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{ timecode: 0, handler: 'blob', id: 1, data: {text: 'DAN DIRKS: My name is Dan Dirks, and I am the moderator of this session. I am a CTA Board Member and National Member from Detroit, Michigan. The title of this session is “Health Care Mobility '}},
{ timecode: 11, handler: 'blob', id: 2, data: {text: 'and ADA Paratransit.” Some ADA Paratransit Systems embrace non-emergency Medicaid transportation and some see it as a “dumping” of clients on an already glutted system, flooded '}},
{ timecode: 23, handler: 'blob', id: 3, data: {text: 'system. ADA Paratransit Medicaid -Systems have found workplace relationships with ADA and Medicaid. We will discuss how non-emergency medical transportation affects urban and small urban areas and how '}},
{ timecode: 35, handler: 'blob', id: 4, data: {text: 'bus passes can be used for Medicaid transportation. This session will run until 11:45AM. We are going to get out a little bit earlier, so that we can get our lunch. We have as a guest speaker the new '}},
{ timecode: 47, handler: 'blob', id: 5, data: {text: 'FTA Administrator, Peter Rogoff. I just literally ran from a meeting with him, was very impressed not only his knowledge about transportation but early on in his career when he was a Senate staffer. '}},
{ timecode: 64, handler: 'blob', id: 6, data: {text: 'He was a staffer on the Health and Human Service side, so he is knowledgeable about Medicaid and Medicare, and I had a strong indication that he is willing, more than willing, to put on his transit '}},
{ timecode: 77, handler: 'blob', id: 7, data: {text: 'hat but to knock on the door of HHS to what he can do to help coordinate and make it easier for all, relative to both. Our first speaker is Valerie Miller, and I am not going sit up here, I am going '}},
{ timecode: 91, handler: 'blob', id: 8, data: {text: 'to kind of move around. Valerie, who is just in front of me, is the Medical Transportation Specialist for CTAA. She has more than 20 years of experience in the transportation field and has held '}},
{ timecode: 104, handler: 'blob', id: 9, data: {text: 'positions both in a not-for-profit and a profit-making transportation center. She was the Executive Director of a Rural Non-Profit Coordination System in “Missoura”, right, and then was '}},
{ timecode: 119, handler: 'blob', id: 10, data: {text: 'employed as a Public Transit and Government Relation Administrator for a national non-emergency medical transportation brokerage for 4 years. I will introduce the speakers first before me, and then '}},
{ timecode: 133, handler: 'blob', id: 11, data: {text: 'I’ll give them the opportunity to speak. Valerie will talk a little bit about the Medicaid Bus Pass, about what works and what doesn’t from a national perspective. What states can look to, '}},
{ timecode: 143, handler: 'blob', id: 12, data: {text: 'what locals can look to, to have a successful program? Valerie. VALERIE MILLER: Thank you, thank you, and first of all I know that there have been some sound problems and I hope that we have those '}},
{ timecode: 154, handler: 'blob', id: 13, data: {text: 'taken care of. For those of you in the back room, if you have trouble hearing during this session just kind of wave you hands and let us know so we can either speak up or get the volume turned up so '}},
{ timecode: 169, handler: 'blob', id: 14, data: {text: 'you can hear. Bus passes I have heard as I have been going across the country, and I have had many phone calls, with bus passes and usage of bus as it pertains to Medicaid and the new Medicaid rulings '}},
{ timecode: 189, handler: 'blob', id: 15, data: {text: 'and regulations, I’ve heard “Oh, you can’t use bus passes anymore, it is too difficult to use bus passes, Medicaid won’t let you use bus passes.” And bus passes are '}},
{ timecode: 204, handler: 'blob', id: 16, data: {text: 'certainly an option with regard to Medicaid. The one thing that you have to understand with bus passes and with usage of any transportation for Medicaid is that it has to be tied to a Medicaid '}},
{ timecode: 220, handler: 'blob', id: 17, data: {text: 'approved trip, medical trip, and so what Medicaid has said, what CMS has said, the Center for Medicare and Medicaid Services, is that they are not going to fund any other service, they are not going '}},
{ timecode: 242, handler: 'blob', id: 18, data: {text: 'to fund public transit, they are not going to fund any other service other than Medicaid approved services. You have to make sure that you can document that the usage of a bus pass is used not to take '}},
{ timecode: 262, handler: 'blob', id: 19, data: {text: 'people to the grocery store, not to take people, not that it can’t be used for that on the side if you give a monthly pass, but you’ve got to document enough trips that it makes it '}},
{ timecode: 280, handler: 'blob', id: 20, data: {text: 'worthwhile to, and cost effective, to use that bus pass. You have to have your ducks in a line. You have to be able to show that if you have, if you give a bus pass, a monthly pass, and it is $20.00 '}},
{ timecode: 301, handler: 'blob', id: 21, data: {text: 'and your average trip cost for one trip is $1.00 then you have 20 one-way trips that you need. Now, I will tell you also that it has been my experience that different CMS offices are pickier than '}},
{ timecode: 325, handler: 'blob', id: 22, data: {text: 'other CMS offices, and that they are a little pickier about it on the East Coast than they are on the West Coast, and so as you spread yourself across the country, there is a different view of how it '}},
{ timecode: 342, handler: 'blob', id: 23, data: {text: 'is seen. Now whether that is going to change and that wave is going to move across the country, and how risky you want to be about paying things back, that’s your choice. But what you have to do '}},
{ timecode: 358, handler: 'blob', id: 24, data: {text: 'is be able to document the fact that you can attribute the usage of that bus pass and the number of trips you are using for that bus pass. But the use of bus, you can use day passes, you can use '}},
{ timecode: 378, handler: 'blob', id: 25, data: {text: 'single tokens, you can use 10-ride trips for 10 rides. There are multiple uses and we can talk about that more, but certainly the usage of fixed-route bus is an option and the usage, the method of '}},
{ timecode: 397, handler: 'blob', id: 26, data: {text: 'identifying whether a person is suitable to ride a bus does not have to be an individual designation per trip, it can be done by policy and by an overall approach. It does not have to be done '}},
{ timecode: 417, handler: 'blob', id: 27, data: {text: 'individually each time that person rides and individually documented each time. That would be my overall approach to it. DAN DIRKS: We got it? Yep. The next, excuse me, speaker is Diane Gallion. Diane '}},
{ timecode: 440, handler: 'blob', id: 28, data: {text: 'is the City Utilities Transit Service Paratransit Supervisor. Interesting isn’t it, utilities. Diane has a degree in accounting from Pittsburg State University in Pittsburg, Kansas, and an MBA '}},
{ timecode: 454, handler: 'blob', id: 29, data: {text: 'in Finance from Rockhurst College in Kansas City, “Missoura, Missoura” for you, too? DIANE GALLION: Missouri. DAN DIRKS: Missouri for Diane. DIANE GALLION: Bilingual. DAN DIRKS: Bilingual, '}},
{ timecode: 462, handler: 'blob', id: 30, data: {text: 'yes. She has worked at City Utilities for 18 years with 15 in transit. She is responsible for among other things Grant Management, the National Transit Database, Civil Rights, Finance and Statistical '}},
{ timecode: 475, handler: 'blob', id: 31, data: {text: 'Data, ADA Compliance, etcetera, etcetera. She is a person that has many hats. She is a CCTA Certified Community Transit Manager, Certified Community Transit Supervisor and with her family, children, '}},
{ timecode: 491, handler: 'blob', id: 32, data: {text: 'and grandchildren lives in Ozark, Missouri. Let’s hear this interesting story about a city utility taking transit and paratransit over. Diane. DIANE GALLION: Good morning. It’s kind of an '}},
{ timecode: 504, handler: 'blob', id: 33, data: {text: 'interesting story on how the utility company in Springfield got started, and maybe you remember if any of you are history buffs, that a lot of municipal utilities, utilities owned transit systems back '}},
{ timecode: 517, handler: 'blob', id: 34, data: {text: 'in the electric street car days. In 1945 City Utilities was chartered by the city to provide public transit. We continue today. We are the only utility company in the nation that still does public '}},
{ timecode: 531, handler: 'blob', id: 35, data: {text: 'transit. We have gas, water, electric, telecommunications, and public transit. It is kind of a unique product line but it works, and the unique thing is the funding stream that supports public transit '}},
{ timecode: 545, handler: 'blob', id: 36, data: {text: 'of Springfield is the rate payers of the electric and gas pay for public transit. It is beneficial to public transit, especially with the day and age of budget cuts and things like that tighten these '}},
{ timecode: 560, handler: 'blob', id: 37, data: {text: 'situations we have a constant revenue stream, and it will probably continue in that kind of form for a while longer. We are looking at becoming a transit authority down the road, so when that happens '}},
{ timecode: 573, handler: 'blob', id: 38, data: {text: 'it is kind of questionable whether utility will continue to operate. We actually operate in the city limits of Springfield. We provide fixed-route bus service and ADA Paratransit; and we got involved '}},
{ timecode: 590, handler: 'blob', id: 39, data: {text: 'with Medicaid back in 1997 when we were approached by the State of Missouri to provide Medicaid bus transportation service. We used it initially to kind of compliment what we were already doing for a '}},
{ timecode: 606, handler: 'blob', id: 40, data: {text: 'Paratransit Bus Service. It is kind of a benefit to our Medicaid passengers. We follow the ADA guidelines strictly on who’s eligible. They have to make application to ride for the Paratransit '}},
{ timecode: 619, handler: 'blob', id: 41, data: {text: 'Bus Service. We approve people based on their disability. When we were approached by the State of Missouri to provide Medicaid we thought sure that is a nice compliment and also a nice revenue stream '}},
{ timecode: 634, handler: 'blob', id: 42, data: {text: 'because the State of Missouri reimburses 50 percent of our operating costs, and you and I both know that operating costs can be a lot more expensive than what we are able to obtain in fares. Right now '}},
{ timecode: 650, handler: 'blob', id: 43, data: {text: 'our current fare for a one-way trip on our Paratransit Service is $2.20. We get reimbursed by the State of Missouri for Medicaid trips $26.22. You can see that the benefit to be able to provide that '}},
{ timecode: 665, handler: 'blob', id: 44, data: {text: 'service to our customers. However, probably 10 percent of our total ADA trips are Medicaid. We don’t go and recruit for Medicaid rides. We just use that as a service to our current existing '}},
{ timecode: 680, handler: 'blob', id: 45, data: {text: 'customers. Now Missouri has an application that once a year they send to each of the public transit providers in Missouri to apply for Medicaid bus service. It’s a fairly simple application. '}},
{ timecode: 696, handler: 'blob', id: 46, data: {text: 'Basically they are trying to determine what is our cost to doing service. We have to provide them a budget, operating costs, break it down. We also have to estimate how much we are going to be '}},
{ timecode: 710, handler: 'blob', id: 47, data: {text: 'incurring for Medicaid trips in relationship to our total Medicaid, our total Paratransit rides. Then we also have to document our revenue streams and how that is going to be covered. Once a year we '}},
{ timecode: 728, handler: 'blob', id: 48, data: {text: 'do that. Usually it is about April of each year, we provide them with our operating costs. Because we are part of the utility, our operating costs are probably more expensive then maybe if we were '}},
{ timecode: 741, handler: 'blob', id: 49, data: {text: 'just a small urban transit system. We are over 200,000 in population and it’s only because we with last census we are one of 52 transit agencies in the country that went over 200,000 that have '}},
{ timecode: 756, handler: 'blob', id: 50, data: {text: 'less than a hundred vehicles. We have 25 fixed-route vehicles, we have five paratransit. We are small urban really in actual size. We only cover the city limits of Springfield, which we probably serve '}},
{ timecode: 773, handler: 'blob', id: 51, data: {text: 'about 151,000 in population; but because of the surrounding communities around Springfield that threw us over the 200,000 population, which makes us more of a large urban, which adds with it a lot of '}},
{ timecode: 788, handler: 'blob', id: 52, data: {text: 'grant requirements, as you know when you go over 200,000. We still serve the citizens of Springfield, and that is really tied to the charter of the city because we are only allowed to go within the '}},
{ timecode: 803, handler: 'blob', id: 53, data: {text: 'city limits. Now we have a wonderful working relationship with our counterparts with OATS, and I think if you were here at the afternoon session, Scott Kosky and I work closely as far as collaborating '}},
{ timecode: 817, handler: 'blob', id: 54, data: {text: 'our transit efforts in Springfield. He is able to go outside the county and the city limits. They provide a lot of that service or bring people into the city limits. We do a lot of collaborative. He '}},
{ timecode: 831, handler: 'blob', id: 55, data: {text: 'actually sits on one of my Paratransit Review Committees to review the applications to be approved for Paratransit Service. Like I said, we provide the Medicaid Service. It is complimentary to what we '}},
{ timecode: 847, handler: 'blob', id: 56, data: {text: 'provide for our access express buses, what we call our Paratransit Service. We don’t go out and recruit. However, we do have a working relationship with the Missouri Brokerage System. Each, '}},
{ timecode: 861, handler: 'blob', id: 57, data: {text: 'Missouri contracts with an administrator and its LogistiCare in Missouri. We have clients referred to us. We don’t have the same arrangement as a private probably operator. It’s more, '}},
{ timecode: 876, handler: 'blob', id: 58, data: {text: 'since we are the public transit provider they are to look to us first to provide the trips. If we cannot provide it then they go outside to the private operators. When they refer people to us, we also '}},
{ timecode: 887, handler: 'blob', id: 59, data: {text: 'have to get them approved for our service because we strictly go by the ADA guidelines and who’s eligible to ride our service. We have to get them an application process to fill out, we have a '}},
{ timecode: 898, handler: 'blob', id: 60, data: {text: 'committee that reviews them, and if they are eligible then they become one of our riders. Then we also let them know that we are a Medicaid provider and we can provide that service to them whereas '}},
{ timecode: 912, handler: 'blob', id: 61, data: {text: 'they don’t have to call the 1-800 number to get their rides for LogistiCare, they can just call us directly and we will provide that service to them. Valerie talked about fixed-route bus passes. '}},
{ timecode: 925, handler: 'blob', id: 62, data: {text: 'LogistiCare does buy fixed-route bus passes. We sell them a daily pass that’s eligible for unlimited rides during the day, and they buy large quantities of fixed-route bus passes to distribute. '}},
{ timecode: 939, handler: 'blob', id: 63, data: {text: 'No we don’t monitor who they give them to. They pay us for those fixed-route bus passes, it’s a nice arrangement. We just basically broker the pass to them and then they are in charge of '}},
{ timecode: 951, handler: 'blob', id: 64, data: {text: 'who is eligible for that service. DAN DIRKS: Very good, thank you. You know Diane went to Pittsburg State University and Karen Hoesch who is the Executive Director of ACCESS, the world renowned ACCESS '}},
{ timecode: 967, handler: 'blob', id: 65, data: {text: 'Transportation System is from Pittsburgh, Pennsylvania, so we have a tie in there. But, you know, I also have an akin to Pittsburgh because my favorite hockey team, the Detroit Redwings, happen to be '}},
{ timecode: 980, handler: 'blob', id: 66, data: {text: 'playing the Pittsburgh Penguins. You know, I know that Karen is going to be looking at red today so I thought I would I’d show you what red is all about It is the Redwings jersey, and I was '}},
{ timecode: 999, handler: 'blob', id: 67, data: {text: 'tempted to wear it but I didn’t want to show up too many people. KAREN HOESCH: I guess we will be talking when the Steelers play the Lions then right? DAN DIRKS: And let me see, how about the '}},
{ timecode: 1013, handler: 'blob', id: 68, data: {text: 'Tigers. How is your baseball team doing? I mean ours is in first place. But the Stanley Cup, I mean that is what it’s all about this time of year. Anyway. Pardon? Karen, as I mentioned, is the '}},
{ timecode: 1029, handler: 'blob', id: 69, data: {text: 'Executive Director of ACCESS and for those of you that aren’t aware, ACCESS is probably one of the finest paratransit operations in our country. In this capacity as executive director, she sees '}},
{ timecode: 1039, handler: 'blob', id: 70, data: {text: 'the daily operations of the largest paratransit brokerage in the United States. They provide over almost 2 million trips on an annual basis throughout Allegheny County, Pennsylvania. They use it with '}},
{ timecode: 1052, handler: 'blob', id: 71, data: {text: 'a decentralized brokerage model with nine separate providers. She directs service provider compliance, customer service, public participation, and everything that is necessary in making this operation '}},
{ timecode: 1065, handler: 'blob', id: 72, data: {text: 'run as smooth as it does. She is also in charge of ADA and ADA compliance and coordination. ACCESS was presented the 2005 United Way Ride National Award by U.S. Secretary Norm Minetta for outstanding '}},
{ timecode: 1079, handler: 'blob', id: 73, data: {text: 'efforts to coordinate human service transportation. Karen has also assisted a number of transit agencies in their implementation of ADA service. That list includes the RTA in Chicago, DART in Dallas, '}},
{ timecode: 1093, handler: 'blob', id: 74, data: {text: 'Utah Transit Authority, Calgary Transit in Alberta, Metro in St. Louis and the Corpus Christi System in Texas and also that small town the other side of Pennsylvania called Philadelphia with SEPTA. '}},
{ timecode: 1110, handler: 'blob', id: 75, data: {text: 'Karen, it is all yours. KAREN HOESCH: Thank you. Well, I’m going to make you endure a power point presentation for two reasons. One is the older I get the harder it is for me to stay focused on '}},
{ timecode: 1123, handler: 'blob', id: 76, data: {text: 'stuff, go figure. I know you’d rather look at that. Which is the other reason I use power point is to cleverly get you to look at the screen and not at me, so we will see if it works. The story '}},
{ timecode: 1151, handler: 'blob', id: 77, data: {text: 'that I have to tell is a lot like the one you heard from Diane, and it’s about how you can successfully blend ADA Paratransit and non-emergency medical transportation. I’m going to take my '}},
{ timecode: 1163, handler: 'blob', id: 78, data: {text: 'charge seriously that we not use jargon. I’m also going to assume that everybody in the audience maybe doesn’t know what ADA Paratransit is and who’s eligible. ADA Paratransit is a '}},
{ timecode: 1175, handler: 'blob', id: 79, data: {text: 'mode of public transportation. It is not separate and distinct from the public transit system except in the way that it operates. It’s designed to act as a safety net for the fixed-route system '}},
{ timecode: 1185, handler: 'blob', id: 80, data: {text: 'for people who can’t use the bus or people who can’t take their trips on the bus. It is a safety net, an accessible fixed-route transit. It’s supposed to be the first choice in an '}},
{ timecode: 1199, handler: 'blob', id: 81, data: {text: 'ADA compliant system because it’s the least restrictive form of transportation. The ADA requires that paratransit providers offer a very high level of service. You can’t turn trips down, '}},
{ timecode: 1212, handler: 'blob', id: 82, data: {text: 'you can’t pick people up late, you can’t ride ‘em around a long time, you can’t have trip purpose restrictions and it has to be offered at the same days and times and places as '}},
{ timecode: 1222, handler: 'blob', id: 83, data: {text: 'the fixed-route services. It is an excellent level of transportation service. And that said, it is very costly to provide because it’s origin-to-destination service. Unlike the bus that is '}},
{ timecode: 1234, handler: 'blob', id: 84, data: {text: 'rolling down the street and the people run to the bus stops, ADA Paratransit picks people up at an origin and takes them to a destination. It’s a very person-centered kind of transportation that '}},
{ timecode: 1246, handler: 'blob', id: 85, data: {text: 'generally has low productivity and as a result frequently has a lot of empty seats. Non-emergency medical transportation and ADA Paratransit have a lot in common. First and foremost, we have our '}},
{ timecode: 1259, handler: 'blob', id: 86, data: {text: 'customers in common, and once you start to dive into this in an ADA Paratransit System, you will find that the same people who are using ADA Complimentary Paratransit are eligible for Medicaid '}},
{ timecode: 1271, handler: 'blob', id: 87, data: {text: 'transportation. Whether or not you have formal relationships and cost sharing for these customers, Medicaid eligible riders are riding your ADA Paratransit Service. For example, most people with '}},
{ timecode: 1285, handler: 'blob', id: 88, data: {text: 'cognitive disabilities who live in the community will be followed by Title 19: Home and Community Based Waiver Funds. All of those people are Medicaid eligible. In Pittsburgh those people take 50 '}},
{ timecode: 1297, handler: 'blob', id: 89, data: {text: 'percent of the ADA Paratransit trips, that’s huge. On top of that, if people need Paratransit to get from origin to destination, they are going to come to your ADA Paratransit Service anyway for '}},
{ timecode: 1311, handler: 'blob', id: 90, data: {text: 'all the other trips that they need, because life is about more than going to the doctor. They migrate to ADA Paratransit, and because it generally tends to have the highest level of service and is the '}},
{ timecode: 1322, handler: 'blob', id: 91, data: {text: 'most customer friendly, they stay in that system for all of their rides. The characteristics of the transportation that both systems offer are similar in that they are origin-to-destination service, '}},
{ timecode: 1333, handler: 'blob', id: 92, data: {text: 'and they require a very high quality of transportation. And, non-emergency medical transportation like ADA paratransit service is expensive, the trips tend to have larger trip lengths, they are time '}},
{ timecode: 1347, handler: 'blob', id: 93, data: {text: 'sensitive – you have to be at the doctor when your appointment starts, and they have in common that they either have no fare or a very low fare that is paid by the customer. Blending these two '}},
{ timecode: 1358, handler: 'blob', id: 94, data: {text: 'systems seems perfectly obvious to us in Pittsburgh. They have similar service design, the same customers, the same trip generators; they both have empty seats, everybody rides together and, best of '}},
{ timecode: 1370, handler: 'blob', id: 95, data: {text: 'all, the kind of service then is transparent to the customer. The who, what, and how of how you accomplish this, first is who is going to manage this operation. Who is going to determine the '}},
{ timecode: 1382, handler: 'blob', id: 96, data: {text: 'eligibility of people and trips because that is what determines how and where the money gets spent. What is the process going to be to determine that? Who is going to manage invoicing and '}},
{ timecode: 1393, handler: 'blob', id: 97, data: {text: 'accountability to these desperate systems? What fare will be paid? Will Medicaid pay $2.20 or will they pay $26.20? That is kind of the heart of the matter. And what will the process be to determine '}},
{ timecode: 1408, handler: 'blob', id: 98, data: {text: 'the fully allocated cost of trips? How will these trips be ride shared in daily operations? In transportation, we are about moving people and I think it’s a great shame that in all of these '}},
{ timecode: 1422, handler: 'blob', id: 99, data: {text: 'discussions we sometimes lose sight of our customers. We will have a better industry when we have service for people in our programs. The bus that is rolling down the road is the bus for everybody. It '}},
{ timecode: 1434, handler: 'blob', id: 100, data: {text: 'should be our job to provide the ride, fill the empty seats, create efficiencies because we are ride sharing people together, and all of the invoicing and cost sharing should take place in the back '}},
{ timecode: 1444, handler: 'blob', id: 101, data: {text: 'office. The benefits to customers and funders are that people then will receive the benefits they are entitled to. If people stick on the ADA paratransit system and don’t use their Medicaid '}},
{ timecode: 1457, handler: 'blob', id: 102, data: {text: 'benefit, they are paying fares for trips they probably can’t afford. The other benefit is that each sponsor pays its fair share. We have a benefit in Pennsylvania in that we have a very strong '}},
{ timecode: 1473, handler: 'blob', id: 103, data: {text: 'foundation of coordination in our state. In fact, it is required in Pennsylvania to be able to capture the state dollars. We also have a variety of state-funded transportation programs; we are very '}},
{ timecode: 1485, handler: 'blob', id: 104, data: {text: 'fortunate in that respect. But, in Pennsylvania, each county is the recipient of those funds so that design and implementation of transportation reflects the local conditions in each county. At the '}},
{ timecode: 1500, handler: 'blob', id: 105, data: {text: 'local level, it is very powerful because you get to create a kind of system that works for you, but everybody is riding together and everybody is sharing the costs. Allegheny County is where '}},
{ timecode: 1511, handler: 'blob', id: 106, data: {text: 'Pittsburgh is, and in our county there are two recipients; the Transit Authority is the recipient of the transit dollars, and the county Department of Human Services is the recipient of the Medicaid '}},
{ timecode: 1523, handler: 'blob', id: 107, data: {text: 'dollars. This also turned out to be a very powerful relationship because the Department of Human Services has a human service orientation. That is, to a large extent what you need in a Medicaid '}},
{ timecode: 1536, handler: 'blob', id: 108, data: {text: 'program because the job of that program is to make sure that people have access to the medical care that they need. That is not a transportation decision. That belongs more with an organization that '}},
{ timecode: 1548, handler: 'blob', id: 109, data: {text: 'has that kind of orientation. Our medical assistance transportation program is very person centered, and the county considers transportation as an entry point to its entire human service offerings. '}},
{ timecode: 1565, handler: 'blob', id: 110, data: {text: 'The county wraps around people who are eligible for transportation and make sure they get linked into other services. The Department of Human Services in Allegheny County then manages the medical '}},
{ timecode: 1577, handler: 'blob', id: 111, data: {text: 'assistance transportation eligibility of people and trips, and they are the ones that make the decision about which mode of transportation their customer uses. Will they receive direct reimbursement '}},
{ timecode: 1588, handler: 'blob', id: 112, data: {text: 'for a car? Will they get a bus pass or will they use paratransit? This relationship is very much built on cooperation and collaboration, and the partnership not only includes the institutions but the '}},
{ timecode: 1602, handler: 'blob', id: 113, data: {text: 'customers themselves and their advocates and community-based service providers. It is absolutely essential that you have the cooperation of all these parties to make this work. There is an '}},
{ timecode: 1612, handler: 'blob', id: 114, data: {text: 'understanding in Pittsburgh that it is important that the transportation service be vibrant and effective. Nobody can get anywhere if the Transit Authority goes broke. It is everybody’s issue '}},
{ timecode: 1624, handler: 'blob', id: 115, data: {text: 'and it is a shared issue. Everybody pays their fully allocated cost for the ride they want to sponsor, and the ADA program and the medical assistance transportation program have a shared eligibility '}},
{ timecode: 1637, handler: 'blob', id: 116, data: {text: 'process. You have heard before that utilization is low. That is the case in Pennsylvania as well. I think in Allegheny County it is something like a 13% utilization rate. They’re out there '}},
{ timecode: 1651, handler: 'blob', id: 117, data: {text: 'marketing for service yet there all these concerns about cost constraints. And, of course, there is an ongoing concern about whether the Department of Public Welfare will be able to continue to pay '}},
{ timecode: 1664, handler: 'blob', id: 118, data: {text: 'for these rides. We have talked about this before, but when cost became a huge issue in Pittsburgh about 4 years ago, we sat down and tried to figure out how we could deliver a less expensive ride. If '}},
{ timecode: 1677, handler: 'blob', id: 119, data: {text: 'there isn’t enough money for everybody, how do we take the $26-dollar ride and make it into a $15 dollar ride? We found that most of the solutions that are instinctive in transportation '}},
{ timecode: 1688, handler: 'blob', id: 120, data: {text: 'won’t work for medical transportation either because of the type of service it is, the characteristics of the customer, or actually prohibitions in state law from putting those kinds of '}},
{ timecode: 1701, handler: 'blob', id: 121, data: {text: 'constraints on it. Requirements should provide constrain-free transportation. It is very much the same as it is in the ADA. We decided that the only way to manage this then was to reduce the demand '}},
{ timecode: 1716, handler: 'blob', id: 122, data: {text: 'for the service. By reducing demand, we were going to get the people on the right mode of transportation for the trip they wanted to take. If people had a choice between paratransit and fixed route, '}},
{ timecode: 1727, handler: 'blob', id: 123, data: {text: 'they almost always selected paratransit because it is more convenient. An origin-to-destination trip usually is better for most people if they have a choice than spending 2 or 3 hours on the bus with '}},
{ timecode: 1739, handler: 'blob', id: 124, data: {text: '4 kids. So, what we did in Pittsburgh was to figure out a rational process for determining the least restrictive, least expensive transportation mode starting with bus, moving to direct reimbursement, '}},
{ timecode: 1758, handler: 'blob', id: 125, data: {text: 'and then moving to paratransit and applying the ADA standards and procedures to medical assistance transportation. In conjunction with that, part of the outcome of the eligibility then is that '}},
{ timecode: 1771, handler: 'blob', id: 126, data: {text: 'consumer will receive transit instruments – bus passes or bus tickets – for the trips they want to take. Before we started this process, people could self-declare which mode of '}},
{ timecode: 1782, handler: 'blob', id: 127, data: {text: 'transportation they wanted to use, and people have built-in biases. The consumer has the bias about what will work the best for them. Medical professionals have a bias about prescribing transportation '}},
{ timecode: 1795, handler: 'blob', id: 128, data: {text: 'because they care about whether their patient can get to their office. HMO’s were competing with each other in our county to enroll participants, so they offered paratransit service as a benefit '}},
{ timecode: 1807, handler: 'blob', id: 129, data: {text: 'to signing up with their HMO. Other agency staffs have the best interest of their client in mind, whatever that means. So, if they believe that paratransit is in their best interest that is what they '}},
{ timecode: 1820, handler: 'blob', id: 130, data: {text: 'prescribe. All of those processes, while perfectly valid to the person that is making the decision, lack measurable criteria. At the same time, the state had conflicting goals; they wanted to save '}},
{ timecode: 1832, handler: 'blob', id: 131, data: {text: 'money, and they also wanted to increase participation. We moved forward to create a person-centered process that considers individual functional ability to use the fixed-route system and to insure '}},
{ timecode: 1845, handler: 'blob', id: 132, data: {text: 'that that process was applied uniformly to every medical assistance transportation customer who wished to ride in a seat in our ADA paratransit service. We have been pretty successful in using this '}},
{ timecode: 1860, handler: 'blob', id: 133, data: {text: 'approach because 85% of the medical assistance transportation trips in Allegheny County are taken on the fixed-route system, and only 15% are taken on ADA paratransit. I can tell you from our ADA '}},
{ timecode: 1876, handler: 'blob', id: 134, data: {text: 'paratransit system the percentage of trips taken on paratransit by people with conditional eligibility that can use the bus sometimes is 18%. There is almost a direct correlation between the '}},
{ timecode: 1890, handler: 'blob', id: 135, data: {text: 'utilization of the fixed-route system and an eligibility process that helps people on the right mode for the trip they want to take. I want to show you two more slides real quickly. Before we '}},
{ timecode: 1903, handler: 'blob', id: 136, data: {text: 'instituted the ADA eligibility process into medical assistance transportation, their ridership was going up between 3 and 5% a year. In fiscal year 2006, when we changed the eligibility process, the '}},
{ timecode: 1917, handler: 'blob', id: 137, data: {text: 'ridership dropped by more than 20,000 rides in one year. It has stayed at that level uniformly since then. This is the money that’s spent, and you can see how the chart was going up between '}},
{ timecode: 1931, handler: 'blob', id: 138, data: {text: 'fiscal year 2003 and 2005. Because there were less rides, less money was spent in fiscal year 2006, and by fiscal year 2008, they still had not gotten to the point of spending that they were at in '}},
{ timecode: 1944, handler: 'blob', id: 139, data: {text: 'fiscal year 2005 despite the fact that transportation costs were increasing at more than 4 times the rate of inflation in the same period. I am here to tell you that if you apply the ADA model to '}},
{ timecode: 1964, handler: 'blob', id: 140, data: {text: 'medical assistance transportation, you will find that there is a good fit. It is possible for all the customers to ride together. We have never had an issue in Pittsburgh in co-mingling, if you will, '}},
{ timecode: 1976, handler: 'blob', id: 141, data: {text: 'people with disabilities and medical assistance transportation rides. It is public transit; people share the rides together. The effect can be that there are significant cost savings for all '}},
{ timecode: 1987, handler: 'blob', id: 142, data: {text: 'concerned. DAN DIRKS: Thank you very much. Since we have only about half hour of questions, I thought what we would do is instead of me asking a few, I will just turn it over to the audience and I can '}},
{ timecode: 2008, handler: 'blob', id: 143, data: {text: 'supplement it from there. AUDIENCE MEMBER: I will make it real fast. I am now going to give you the perspective of the people that you serve. One—the use of tokens creates an underground '}},
{ timecode: 2030, handler: 'blob', id: 144, data: {text: 'economy. It draws the wrong environment to locations at bus stops. It is also the same with passes. Anything that can be sold to somebody else, that is transferable, is not effective. It has got to be '}},
{ timecode: 2044, handler: 'blob', id: 145, data: {text: 'some kind of a person – like a successful parking thing where it is tied to your license. You have to have something tied to it so they can’t do it. Second of all is that everybody is '}},
{ timecode: 2056, handler: 'blob', id: 146, data: {text: 'talking about doing this ADA eligibility, whether they can use a bus or not. It is not a question of whether they can use the bus or not, it is a question of whether they can use the route or not. So, '}},
{ timecode: 2065, handler: 'blob', id: 147, data: {text: 'you have people say, oh, this guy can use the bus, but you know what? There is no bus within 15 miles of his house; but he can functionally use the bus, so we are going to give him a bus pass. '}},
{ timecode: 2074, handler: 'blob', id: 148, data: {text: 'Numerous times, in my own personal experience, I have received calls from case managers where they have lost people because they came discharged out of a hospital and they gave him a bus pass or a '}},
{ timecode: 2087, handler: 'blob', id: 149, data: {text: 'token. So I really think – I don’t want to go anymore – but I will be sending you each individual things, but you have really got to look at the other side. DIANE GALLION: I think '}},
{ timecode: 2097, handler: 'blob', id: 150, data: {text: 'for Medicaid issues for – I know in my experience when I worked on Medicaid issues, part of issues of using bus passes was looking at how close they were to the route. So, bus passes were not '}},
{ timecode: 2113, handler: 'blob', id: 151, data: {text: 'sent out to be – the use of bus when you’re looking at it with Medicaid are trip appropriate. Is that an appropriate trip to use with bus, and it is not only the first question that you '}},
{ timecode: 2128, handler: 'blob', id: 152, data: {text: 'look at in assigning bus is first, the mode of transportation. Is that an appropriate mode of transportation? Is that person able to use public transit? The second thing you look at if the answer to '}},
{ timecode: 2141, handler: 'blob', id: 153, data: {text: 'that is yes, is that an appropriate trip? Is the bus an appropriate trip? Is the route an appropriate trip? Are they fixed routes? Is that usable? Is there more than one transfer usually for that '}},
{ timecode: 2158, handler: 'blob', id: 154, data: {text: 'trip? And then, you have to have criteria and, again, that is something that you set. So I think – and often Medicaid will set the criteria through the state or through the brokerage; they will '}},
{ timecode: 2172, handler: 'blob', id: 155, data: {text: 'have those criteria that there may be no more than one or two transfers. If there isn’t, that is definitely something that should be looked at because it has to be a usable function. '}},
{ timecode: 2186, handler: 'blob', id: 156, data: {text: 'That’s the difference between giving out blanket passes and blanket day passes or monthly passes and looking at trip-appropriate passes. When you have tied it to the individual trip, then you '}},
{ timecode: 2203, handler: 'blob', id: 157, data: {text: 'have also looked at that trip and said this is an appropriate trip for public transit. KAREN HOESCH: That is the same process that is used in Pittsburgh. First, there has to be a bus to be able to use '}},
{ timecode: 2218, handler: 'blob', id: 158, data: {text: 'the bus. The criteria that the county Department of Human Services has is that the origin and destination have to be within a half a mile of walking. And then they use a criteria for total travel '}},
{ timecode: 2231, handler: 'blob', id: 159, data: {text: 'time. Therefore, it’s the flip of what it would be in the ADA. It has to be comparable to what a reasonable person would do if they were driving there in their own vehicle, so you don’t '}},
{ timecode: 2241, handler: 'blob', id: 160, data: {text: 'have bus trips that take 3 or 4 hours. DAN DIRKS: I am going to put my old general manager’s hat on. Whether it is paratransit service or fixed-route service, it is very, very important for '}},
{ timecode: 2252, handler: 'blob', id: 161, data: {text: 'people to complain. Because without the complaint, the supervisors are not going to find out what’s happening, and if you’re not comfortable with the response you get from the supervisor, '}},
{ timecode: 2264, handler: 'blob', id: 162, data: {text: 'you move up. You have to advocate, and the same thing goes for you as a transit manager. One complaint is probably 50 that 49 don’t want to give you. I think it is important from a customer '}},
{ timecode: 2284, handler: 'blob', id: 163, data: {text: 'perspective, customer service perspective to try to follow up on all of that to the extent you can. DAVE CRYA: Karen, the level of service for the ADA service is, I am assuming, door; is that correct? '}},
{ timecode: 2303, handler: 'blob', id: 164, data: {text: 'KAREN HOESCH: In Pittsburgh? Door to door or door through door if people need it and assistance up or down as many as 4 steps. DAVE CRYA: Does Medicaid require the door through door? KAREN HOESCH: In '}},
{ timecode: 2314, handler: 'blob', id: 165, data: {text: 'Pittsburgh, they don’t. But we would be happy to offer it if they did. DAVE CRYA: So you are able to do that type of thing. KAREN HOESCH: Yes. DAVE CRYA: Then you have nine service providers for '}},
{ timecode: 2323, handler: 'blob', id: 166, data: {text: 'demand responsive, and they are all Medicaid approved, correct. KAREN HOESCH: Yes. DAVE CRYA: Is that process very difficult? KAREN HOESCH: I am saying yes because access is the brokerage. The broker '}},
{ timecode: 2339, handler: 'blob', id: 167, data: {text: 'is actually required to insure the eligibility of each of its providers. We are responsible for managing the standard for criminal and child abuse clearance, background checks, all of those things. '}},
{ timecode: 2357, handler: 'blob', id: 168, data: {text: 'DAVE WHITE: Just a quick question: On your negotiation with the Health and Human Services Department around the rate to pay for paratransit for Medicaid, it sounds like you are getting the fully '}},
{ timecode: 2376, handler: 'blob', id: 169, data: {text: 'allocated cost. Maybe you can just enlighten us how you got them to pay that fully allocated cost as opposed to a $2- or $3-dollar ADA rate. KAREN HOESCH: It started that way, so there was never '}},
{ timecode: 2391, handler: 'blob', id: 170, data: {text: 'really any discussion when the program started. I think we have been doing medical assistance transportation for more than 20 years. What we do on a quarterly basis is a cost analysis of medical '}},
{ timecode: 2404, handler: 'blob', id: 171, data: {text: 'assistance trips. Their price reflects the characteristics of their trips, not anybody else’s trips. That’s how we make sure that we are not overcharging them. AUDIENCE MEMBER: Do you have '}},
{ timecode: 2421, handler: 'blob', id: 172, data: {text: 'a list or a form of how you determine if someone is appropriate for paratransit versus bus? You mentioned some of the reference criteria in Power-Point, but I am looking for like a form we could '}},
{ timecode: 2440, handler: 'blob', id: 173, data: {text: 'duplicate or borrow from you? KAREN HOESCH: The process that we use is one that you can get from Easter Seals Project Action. I don’t know if you’ve ever gone to their website, but all of '}},
{ timecode: 2453, handler: 'blob', id: 174, data: {text: 'their information is free. There is a guidebook and a 3-CD set that explains how to implement ADA paratransit eligibility in the way I described. AUDIENCE MEMBER: And you found that to be consistent '}},
{ timecode: 2467, handler: 'blob', id: 175, data: {text: 'with the Medicaid rules. KAREN HOESCH: Yes. AUDIENCE MEMBER: My question also piggybacks on David’s last question. And, Karen, I think you mentioned this briefly during your presentation. Can '}},
{ timecode: 2481, handler: 'blob', id: 176, data: {text: 'this Medicaid/ADA cost-sharing relationship continue under the new CMS and EMT regulations? My dilemma is in reading those regulations, is an ADA trip, is that a fixed-route trip? Or is it a '}},
{ timecode: 2497, handler: 'blob', id: 177, data: {text: 'demand-response trip? Because, if it is a fixed-route trip, CMS is stating that we can’t pay more than what the general public would pay for that trip, which would be two times the normal fare '}},
{ timecode: 2511, handler: 'blob', id: 178, data: {text: 'of a fixed route trip. If it is a demand-response trip, I guess we can negotiate those rates, but I am not really clear as to which type of trip it is and can these cost-sharing relationships continue '}},
{ timecode: 2524, handler: 'blob', id: 179, data: {text: 'under the new regulations. VALERIE MILLER: Actually, I have the regulations right here. It says, verbatim: That Medicaid program is paying no more for fixed-route public transportation than the rate '}},
{ timecode: 2546, handler: 'blob', id: 180, data: {text: 'charged to the general public. That is for fixed route. And no more for public paratransit services than the rate charged to other state human services agencies for comparable service. So, if you are '}},
{ timecode: 2562, handler: 'blob', id: 181, data: {text: 'charging fully allocated costs to other state human service agencies then you have no issues. KAREN HOESCH: That’s the case in Pennsylvania. Pennsylvania requires that paratransit providers have '}},
{ timecode: 2577, handler: 'blob', id: 182, data: {text: 'a general public fare structure that is essentially set to recover cost, and then a sponsor of a paratransit ride may subsidize that fare. So, seniors get an 85% discount on the general public fare, '}},
{ timecode: 2593, handler: 'blob', id: 183, data: {text: 'and that is one of the reasons Pennsylvania has been able to implement this across the state; it is because there is a rational fare level that is set at cost recovery. VALERIE MILLER: This is a '}},
{ timecode: 2604, handler: 'blob', id: 184, data: {text: 'change for CMS. This is a new direction for CMS, and this was kind of a “give” for CMS. So, for those of you who have not – who do ADA paratransit, a complimentary paratransit with '}},
{ timecode: 2623, handler: 'blob', id: 185, data: {text: 'your fixed route and you have not wanted to look at doing ADA paratransit Medicaid because the state has only said, or whoever, has only said that they will pay the public fare, then this is a new '}},
{ timecode: 2645, handler: 'blob', id: 186, data: {text: 'approach. This is included on the flash drive, and it happens to be on page 31 in the right-hand column in the middle of the page. When you look on your flash drive at the federal regs that are '}},
{ timecode: 2661, handler: 'blob', id: 187, data: {text: 'included, you will be able to find it there. AUDIENCE MEMBER: Some of us in rural areas are struggling with how to coordinate, and we don’t have the volume, for instance, that Pittsburgh would '}},
{ timecode: 2679, handler: 'blob', id: 188, data: {text: 'have. But I was curious in terms for who pays for your brokerage to exist and do its work? How is that done? And secondly, Valerie, you are aware of rural Western areas, very rural areas where – '}},
{ timecode: 2695, handler: 'blob', id: 189, data: {text: 'what a lot of us struggling for in the rural areas is everybody wants us to coordinate, but there is no money for doing that and it can’t be done as a voluntary activity without a great deal of '}},
{ timecode: 2708, handler: 'blob', id: 190, data: {text: 'stress on our transit human service systems. So if you could address those two thing – how is that paid for to be the brokerage? Do you take a piece of the cost of the fares? Is there a separate '}},
{ timecode: 2718, handler: 'blob', id: 191, data: {text: 'grant from the state to you? Do you have to bill Medicaid for each and every ride? Or do you have a contract? How hard is it? How easy is it? Are you like a doctor’s office constantly billing '}},
{ timecode: 2729, handler: 'blob', id: 192, data: {text: 'Medicaid? How does that come out financially and then what are the alternatives in rural, really rural areas? KAREN HOESCH: Our brokerage is paid for by all the users of the service. So the '}},
{ timecode: 2747, handler: 'blob', id: 193, data: {text: 'administrative costs are shared between all of the users, although our Transit Authority pays a slightly higher percentage than the other uses because they have to have ADA complimentary paratransit. '}},
{ timecode: 2759, handler: 'blob', id: 194, data: {text: 'So a certain infrastructure would have to exist whether there were other sponsors or not. That said, our brokerage feels very strongly that money shouldn’t not be spent on administrative costs; '}},
{ timecode: 2770, handler: 'blob', id: 195, data: {text: 'it should be spent on service. Our administrative cost is 5.4% of total. I defy any non-profit in this room to beat that. We are very, very thrifty. VALERIE MILLER: Are you looking at being a '}},
{ timecode: 2788, handler: 'blob', id: 196, data: {text: 'brokerage just for Medicaid? Or are you looking at being a coordinator? I am asking because there are some specific new rulings prohibiting, in some instances – in many instances – brokers '}},
{ timecode: 2813, handler: 'blob', id: 197, data: {text: 'being Medicaid providers. You want to be careful when you start talking about wanting to be a broker if you are a Medicaid provider. AUDIENCE MEMBER: Okay, good, that clarifies that for me; that '}},
{ timecode: 2827, handler: 'blob', id: 198, data: {text: 'helps. In many of the Western states where populations are small, the state Medicaid agency itself sometimes handles Medicaid transportation at the state level. So, human service providers and transit '}},
{ timecode: 2842, handler: 'blob', id: 199, data: {text: 'providers at local areas are trying to do a kind of coordination and a kind of brokerage, not be being paid to be a broker but we’re trying to coordinate, we are trying to figure out efficiency '}},
{ timecode: 2854, handler: 'blob', id: 200, data: {text: 'for human service trips and ADA paratransit, etc. Then we are often dealing directly with the state Medicaid agency; there are not local brokerages. I am just trying to figure out generally in this '}},
{ timecode: 2868, handler: 'blob', id: 201, data: {text: 'whole conference that maybe we can’t be a broker, but coordination takes effort. It takes the 5%. It takes some effort, and part of what’s going to, I hope, come out of the new '}},
{ timecode: 2879, handler: 'blob', id: 202, data: {text: 'reauthorization is some recognition that if coordination is wanted, coordination has to be paid for as a viable, valuable function. Brokerage is just one kind of coordination. VALERIE MILLER: '}},
{ timecode: 2893, handler: 'blob', id: 203, data: {text: 'You’re wanting to coordinate between systems in your area, and I think there are many ways that you can coordinate. I personally would like to see some coordination. One of my biggest problems '}},
{ timecode: 2912, handler: 'blob', id: 204, data: {text: 'I’m seeing, and I haven’t figured out how to address it, is that I would like to see coordination between counties to get one of the biggest barriers to medical transportation are county '}},
{ timecode: 2929, handler: 'blob', id: 205, data: {text: 'lines. I get many, many phone calls from people who can’t cross that county line for medical transportation. Not for Medicaid that we’re talking now, but…I would love to talk to you '}},
{ timecode: 2942, handler: 'blob', id: 206, data: {text: 'after this conference and continue this and to talk about the coordination in your Western areas. KAREN HOESCH: You asked about billing Medicaid directly. In Pittsburgh, the medical assistance '}},
{ timecode: 2959, handler: 'blob', id: 207, data: {text: 'non-emergency transportation is billed to our county, and then they bill Medicaid. We also provide common community-based waiver Medicaid transportation for the aging and disability wavers, and for '}},
{ timecode: 2973, handler: 'blob', id: 208, data: {text: 'those we do bill Medicaid directly in Pennsylvania. It is a pain in the “doopah.” AUDIENCE MEMBER: Diane, when you implemented the ADA criteria process, what did that look like? The '}},
{ timecode: 2987, handler: 'blob', id: 209, data: {text: 'implementation and what did your transition look like for people who had been accustomed to ADA who were kind of being transitioned into the fixed-route? DIANE GALLION: We have the complimentary '}},
{ timecode: 3000, handler: 'blob', id: 210, data: {text: 'paratransit, so most of our clients actually are eligible to ride those fixed-route and the paratransit busses because it is based on – you know, we followed along with the Easter Seals very '}},
{ timecode: 3012, handler: 'blob', id: 211, data: {text: 'much when we developed our ADA application, our guidelines, our policies and procedure, so we followed along that, and we assumed Medicaid – we actually billed Medicaid or the state directly. '}},
{ timecode: 3027, handler: 'blob', id: 212, data: {text: 'The passenger’s ride is free, and then once a month I send a billing to Medicaid for the Medicaid rides. It was kind of seamless for us; it was the same clients we were already providing trips '}},
{ timecode: 3041, handler: 'blob', id: 213, data: {text: 'for. It is that now we also will receive money for the trips from the state of Missouri, which is actually more lucrative than just charging the $2.20 for a one-way trip. They were already our clients '}},
{ timecode: 3054, handler: 'blob', id: 214, data: {text: 'to start with, so we just offered them a service to do Medicaid. AUDIENCE MEMBER: Do your agencies get involved in the coordination of trips for mental health patients or possibly substance treatment '}},
{ timecode: 3067, handler: 'blob', id: 215, data: {text: 'patient at all? DIANE GALLION: We don’t in Springfield, but it is based on each region on this waiver program. One of my counterparts in Jefferson City, Missouri, actually does participate in '}},
{ timecode: 3080, handler: 'blob', id: 216, data: {text: 'that waiver program, and it is for the people that are Medicaid eligibility. There isn’t a restriction; it doesn’t have to be non-emergency medical trips that they provide. It’s any '}},
{ timecode: 3090, handler: 'blob', id: 217, data: {text: 'trips to anywhere, and they get reimbursed at 60% of their operating costs. KAREN HOESCH: We have a substantial number of people that use our paratransit system for behavioral health transportation, '}},
{ timecode: 3105, handler: 'blob', id: 218, data: {text: 'partial hospitalization, and day programs. I would say it’s fairly significant on non-emergency medical transportation. AUDIENCE MEMBER: I am Doug Bernie from the Federal Transit Administration: '}},
{ timecode: 3119, handler: 'blob', id: 219, data: {text: 'I just wanted to address the question that was raised by the rural area, which was how do you pay for coordination? I wanted to mention that SAFETEA-LU did us a big favor because in SAFETEA-LU, for '}},
{ timecode: 3136, handler: 'blob', id: 220, data: {text: 'the first time, they recognized the concept of mobility management. It recognized that it is a capital cost, which meant that any of the federal transit programs can pay for 80% of the cost of '}},
{ timecode: 3149, handler: 'blob', id: 221, data: {text: 'mobility management. One of the eligible items underneath mobility management is brokerage. In almost all of our programs, we can fund brokers and pay 80% of the cost of those brokers. The other thing '}},
{ timecode: 3164, handler: 'blob', id: 222, data: {text: 'that SAFETEA-LU was, it said the matching funds which often come from state and local sources could come from other non-DOT federal funds. You could have actually Medicaid paying a certain percentage '}},
{ timecode: 3178, handler: 'blob', id: 223, data: {text: 'of the brokerage and the FTA paying the other percent. Now, in Pittsburgh, all the partners pay for it. But, I just want to point out that option in the federal programs. And what we’re finding '}},
{ timecode: 3189, handler: 'blob', id: 224, data: {text: 'is that the mobility management functions are being funded at a great rate under the JARK and New Freedom programs. A lot of those dollars are going to create mobility management and coordination '}},
{ timecode: 3202, handler: 'blob', id: 225, data: {text: 'arrangements. That could work as well in rural areas either out of your 5307 dollars or out of the JARK dollars or out of your New Freedom dollars, and also, out of the 5310 dollars. All of those '}},
{ timecode: 3216, handler: 'blob', id: 226, data: {text: 'dollars can be used for mobility management and coordination. AUDIENCE MEMBER: One of the things that was mentioned was reauthorization. Reauthorization is coming up, and congress will either extend '}},
{ timecode: 3229, handler: 'blob', id: 227, data: {text: 'it later this year or adopt a reauthorization in transportation. We also have reauthorization down the road coming up with health and human service, Medicaid, Medicare, whatever, whatever. In an ideal '}},
{ timecode: 3242, handler: 'blob', id: 228, data: {text: 'world, what types of things should be addressed from your perspectives that will make accessibility, mobility for the customers that you serve easier and also make it more manageable, more easily '}},
{ timecode: 3256, handler: 'blob', id: 229, data: {text: 'manageable, for you yet provide the kind of accountability that probably should be done? What do you want? That’s really what I am asking. VALERIE MILLER: I think I would certainly like – '}},
{ timecode: 3276, handler: 'blob', id: 230, data: {text: 'I mean, there are – you know, one thing in any of the legislation coming up, any of the governmental workings, I guess, coming up, one of the things that seriously concerns me – there is '}},
{ timecode: 3294, handler: 'blob', id: 231, data: {text: 'much talk about national health care, but in that I am not hearing any talk about transportation included in that national health care. And transportation is included in the Medicaid issues, but if we '}},
{ timecode: 3315, handler: 'blob', id: 232, data: {text: 'move to one national healthcare program, I don’t want to see the transportation component somehow get lost in all of that. I have great concern in the rush to get a national healthcare model '}},
{ timecode: 3332, handler: 'blob', id: 233, data: {text: 'that somehow the transportation component will be misplaced. That is a huge concern to me, and I think it should be a concern to all of us. We’ve just seen the transportation component for '}},
{ timecode: 3350, handler: 'blob', id: 234, data: {text: 'Medicaid being misplaced in Michigan, and Idaho has done some work on misplacing the transportation component for Medicaid, so I think we need to be very vigilant with our concerns for that and make '}},
{ timecode: 3375, handler: 'blob', id: 235, data: {text: 'sure that we make our concerns known. That as part of any kind of healthcare reform, that we keep that component in the forefront, that medical transportation not be lost in any kind of healthcare '}},
{ timecode: 3398, handler: 'blob', id: 236, data: {text: 'reform. And I think part of doing that – when we talked about the medical home in the last session, that part of doing that is also making sure that we become integrated in the medical side of '}},
{ timecode: 3415, handler: 'blob', id: 237, data: {text: 'the industry as well as the transportation. We tend to be – and CTAA is working in that, and that is part of what I’m doing is trying to integrate transportation into the medical side as '}},
{ timecode: 3428, handler: 'blob', id: 238, data: {text: 'well as the transportation side. That being said, I think that’s important; that we continue to work on the medical part of transportation and also, with the Medicaid issues, not lose sight of '}},
{ timecode: 3445, handler: 'blob', id: 239, data: {text: 'the fact that Medicaid transportation is not a given and it needs to be a given. We need to make sure that that is a firm benefit that cannot be taken away at a whim. AUDIENCE MEMBER: So, Valerie, '}},
{ timecode: 3468, handler: 'blob', id: 240, data: {text: 'would you recommend that the audience here kind of attack their congressman or congresswoman and senators over this issue? VALERIE MILLER: You know, education of our congressional staff is the best '}},
{ timecode: 3483, handler: 'blob', id: 241, data: {text: 'thing that we can do. My daughter, who was up there, worked for a senator in Washington D.C. for 2 years, and that was a wonderful lesson to me, because what it taught me was how fluid the staff is of '}},
{ timecode: 3501, handler: 'blob', id: 242, data: {text: 'our congressmen, even long-term senators and congressional staff. And just because you’ve met with your senator and you’ve met with congressman doesn’t mean you don’t need to '}},
{ timecode: 3513, handler: 'blob', id: 243, data: {text: 'reeducate that staff every year or every two years because they have new staff. You need to be updating them. Just because you think that they know your system, put it in front of them again and '}},
{ timecode: 3528, handler: 'blob', id: 244, data: {text: 'educate and educate and reeducate because it is so important for them to understand, not only from your perspective but from the people that you are dealing with, whether it is from the medical side, '}},
{ timecode: 3546, handler: 'blob', id: 245, data: {text: 'whether it is from the transportation from some of the people you transport, yeah! Definitely. Go back home, and if they have listening posts at home and you would be amazed that nobody comes; it is '}},
{ timecode: 3564, handler: 'blob', id: 246, data: {text: 'so important to go and make those contacts. It is absolutely vital, and it does make a difference. DAN DIRKS: And bring one of your customers with you, too. VALERIE MILLER: Yes, bring your customers; '}},
{ timecode: 3576, handler: 'blob', id: 247, data: {text: 'that\'s who they want to listen to. DAN DIRKS: We have time for 2 quick questions. AUDIENCE MEMBER: Karen, in 2005 you had an innovative program with Traveler’s Aid in which you provided bus '}},
{ timecode: 3597, handler: 'blob', id: 248, data: {text: 'tokens and passes to individuals coming from medical facilities. It strikes me, if I remember the number right, you said 18,000 trips a month on it. Is something like that still continuing? Question 2 '}},
{ timecode: 3613, handler: 'blob', id: 249, data: {text: 'is did you experience any increased pressure then or later from BPW to increase the percentage of trips on substantially increase the percentage of trips on your bus system, the fixed route rather '}},
{ timecode: 3632, handler: 'blob', id: 250, data: {text: 'than the paratransit? KAREN HOESCH: First of all, the Traveler’s Aid reference is to the agency that the county contracts with to do the distribution of the transit fare instruments. So once the '}},
{ timecode: 3647, handler: 'blob', id: 251, data: {text: 'person is determined eligible for bus or paratransit or both, whatever, they get their bus pass or ticket from Traveler’s Aid and that non-profit does all the accountability follow-up for the '}},
{ timecode: 3659, handler: 'blob', id: 252, data: {text: 'county, so they have contracted that out. It is a very good relationship. The county spends more than $3 million dollars on transit instruments for Medicaid-eligible trips. What we did in Pittsburgh, '}},
{ timecode: 3673, handler: 'blob', id: 253, data: {text: 'instead of waiting for the Department of Public Welfare to come to us or to come to anybody and say, we need to get more people on the bus, we got out ahead of it using the same rationale as we do on '}},
{ timecode: 3684, handler: 'blob', id: 254, data: {text: 'ADA paratransit because it is the least restrictive, least expensive mode of transportation and there was already a model for making those decisions in Pittsburgh. AUDIENCE MEMBER: Karen, is your '}},
{ timecode: 3699, handler: 'blob', id: 255, data: {text: 'Power Point file on the flash drive is under what label? KAREN HOESCH I don’t know, actually. But I have your card, so I can make sure you get it. VALERIE MILLER: Did you send it to me? KAREN '}},
{ timecode: 3706, handler: 'blob', id: 256, data: {text: 'HOESCH: Yes. VALERIE MILLER: Then it’s on the file on the flash drive under Partnership for Wellness. If you sent it to me, it is on the flash drive. It should be there. If you can’t find '}},
{ timecode: 3722, handler: 'blob', id: 257, data: {text: 'it, let me know. But this whole thing is also – the whole session is being recorded, so you’ll be able to find it within a couple of weeks. We are going to have a separate web site that '}},
{ timecode: 3738, handler: 'blob', id: 258, data: {text: 'will be listing for this, too. DAN DIRKS: Thank you, ladies. We’re kind of running of time. Let’s give them a round of applause. DAVE WHITE: Thank you very much. That was a great '}},
{ timecode: 3772, handler: 'blob', id: 259, data: {text: 'presentation. I actually have an affinity for Pittsburgh. I went to school at Washington and Jefferson just south of Pittsburgh, and your mayor is an alumni of Washington and Jefferson. He happens to '}},
{ timecode: 3787, handler: 'blob', id: 260, data: {text: 'be about the youngest Mayor in the United States. He is the youngest, that’s right. We are about to have lunch, but right after that, at 2 o\'clock, we are all going to gather back here for an '}},
{ timecode: 3807, handler: 'blob', id: 261, data: {text: 'afternoon of continuing discussion of Medicaid and Medicare. We are going to start out with about a half-hour presentation of an overview of what’s going on in Medicaid and Medicare by Families '}},
{ timecode: 3823, handler: 'blob', id: 262, data: {text: 'USA from Washington. It is going to be a great introduction to the challenges confronting Medicaid and Medicare. That is going to lead into a more specific discussion lead by CTAA’s own David '}},
{ timecode: 3840, handler: 'blob', id: 263, data: {text: 'Raphael back there in the corner on the challenges facing Medicaid non-emergency medical transportation. And then we are going to wrap up the conference with a really – I think it’s going '}},
{ timecode: 3853, handler: 'blob', id: 264, data: {text: 'to be a really interesting discussion about a new challenge facing a lot of us in the business, and that’s stretcher transportation that is popping up; that is going to be led by Dave Cyra later '}},
{ timecode: 3869, handler: 'blob', id: 265, data: {text: 'on in the afternoon. So everybody, get back here at 2 o\'clock for that. Now, the luncheon I think is going to be very interesting. I mentioned it yesterday and I think this morning. The FTA '}},
{ timecode: 3884, handler: 'blob', id: 266, data: {text: 'Administrator confirmed just last week, and the reason I wasn’t able to be with you guys when you started this morning was because our board, the CTAA Board, was meeting with him, Peter Ragoff. '}},
{ timecode: 3895, handler: 'blob', id: 267, data: {text: 'He is a very interesting guy with 20+ years experience with the Senate Transportation Committee. I didn’t know that before that he spent a couple of years on the health and human services side '}},
{ timecode: 3911, handler: 'blob', id: 268, data: {text: 'in the senate on the senate staff. We started talking about, needless to say, we spent a lot of time on reauthorization and talking about what his approach might or might not be there. But, we also '}},
{ timecode: 3926, handler: 'blob', id: 269, data: {text: 'talked about Medicaid and medical transportation, and he seems to be really interested in learning about yours, ours, all of our concerns and challenges in that area. Doug, don’t tell him I said '}},
{ timecode: 3946, handler: 'blob', id: 270, data: {text: 'this, but he seems like a very accessible guy, so please feel free to pigeon hole him a little bit. He has a stack of business cards like this, so ask for one, ask for his business card and get your '}},
{ timecode: 3960, handler: 'blob', id: 271, data: {text: 'comments, thought, concerns off to Peter either regarding obviously reauthorization but specifically medical transportation concerns. Let’s get off to lunch and we\'ll see you all back here at '}},
{ timecode: 3974, handler: 'blob', id: 272, data: {text: '2:00PM. Thank you very much.'}},
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