population of Florida- 18 million • Percentage of Elderly (60+)- 22% • Number of Counties- 67 • Number of Transit Systems- 28 • Dollars spent on TD Services- $372 M • Total Trips Provided- 52.8 M • Dedicated Funding for Both TD and Public Transit

16. History in Florida and Who’s Leading the Charge • 1979- Law Mandating Coordination • 1989- State Transportation Disadvantaged (TD) Trust Fund and Independent Commission Created • Florida Commission for the Transportation Disadvantaged is State Agency Responsible for Statewide Coordination

17. How It’s Done • Each County must have a Community Transportation Coordinator (CTC) Approved by the Commission. They include: • County/City Government- 29 • Private, Non Profit- 20 • Private, For Profit- 3 • Each County must have a Local Coordinating Board • State Commission oversees the entire TD Program • All Agencies Must Contract with CTC

18. Community Transportation Coordinator Types Include: • Sole Source • The coordinator is the broker of the service and the only provider of transportation services. • Provides a “One-Stop Shop”, for coordination of all funding sources. • Often found in small rural areas or where there is limited competition • Partial Brokerage • The coordinator provides the brokerage service and some of the street service. • System has broader knowledge of proper gate keeping techniques and operational issues.

19. CTC Types (Continued) • Complete Brokerage • All services are managed and brokered by the coordinator but does not provide transportation. Services are procured through a competitive process. • Ensures proper gate keeping and use of the most cost- efficient provider with little perceived bias. • Brokerages may be governmental, private for- profit, private non-profit, etc.

20. Medicaid Agency Provides for the Majority of the Human Service Transportation Funding • Agency serves on the Commission (non-voting) • Agency serves on each Local Coordinating Board (voting) • Agency contracts with the Commission (since 2004) to carry out non-emergency transportation on their behalf

21. Medicaid History • 2003- Medicaid Releases Independent Assessment- • $22- $54 million Saved! • Fixed price contract encouraged • 2003- Legislature reduces funding for Medicaid transportation causing even more reasons to coordinate • November 2004- Contract Began with the Commission- Funds capped at $72.9 million for entire state

22. Commission’s Relationship with State Medicaid Agency • Manages the Medicaid Non Emergency Transportation Program (NET) • Receives a lump sum payment each month from Medicaid Agency • Identifies Subcontracted Transportation Providers (STPs) • Ensures NET services statewide • Receives encounter data and billing information • Ensures compliance

23. The Role of the Subcontracted Transportation Provider (STP): • Serves as Gatekeeper for the service area • Verifies beneficiary’s Medicaid eligibility • Verifies the trip purpose to receive a Medicaid compensable service • Utilizes the most appropriate and cost-effective mode of transportation • Provides reports to Commission for billing

24. How the Commission Implements this Innovative Contracting Concept: • They already had contracts in every county with one Community Transportation Coordinator (the “CTC” is required by State law) • They gave the CTC first right of refusal. • 63 of 67 CTCs agreed to participate • The remaining 4 counties were competitively procured by the Commission for a Medicaid Subcontracted Transportation Provider

25. Minimum Standards Are Required for Involved Providers To: • Respond to transportation inquiries and requests • Respond to beneficiary complaints • Train customer service representatives on the complaint process • Provide toll-free access for requests for transportation services • Provide 24-hour toll-free access to services for urgent care on holidays, weekends and after business hours • Take reservations three (3) days in advance • Answer telephone calls (90%) within 3 minutes • Drop off beneficiaries no more than one (1) hour prior to local appointment time • Provide adequate notice to beneficiaries of delays, alternative schedules, or alternate pick-up arrangements

26. Other Innovative Transportation Choices by the Provider Include: • Transit Utilization is Required • Mileage fee • Volunteer, Friends, Family • Payment for auto repairs • Gas vouchers, rental cars • Any other innovative program is allowable!

27. Staying Within the Budget and How Providers Do It! • Gatekeeping, Gatekeeping, Gatekeeping!! • Requiring fixed route usage, where applicable • Requiring use of closest provider, when appropriate • Using the most cost-effective provider • Verifying that beneficiaries are Medicaid eligible • Documenting abusers of system • Reservations must be made 72 hours in advance • Cancellations must occur 24 hours in advance • Document and refer “No-Shows” for education

28. For MoreUseful and Best Coordination Practices in Other States and Communities Across the Country Go to:www.ctaa.org andwww.unitedweride.gov

29. Other Forms of Available Technical Assistance • As your Coordination Ambassador, CTAA is committed to helping you be successful! • Please take advantage of these services as you move forward • Some services at both the State and community level, include, but are not limited to: facilitation, training, advice, analysis, education, speaking to groups or conferences about coordination, problem solving, eliminating barriers and more.

30. Other CTAA Programs Include: • Employment Transportation • Medical Transportation • Senior Transportation • Federal Regulations and Legislation • Coordination Programs • Annual Institute for Transportation Coordination (August 20-23 – Washington, D.C.) • Transit Financing and Investment • National Insurance and Fuel Discount Programs • Professional Development & Training • Annual EXPO & Training (2008 Site-New Orleans) • Visit www.ctaa.org and www.unitedweride.gov for more opportunities and resources

31. In Closing • Continue the good work in your area; • Take advantage of the available and enhanced technical assistance; and • Let us know how we can help!

32. Thank You!

33. Contact Information Jo Ann Hutchinson Coordination Ambassador Community Transportation Association of America hutchinson@ctaa.org (800) 891-0590, Ext. 730 www.unitedweride.gov www.ctaa.org