NCSL Legislative Summit

Transcription

1 NCSL Legislative Summit Human Services Transportation Coordination Governor Steve Beshear, Commonwealth of Kentucky Secretary Mike Hancock, Kentucky Transportation Cabinet Presented by Executive Director Vickie S. Bourne Office of Transportation Delivery Kentucky Transportation Cabinet July 16, 2010

2 Kentucky Broker Concept In Kentucky, a single coordinated Human Service Transportation.among several state administered human service programs was established. The model established a series of transportation Brokers throughout the state whose job it was to secure the most cost effective transportation delivery for the human service clients of the various programs r involved. Source: United We Ride A Framework for Action: Building Source: United We Ride A Framework for Action: Building the Fully Coordinated Transportation System

3 KYTC/OTD Mission To provide a safe, efficient, environmentally sound and fiscally responsible transportation system that delivers economic opportunity and enhances the quality of life in Kentucky.

4 NEMT HSTD Reasons to Coordinate? The Coordinating Council on Mobility and Access Since (1986) (9 -Joint effort of USDOT and DHHS Federal Coordination Mandate -USDOT - TEA21 (1998)

5 NEMT HSTD Reasons to Coordinate? Economic Benefits -Transit Cooperative Research Program Report 91 (2003)

6 The Transit Cooperative Research Program report, #91 completed in 2003 referred to and praised Kentucky s HSTD Program many times. If 10 of the 50 states were to implement a program such as that being created in Kentucky, annual benefits to the Medicaid Program could reach 100 million per year.

7 NEMT HSTD Reasons to Coordinate? The President s Executive Order Human Service Transportation Coordination Feb 26, 2004

8 NEMT HSTD Reasons to Coordinate? Kentucky Governor Patton -Empower Projects 23 DESIGNED Empower Projects - HSDT Selected 1 of 7 KY Empower Projects -HSTD Implementation Team

9 More Reasons to Coordinate 1996 KY Medicaid Population 240, KY Medicaid id Population over 800, US Persons below poverty 13.2% KY Persons below poverty 17.3% Current US Unemployment 9.3% KY Unemployment is 10.1%

10 More Reasons to Coordinate Persons 65 and older in KY make up 13.3% 3% Kentucky s Population-compared to the Nation s with 12.8%

11 Aging Americans: STRANDED WITHOUT OPTIONS

12 Disabled Age Group (US 12.9%) What five States t have the highest h disability rate? West Virginia 21.9% Mississippi 20.5% Kentucky 20.2% Arkansas 20.0% Alabama 18.6% Based on 2006 American Community Survey/US Census

13 Before KY HSTD Coordination Non-Emergency Medical Transportation Voucher System Understaffed State case workers in each county issued voucher for Transportation Dept Medicaid had Thousands of Contracts Delay in Payments to Providers 1996 Actuarial Study Report predicted cost would be over $60 million by 2002

14 Before KY Coordination Fraud & Abuse of Non-Emergency Medicaid Transportation Billings for excessive mileage Ineligible trips No Recipient nor Provider Accountability Escalating Costs NoSaeySa Safety Standards dads Resource Inefficiency Administrative Operational Need for Greater Mobility

15 Why did we Unite? Yesterday Today

16 Muhammad Ali He who is not courageous enough will not accomplish anything in life. Muhammad Ali

17 Goals of KY HSTD Accessibility Timeliness Safety Provider/Recipient Accountability Customer Satisfaction i Cost

18 KY HSTD Objectives Objectives of Human Service Transportation Delivery Program-HSTD Improve access to medical care reduce the rate of growth in expenditures prevent unnecessary/inappropriate utilization reduce administration costs provide access to quality service for recipients 18

19 Chain of Events Empower KY Business Case Transportation Cabinet designated lead Sponsor KY HSTD Legislation KY State Representative Jimmie Lee State Law KRS Administrative Regulations 603-KAR 7:080 Joint hearings/statements of considerations

20 Chain of Events 1. Law 468 (Passed April 14, 1998) - All willing and Able Providers (b) waiver - No Freedom of Choice 2. Law 488 (Passed April 6, 2000) Gave Freedom of Choice to all 07 s and 08 s -Covered Services Increase due to Waiver Programs -SCL/ADC adjustments put in Broker Contracts -Transportation to set Sub Rates -Program Coordinator Setup 3. SB law on escorts March 2003

21 Chain of Events Inter-agency Decision Making Body Coordinated Transportation Advisory Council (CTAC) Authority by KY Statute Open to Public Voting members Health and Families Cabinet Workforce Development Transportation Meets Monthly Oversees Progress Program Issues Policy

22 Chain of Events Executive Quality Management Council (EQMC) Meets Monthly Between Cabinets Draft Policy Take issues to CTAC Develop pquality Improvement Plan

23 Partners/Funding Source KY Transportation Cabinet Public Transit/Bus System KY Education Cabinet Department of Workforce Investment Office for the Blind Office of Vocational Rehabilitation KY Health & Family Services Cabinet Non-Emergency Medicaid KY Finance Cabinet Tentative Partners Aging and Veterans Group

24 How the Dollars Flow 1996 Began Framework for Coordination 1998 First Broker 2004 Statewide fully operational Agreements Annual Agreements between Partners/Transportation Cabinet Finance Cabinet Annual Agreements with Transportation Broker Transportation Broker Agreement Subcontractor

25 Human Service Transportation Regions

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27 Broker Responsibilities Serve as Gatekeepers Verifying i the recipient s i eligibility ibili Assessing the recipient s need Educating the recipients Determining the appropriate transportation 01 Private Auto and Foster Parent Providers 02 Regular Taxi Service (Ambulatory) 03 Fixed Route Bus System 04 Non-profit demand response bus service 07 Ambulatory but disoriented 08 non-ambulatory who needs physical assistance

28 Submittals by Each Broker to KY Transportation Cabinet Broker Accountability Encounter Trip Data Complaint Tracking Phone Report Financial Line Item Budget Vehicle Inventory Monthly Invoice Monthly Summary Peer to Peer Review Eliminate i Fraud or Abuse

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30 Transportation Medicaid Specialist

31 Different Programs/ Different Funding Sources/ Different Payment Mechanisms United into a KY Coordinated Human Service Transportation Delivery Program. Public Transit - Fare Workforce Fee Dept Blind Voc Rehab Medicaid Capitated

32 NEMT Factors Affecting Costs 72 Hour Notice Freedom of Choice State Program Coordinators/ Transportation ti Specialist 800 line/complaints/denials Urgent Care Waiver Programs - ADC / SCL Bus Passes Private Autos

33 KY Non-Emergency Medical Transportation Delivery Cost Projection Dollars in millio ons Without Coordination Consolidated Approach 20 - FY98 FY99 FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 Fiscal Year

34 Safety/Security Transit on board cameras AVL/MDT Software tracking systems

35 KY NEMT SFY 10 STATS $60,503, Expenditures 3,014,698 NEMT Trips Cost per trip $20.07 Cost per mile $1.83 9,352 denials 52 Recipient Appeal Hearings/.05% of total denials-100% of hearings affirmed/dismissed/settled/withdrawn no decision to deny was reversed by Order -140 Complaints

36 KY Human Service Transportation Delivery Customer Satisfaction Line (State & Regional Level) Complaint Tracking (State & Regional Level) Monthly Phone Surveys 96% Customer Satisfaction Monthly Rider Surveys 100% Customer Satisfaction Legislative Research Committee % Customer Satisfaction

37 UK Study Conclusion Overall, the Human Service Transportation Delivery Program is a success story. The average cost per trip is lower while ridership has increased. Moreover, a high majority of the users of the program remain satisfied. And, while there are still issues to be resolved between some participants, the new program has achieved much more than fully anticipated.

38 Bottom Line Save Cost/ Cost Containment Eliminate Fraud & Abuse Safer Transportation & Better Quality Service Vehicle Inspections Drug and Alcohol Testing Driver Background checks Better Use of Resources Dollar Infrastructure

39 Continue to Grow You ve got to continue to grow, or you re like last night s cornbread, - stale and dry. Loretta Lynn

40 UNITED WE RIDE! Kentucky Transportation Cabinet Office of Transportation Delivery Contact: Vickie S. Bourne Executive Director or Jeremy Thompson, Br Mgr

41 Coordination Studies Business Study (Empower) Deloitte & Touche Milliman and Robertson (Established First Cap Rates) UK Study(Conclusion) Tichnor Study (Recommended Cap Rate) New Actuarial underway PricewaterhouseCoopers LLP. Their focus on cap rates adjusted to actual cost. US Transit Cooperative Research Report - Report indicates that coordination offers real improvement in efficiency, i productivity, it and cost effectiveness.