Identification of Transportation Services, Costs, and Revenues |
|
|
Once participating agencies have jointly identified their client needs and the broad range of demand for paratransit services and other public transit, the next step in the coordination process is to inventory the current transportation services available from the various agencies. In many cities there are numerous public and private providers of general, specialized and paratransit services, often funded by one or more agencies or funding sources. All too often, agencies are unaware that they are, in certain cases, providing identical and parallel services to those of another agency. As participating agencies coordinate, the current schedules and passenger loads for each carrier/provider are analyzed to identify where opportunities exist to consolidate routes, develop ride sharing or commingling agreements, and eliminate duplication, thereby realizing efficiencies of scale. However, analysis is not complete without the identification of attendant service costs for each provider. As discussed earlier, health and human service agencies do not have Federal requirements to specifically identify the cost and operational information for the transportation services that they provide. Without this information, it is very difficult for these agencies to identify the full cost of providing transportation services to their clientele. Without adequate information, it also becomes difficult to assess the cost-effectiveness of a coordinated approach between agencies because of the difficulty in highlighting the potential savings to specific agencies. Cost information is also critical in assessing operating efficiencies within each agency’s transportation service and for establishing cost sharing arrangements. In areas that have established full cost accounting, agencies have information available on all transportation-related costs including labor, fuel, insurance, vehicle depreciation, and maintenance. When agencies work together on coordination, agreeing on the basis of how to account for transportation costs and on which items to include, is often the first order of business. In some instances, mandates in Florida and other states have required full-cost accounting be put in place for all local agencies receiving either federal or state funding related to transportation. In other instances, local agencies have adopted a full-cost accounting model and used it as the basis to begin negotiations with other agencies to coordinate and share the costs of providing paratransit services. The adoption of full-cost accounting practices not only has allowed many health and human service agencies to identify the true cost of providing transportation services for the first time, but has also been critical in highlighting the need for coordination to better utilize available resources. The identification of transportation services, costs, and revenues is critical to developing a coordinated approach to transportation service delivery in many ways. Once this information has been established, realistic planning can begin based on available resources and costs. The identification and sharing of information will allow agencies to avoid duplication of services, realize economies of scale, and sometimes leverage available dollars for state or Federal match purposes. Better information regarding available public transit services can also help health and human service agencies in their decisions to locate their facilities in areas more readily served by public transportation, thereby avoiding the need for more expensive specialized transportation services. The two following examples illustrate how various agencies have come together to share information and to identify all available services, costs, and revenues for paratransit services, the impetus, the agencies involved, the basis of estimating costs, the challenges faced, and the benefits realized from their efforts. For additional information about identifying transportation services, costs, and revenues, please see "Planning Guidelines for Coordinated State and Local Specialized Transportation Services," Checklist of Transportation Planning Steps, Step 6.7 A. Miami, Florida - Identifying Transportation Services, Cost and Revenues Through a Community Transportation Coordinator
In 1979, the Florida Legislature enacted a law that created a council and requires coordination among programs that receive local, state, and federal funds to provide or purchase transportation for persons "who because of physical or mental disability, income status, or age are unable to transport themselves or to purchase transportation and are, therefore, dependent upon others to obtain access to health care, employment, education, shopping, social activities, or other life-sustaining activities, or children who are handicapped or high-risk or at-risk." Florida Statutes, §427.011 These persons were collectively termed "transportation disadvantaged." The law created the Coordinating Council on the Transportation Disadvantaged. The Council's policies for coordination were promulgated in 1980. The Council's first five-year state plan was developed in 1984. In 1989, the Legislature elevated the Council to an independent Commission and established separate funding authority. The Commission for the Transportation Disadvantaged (the TD Commission) was located in the DOT for administrative purposes but had its own staff and operated as an independent agency. The Commission helped to establish local coordinating boards covering all of Florida’s 67 counties. Each coordinating board selects a community transportation coordinator (CTC) who coordinates all local transportation services using a variety of service delivery options - either as a broker, a broker/provider, or a sole provider, as in some rural areas. Each of the 50 CTCs is required to work with the local coordinating board, which typically includes local district office representatives from the following organizations:
In Miami-Dade County, the MDTA is the designated CTC for the county. MDTA was a logical choice, not only because it is a provider of transit and rail service throughout the county, but as a county agency, it is also able to receive pass-through funding of state and Federal transportation funding. As a recipient of FTA 5310 (Specialized Transportation Services) funds and state funding from the Transportation Disadvantaged (TD) Trust Fund, local health and human service agencies have incentives to coordinate with the CTC if they wish to be eligible for these funds. The Miami-Dade coordinated system receives approximately $500,000 annually in 5310 funding and received $4.1 million in the current year in TD funds. Approximately $3.1 million of the TD funds are designated to support MDTA’s ADA complementary paratransit services, while the remaining $1 million is used to pay for the unmet demand or service gaps identified by the CTC. Coordination is particularly vital in Miami-Dade County, where approximately 25% of the population of two million is at or below the poverty level and is very dependent on the coordinated transportation services. The CTC provided almost sixteen million trips during the past year to more than 125 local organizations and health and human service agencies. The coordinated system uses 732 vehicles to provide transportation disadvantaged services, not including MDTA’s fixed-route buses, which are also being used to provide coordinated trips at lower costs. The coordinated system was developed and is continually being refined as the CTC examines available services, costs and revenues of all providers and users of the system. The CTC works with agencies through the local coordinating board to develop a Coordinated Community Transportation Disadvantaged Service Plan every two to three years. For each local agency, the Plan identifies available agency transportation services, funding, client demand, and unmet demand in the area. The advantage of having a CTC to coordinate between various agencies is their ability to examine the local transportation universe as a whole and identify opportunities for cost savings, consolidation and enhancement of services. The CTC monitors the cost and efficiency of operations on a monthly basis through cost and ridership information provided by regular contact with local agencies. Each agency is required to coordinate and share information about their transportation services (routes, ridership, frequency, cost) with the CTC in compliance with the state law on coordination and also under reporting requirements to receive 5310 grant and TD funding. Operating reports from grant recipient agencies provide the CTC with operating data and cost information to help identify the actual cost of providing transportation to the various agencies’ clientele and determining the utilization of the services they provide. The CTC examines available service and cost information provided by other agencies, assesses the efficiency of those operations based on the costs incurred, and compares that with MDTA’s ADA complementary paratransit services (which cost approximately $15.28 per ride for the county to provide) or other less expensive alternatives including MDTA’s fixed-route rail and transit systems (which are fully accessible). The CTC uses this information as the basis to negotiate rates with each of the health and human service agencies and to develop service contracts and agreements with transportation providers. Being at the center of the operations has allowed the CTC to develop innovative programs for delivering transportation services based on their knowledge of local transportation services and costs. By examining the numbers and types of trips being provided by health and human service agencies, the CTC realized that many of these trips could be provided at a far lower cost on accessible vehicles in the MDTA system. In response, the CTC developed an idea for the ADA Free Ride program, whereby ADA-eligible riders get a free pass if they choose to ride accessible vehicles in the MDTA system, thereby avoiding the co-payment fare for the paratransit ride and increasing their own mobility. This program has reduced the number of paratransit trips by 25,000 over the past year at a significant savings to the agencies and the MDTA. Even more notable was the CTC’s success in working with the Agency for Health Care Administration (AHCA) to implement the Metro Pass program. The program encourages those Medicaid recipients who can use the public transit system to use the monthly Metro Pass. The Metro Pass gives them unlimited transportation on the fixed-route system at a cost of only $30-$50 per month to AHCA. This program has resulted in the avoidance of providing more costly paratransit trips and resulted in an estimated $600,000 savings per month in Medicaid-related transportation for AHCA for a total savings of more than $24.6 million since 1993, according to MDTA. B. State of Kentucky - Developing a Statewide System to Provide Services and Control Costs
In Kentucky, the Families and Children Cabinet identified 22 rural counties with little or no public transportation systems. Due to this lack of transportation, welfare recipients in the more rural counties were often exempted by the state from requirements to participate in job training and work activities that limited the state’s success in moving people from welfare to work. Medicaid trips in more rural counties were available through local taxi systems; however, there were concerns about fraud and abuse under that system. The cost of non-emergency medical transportation statewide had risen an average of 22.3% in each of the preceding 10 years. Against a backdrop of the passage of national welfare reform legislation and concerns about Medicaid transportation programs, the state selected the transportation delivery process, among other state programs, for redesigning under the governor’s 1996 state level re-engineering project known as Empower Kentucky. The state formed the Kentucky Transportation Delivery Team, which included representatives of the following agencies:
The team’s mission was to define the need for transportation and develop a statewide coordinated human transportation delivery service network to meet that need. One of the team’s first tasks was to examine the level of transportation services available throughout the state. The team divided Kentucky into sixteen human service transportation regions based upon the number of Medicaid and Temporary Assistance Needy Families (TANF) recipients, and the availability and capacity of local transportation providers. For each region, a single broker/provider was selected who was responsible for coordinating and/or providing all trips. The broker/provider had access to eligibility lists via the Internet for health and human service, Medicaid and TANF riders. In a move to centralize oversight of the transportation services under the proposed system, the state decided to consolidate the administration and funding of all human service transportation under one agency, the State Transportation Cabinet. The Transportation Cabinet was reorganized to create a Human Service Transportation Delivery Branch to work with the Public Transit Branch to coordinate operations. Using available cost data based on previous transportation operations by individual agencies, including receipts for past Medicaid transportation services, the state projects that they will realize approximately $3 million in annual cost avoidance by the year 2002 through consolidation and coordination. At first, a number of health and human service agencies resisted consolidation under the Transportation Cabinet for fear that they would not be as sensitive to their clients. The formation of the Human Service Transportation Delivery Branch, staffed in part by former health and human service employees familiar with their clients needs, helped to ameliorate this concern. The development of interagency agreements to transfer funding to the Transportation Cabinet was also critical in coordinating services. These agreements were formed as a result of support from the Governor and Cabinet Secretaries, but also by the agencies working with the Transportation Cabinet to identify the current costs of transportation services. In certain cases, such as TANF and Medicaid, there were records of past transportation expenditures, while in other cases, such as Mental Health/ Mental Retardation Services, an actuarial study was conducted to assess historical cost and the number of trips provided to determine the revenues that would be transferred to the Transportation Cabinet to support the coordinated system. The success of the proposed system depends in large part on the state’s effort to set a capitated rate for TANF and Medicaid non-emergency trips, which account for 90% of all trips (other trips are on a fee basis). Under this system, the Transportation Cabinet pays regional broker/providers a flat rate per month based on the number of eligible recipients. The rate, which is based on historical data and actuarial studies, determines funding to the broker and the expense to the state. The Transportation Cabinet hopes to satisfy demand under this arrangement while making it a feasible undertaking for the broker/providers. Prior to consolidation, the Transportation Cabinet provided $7 million in funding to local transit agencies throughout the state. Under the consolidated system with funds transferred from other agencies, the Cabinet has approximately $50 million in funding to pay for services provided by the broker/providers. Changes to state statutes and regulations and a Medicaid waiver from Health Care Financing Administration (HCFA) have also been important parts of putting the new regional broker system in place. The Medicaid waiver, which will end freedom of choice in terms of transportation providers, carries with it a 5% reduction in funding to the state, but the state believes that the efficiencies realized through the new system will make up for that reduction. While some clients originally resisted the lack of choice, the regional broker system guarantees the availability of transportation in all areas of the state, including areas that had no available service under the former system. Taxis are to adhere to new rates as regulated in the past legislative session, which gives broker/providers additional ability, particularly in rural areas, to provide needed transportation services at a reasonable cost. The Transportation Cabinet has established an evaluation system that includes a two-way complaint tracking system via the broker, and at the state level, via a toll free number for customers. The state will also conduct site visits to broker/providers and has implemented rigorous reporting requirements for the broker/providers. An oversight committee including staff from each of the participating agencies has also been created to provide feedback during the first two years of the coordinated system. To date, twelve regions have selected a broker provider and operations are underway, while the remaining four regions are scheduled to select a broker. 7 Coordinating Council on Access and Mobility, op cit, p. 27.
|