Presented by: Judith Norman - Transportation Consultant (JNTC) In Association with:

1. Draft Presentation to:California Department of Transportation (Caltrans)Mobility Action Plan (MAP) Phase IImplementation StudyMAP PAC Committee Meeting Presented by: Judith Norman - Transportation Consultant (JNTC) In Association with: The National Conference of State Legislatures January 21, 2009

2. MEETING PURPOSE AND OUTCOMES Present study updates, discuss and receive feedback on the following MAP Study work tasks and activities: • Legislative Update/Action Item Follow-up: Federal and California Human Service Transportation-Related Acts and Statutes • Technical Update: Coordinated Plan Review and Gap Analysis Methodology: Draft Study Geographic Regions and Information Analysis Process Judith Norman-Transportation Consultant

3. LEGISLATIVE UPDATE • Revised and updated California Coordinated Human Service Transportation Matrix to include historical Federal and California Acts and Statutes • Conducted further research to address MAP PAC last meeting action items to update information on Federal and California statutes related to public transit- human service coordination Judith Norman-Transportation Consultant

4. LEGISLATIVE UPDATE • New Research and Updates by NCSL on key Statutes: • Americans with Disabilities Act (ADA) • Transportation Development Act (TDA) • Social Service Transportation Improvement Act (SSTIA) • Technical Assistance to Paratransit Providers • Deficit Reduction Act • Medi-Cal Judith Norman-Transportation Consultant

5. ADA • The Americans with Disabilities Act (ADA) of 1990: • Gives civil rights protections to individuals with disabilities • Guarantees equal opportunities for individuals with disabilities Judith Norman-Transportation Consultant

6. ADA • Title I of the Act prohibits discrimination against people with disabilities in employment practices • Includes job applicants. • Employers with 15 or more employees are required to comply with the ADA. Judith Norman-Transportation Consultant

7. ADA • Title II of the act prohibits discrimination against individuals with disabilities in all programs, activities, and services of public entities. • Applies to all state and local governments, and other instrumentalities of state or local governments. • This includes public and private entities that provide public transportation Judith Norman-Transportation Consultant

8. ADA • Title II requires public entities: • To have vehicles for regular transit services be readily accessible and usable by persons with disabilities, including those who use wheelchairs. • Fixed route service also provide paratransit and other special transportation services to persons with disabilities, including those who use wheelchairs. • Service has to be comparable to regular transit services. • To provide the paratransit and special transportation services within their service area. • New vehicles for public demand responsive transit service be accessible and usable by persons with disabilities, including those who use wheelchairs. Judith Norman-Transportation Consultant

9. ADA • Title II requires private entities: • That purchase or lease vans with a seating capacity in excess of 16 passengers (including driver) to be accessible and usable by persons with disabilities, including those who use wheelchairs. • That provide a fixed route service with a vehicle with a seating capacity of 16 passengers (including driver), that is similar in service to regular transit services to persons without disabilities. • That provide a demand responsive system with a vehicle with a seating capacity of 16 passengers (including driver), that is comparable in service to regular transit services. Judith Norman-Transportation Consultant

10. ADA • FTA published a rule explaining the transit-related requirements of the ADA. They provide that: • A public entity operating a fixed route system has to provide a complementary paratransit or other special service to persons with disabilities. To qualify as complementary, the service has to: • Provide service within a width of three-fourths of mile of each fixed route. • Provide paratransit service to any ADA eligible person at a specified time in response to that person's request made the previous day. • Charge a fare that does not exceed twice the fare charged to a person paying a full fare at the similar time of day on the entity's fixed route. • Provide service during the same hours as the fixed route service. Judith Norman-Transportation Consultant

11. ADA • The public entity cannot: • Impose restrictions on the type of trip • Restrict the number of trips a person can take • Impose waiting lists for access to the service • Have a pattern or practice that significantly limits the availability of the service • Accompanying persons to the disabled individual are allowed to ride with them. • Develop a process for establishing the eligibility of persons who want to use the paratransit service. • Allow visitors (persons who do not reside in the entities jurisdiction) to access the complementary service. Judith Norman-Transportation Consultant

12. ADA AND NEW FREEDOM • The New Freedom Program (49 USC § 5317) funds are available to public transportation service providers whose services go beyond those required by the ADA, which are: • New public transportation, or • New alternatives to public transportation Judith Norman-Transportation Consultant

13. ADA AND NEW FREEDOM • Complementary paratransit services can be eligible under New Freedom in several ways if the services provided meet the definition of "new," which is: • Not operational as of August 10, 2005 or • Did not have an identified funding source before August 10, 2005. Judith Norman-Transportation Consultant

14. ADA AND NEW FREEDOM • "Going beyond" the ADA means: • Paratransit service beyond the three-quarter mile requirement • Paratransit hours beyond fixed route hours • Incremental cost of providing same day service • Incremental cost of door-to-door service to eligible ADA riders • Level of service enhancements: escorts, door-through door service • Vehicles with mobility aids for persons with disabilities Judith Norman-Transportation Consultant

15. ADA AND NEW FREEDOM • The New Freedom Program is direct consequence of theSupreme Court Olmstead v. L.C. decision. • The Court interpreted Title II to require states to place persons with mental disabilities in community settings instead of institutions. • Executive Order 13217 orders the Fed Govt. to help states implement the Olmstead decision. Judith Norman-Transportation Consultant

16. TDA • The Transportation Development Act (TDA) consists of nine articles in the California Public Utilities Code, which makes it lengthy in both size and detail. • The TDA specifies in great detail how public transportation is to be funded by state resources. • The TDA was enacted to ensure that public transportation is an essential component to a balanced transportation system Judith Norman-Transportation Consultant

17. TDA • The transportation planning agency in each area of the state is in charge of funding claims. • Transit operators and city or county governments transit operators can only file claims for money that was apportioned to their area. • CTSAs are funded under TDA articles 4.5 and 6.5. Judith Norman-Transportation Consultant

18. TDA • If a CTSA or other transit operator receives funding under the TDA it will be held accountable by the state by: • Filing claims with the transportation planning agency, • Submitting annual certified fiscal audits, and • Maintaining required fare revenue ratios for transit services • The CTSA must participate in and audit that the funds were spent within laws and regulations. • Since the CTSA is a claimant, it alone has these responsibilities, even when the CTSA’s primary function is to channel funds to other organizations which are actually providing the transit services. Judith Norman-Transportation Consultant

19. TDA • Social services transportation advisory councils: • Have to consist of the elderly, disabled, transit providers for seniors, the local CTSA • Have to: • Annually identify unmet transit needs in their area • Review and recommend action to the Transportation Planning Agency, and • Advise the Transportation Planning Agency on transit issues Judith Norman-Transportation Consultant

20. TDA • Citizen Participation Process • Transportation planning agencies have to establish an advisory council to get advice from the transit dependent, and transit disadvantaged persons. • Have to hold at least one hearing, with broad community participation • In addition to hearings, teleconferences, questionnaires, telecanvassing, and email can be used to obtain feedback. Judith Norman-Transportation Consultant

21. SOCIAL SERVICE TRANSPORTATION IMPROVEMENT ACT (SSTIA) • Created Consolidated Transportation Service Agencies or CTSAs • CTSAs are designated by: • County Transportation Commissions (CTCs), • Local Transportation Commissions (LTCs), • Regional Transportation Planning Agencies (RTPAs), or • Metropolitan Planning Organizations (MPOs) Judith Norman-Transportation Consultant

22. SOCIAL SERVICE TRANSPORTATION IMPROVEMENT ACT (SSTIA) • The SSTIA required Regional Transportation Planning Agencies or County Transportation Commissions to adopt and submit an action plan • The Action Plan has to: • Designate a CTSA within the area of the transportation planning agency. • Could designate more than one CTSA if there was improved coordination • An identification of the social service recipients to be served. • Measures to coordinate the social service transportation services with existing fixed-route services. Judith Norman-Transportation Consultant

23. SOCIAL SERVICE TRANSPORTATION IMPROVEMENT ACT (SSTIA) • Each CTSA is an entity separate of the transportation planning agency. • A CTSA can be: • A public agency including a city, county, operator, any state department or agency, public corporation, or public district, or a joint powers • A common carrier of persons • A private entity operating under a franchise or license. • A nonprofit corporation • A private entity (nonprofit) or a private company may be a CTSA if it is a legal entity eligible to file TDA claims and provide transit services. • A CTSA designation can be rescinded by the transportation planning agency. Judith Norman-Transportation Consultant

24. TECHNICAL ASSISTANCE UNDER SSTIA • Technical Assistance to Paratransit Providers (Cal. Government Code § 15984 (West 2009)) • Requires Caltrans to provide technical assistance to paratransit providers who want to explore coordination strategies but lack implementation capability. Judith Norman-Transportation Consultant

25. MEDICAID • Medicaid is a federal-state partnership that was created by Congress in 1965. • Is an optional state program, but every state and territory participates • Today Medicaid provides funding for: • Low income parents • People with significant disabilities • Long term care for the elderly Judith Norman-Transportation Consultant

26. MEDICAID • States that Medicaid transportation related costs are either administrative costs, or medical assistance. • Administrative costs are reimbursed at a flat rate of 50% • Medical assistance is reimbursed at the state's federal rate, which is anywhere from 50% to 77% - California's rate is 50% Judith Norman-Transportation Consultant

27. MEDICAID • Providers can be reimbursed for travel and other travel related expenses (42 CFR 440.170(a)). They are: • The cost of transportation • The costs of meals and lodging to and from the medical facility • The cost of an attendant, if necessary Judith Norman-Transportation Consultant

28. MEDICAID • A state Medicaid plan must "specify that the Medicaid agency will ensurenecessary transportation for recipients to and from providers…" (emphasis added) (42 CFR 431.53) • States have a lot of flexibility in meeting the mandate of assuring medical transportation. Judith Norman-Transportation Consultant

29. MEDICAID • How a state will provide non-emergency transportation all depends on its definition of "necessary". • Many states look to this criteria to define "necessary:" • Transportation to and from Medicaid covered services; • Use of the least expensive mode of transportation available that is appropriate for the client; • Restrictions to the nearest qualified provider • No other transportation services available free of charge; and, • Exclusions for clients receiving services that include transportation. Judith Norman-Transportation Consultant

30. MEDI-CAL • California’s Medicaid plan includes a simple “Assurance of Transportation,” guaranteeing necessary transportation to and from covered medical services. • Reimbursement of travel to medical appointments is restricted to persons who are physically unable to use conventional modes of transportation (22 CCR § 51151). • Costs are only covered if transportation by ordinary means is medically inadvisable (22 CCR § 51323). Judith Norman-Transportation Consultant

31. MEDI-CAL • Bingham v. Obledo (1983) • Recipients sued the state because the state plan violated the assurance of transportation requirement since it did not assure necessary transportation to all recipients. • Argument was that Medi-Cal transportation was only offered to the severely disabled. Judith Norman-Transportation Consultant

32. MEDI-CAL • Bingham v. Obledo (1983) • Court ordered the state to amend its plan that takes into account all qualifying recipients. • Court then mentions that that the state is not required to furnish transportation or pay for it. • To comply with the court order, Department of Health Care Services expanded upon the information about transportation options that Medi-Cal offices provide to county welfare and local Social Security Offices. Judith Norman-Transportation Consultant

33. MEDI-CAL • To provide transportation to Medi-Cal beneficiaries, transit providers have to be certified by the Dept. of Health Care Services • Application process Judith Norman-Transportation Consultant

34. MEDI-CAL • California's emergency and nonemergency transportation programs are decentralized. • Usually administered by the local Medi-Cal offices • Ambulances, wheelchair vans and litter vans are the only acceptable modes. • Local public transit agencies are not eligible for reimbursement under current Medi-Cal rules (22 CCR § 51151) Judith Norman-Transportation Consultant

35. NEW CMS RULEDEFICIT REDUCTION ACT • Deficit Reduction Act of 2005 rule (42 CFR Part 440) • Before the rule, a state couldn't contract with a broker or provide different services in different areas of the state without obtaining a waiver. • The new rule does away with the waiver requirement. • Gives states the option of using a non-emergency medical transportation broker when providing transportation as medical assistance under the state plan. Judith Norman-Transportation Consultant

36. DEFICIT REDUCTION ACT:NEW CMS RULE • The rule: • Allows brokers to provide for transportation services that include wheelchair vans, taxis, stretcher cars, bus passes and tickets. • Allows the Secretary to allow for the use of other forms of transportation. • Creates a competitive bidding process. • Creates oversight procedures • Requires the broker must be an independent entity • Provides an exception for a non-governmental broker • If a governmental agency is the broker it can subcontract with a government-owned or controlled transportation provider • Gives the Secretary the authority to add any other medical care which can be covered by the state Judith Norman-Transportation Consultant

37. END OF TECHNICAL PART I Judith Norman-Transportation Consultant

38. STUDY TECHNICAL ELEMENTS • Review of Public Transit – Human Service Coordinated Transportation Plans • Large and Small Urban Plans • Rural Plans • Summarize and profile existing needs, strategies and implementation of local priorities • Element of Statewide Executive Summary • Interregional Gap Analysis • Derived from review of individual coordinated plans • Element of Statewide Executive Summary Judith Norman-Transportation Consultant

39. GOAL OF COORDINATED PLAN REVIEW • Provide a Statewide View of all Coordinated Transportation Plans in California • Inform the development of the Statewide Implementation Plan Judith Norman-Transportation Consultant

40. COORDINATED PLANS:ELEMENTS TO BE REVIEWED • Current transportation needs by target population • Inventory of transportation resources available within the region • Real or perceived barriers to coordination • Identification of current or potential funding sources expended on transportation for client populations Judith Norman-Transportation Consultant

41. COORDINATED PLANS:ELEMENTS TO BE REVIEWED • Strategies and plans to address needs, gaps and deficiencies • Identification of duplicative or restrictive local regulations and/or policies which serve to limit coordination; • Priorities for selection of coordinated projects, including regional mobility management; and • Specific coordinated plan and project recommendations; including timing and phasing of projects. Judith Norman-Transportation Consultant

42. COORDINATED PLAN REVIEW METHODOLOGY • Review individual plans and analyze by geographic region with each MPO/RTPA • Code Responses and Construct a Microsoft Excel Matrix to summarize plan review elements in detail Judith Norman-Transportation Consultant

43. PROPOSED MAP STUDY GEOGRAPHIC REGIONS Judith Norman-Transportation Consultant

44. PROPOSED MAP STUDY GEOGRAPHIC REGIONS: RATIONALE • Utilizes established Caltrans Districts framework • Condenses to 11 geographic regions (Districts 7 – Los Angeles and 12- Orange County combined) • County groupings used for locale of Regional Roundtables Judith Norman-Transportation Consultant

45. 2008 REGIONAL POPULATION ESTIMATES Judith Norman-Transportation Consultant

46. 2008 REGIONAL POPULATION ESTIMATES Judith Norman-Transportation Consultant

47. GAP ANALYSIS:PURPOSE • Evaluation and assessment of existing needs, strategies, and implementation • Identify interregional gaps, needs, and strategies to identify and address deficiencies across the regions • Provides solid framework for development of Statewide Executive Summary Judith Norman-Transportation Consultant

48. GAP ANALYSIS:METHODOLOGY Using Excel Matrix which was constructed in Plan review: • Populate a relational Access analytical database to allow thorough review of plan elements Judith Norman-Transportation Consultant

49. HOW WILL THE DATABASE HELP US? • Organize and Sort Large Amounts of Plan Information • Compile and cross tabulate information • Identify trends, commonalities and unique issues within the plans (urban, rural, regionally and statewide) • Can ultimately be used for information-sharing and coordinated planning purposes Judith Norman-Transportation Consultant

50. NEXT STEPS/MEETING • Work with Human Services on additional statute research and analysis • Begin Large/Small Urban Coordinated plan review • Complete Access database structure • Develop stakeholder involvement draft interview questions and topics • Commence regional roundtable planning and scheduling efforts • Next Meeting: March 25, 2009 – Southern California – City of Norwalk, CA. Judith Norman-Transportation Consultant