COORDINATING RURAL AND HUMAN SERVICES 2015 REPORT PREPARED FOR THE GOVERNOR S OFFICE OF PLANNING AND BUDGET

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1 COORDINATING RURAL AND HUMAN SERVICES TRANSPORTATION IN GEORGIA 2015 REPORT PREPARED FOR THE GOVERNOR S OFFICE OF PLANNING AND BUDGET CREATED BY THE GOVERNOR S DEVELOPMENT COUNCIL AND THE GEORGIA COORDINATING COUNCIL FOR RURAL AND HUMAN SERVICES TRANSPORTATION AUGUST 2015

2 THE GOVERNOR S DEVELOPMENT COUNCIL GEORGIA REGIONAL TRANSPORTATION AUTHORITY 245 Peachtree Ave. NE, Suite 400 Atlanta, Georgia grta.org

3 REPORT PURPOSE The Transportation Investment Act of 2010 calls for the Governor s Development Council (GDC), with assistance from the Georgia Coordinating Committee for Rural and Human Services Transportation (RHST Committee), to provide the Governor s Office of Planning and Budget (OPB) with an annual report identifying methods to increase the coordination of Georgia s rural and human services transportation (RHST) system. The purpose of the legislation and the resulting report is to ensure the most cost-effective delivery of RHST services in Georgia in order to best serve the clients utilizing the system. A draft version of the report is to be provided by July 1 st to the RHST Advisory Subcommittee, and a final report is to be provided to OPB no later than September 1 st, annually. This report satisfies the GDC s legislative requirements by providing an examination of the nine reporting tasks from the Transportation Investment Act that were assigned to the GDC in O.C.G.A The GDC s annual reporting effort is also a critical part of achieving the Governor s Strategic Goals for Georgia. Achieving cost efficiencies in RHST delivery is consistent with Georgia s vision of a lean and responsive state government. Further, the following specific goals can be achieved by this reporting effort: Improve the movement of people and goods within the state; Leverage public-private partnerships and improve intergovernmental cooperation for successful infrastructure development; Increase access to health services throughout the state; Improve access to treatment and community options for those with disabilities; and Build and maintain a quality state government workforce. 1 1 Governor s Office of Planning and Budget, Governor s Strategic Goals for Georgia, accessed via June 3rd, 2013.

4 LEGISLATIVE TASKS The Transportation Investment Act of 2010 requires the GDC to evaluate the following nine areas and to make recommendations to improve coordination: O.C.G.A (1): An analysis of all programs administered by participating agencies, including capital and operating costs, and overlapping or duplication of services among such programs, with emphasis on how to overcome such overlap or duplication. O.C.G.A (2): (An examination of) the means by which transportation services are coordinated among state, local, and federal funding source programs. O.C.G.A (3): (An examination of) the means by which both capital and operating costs for transportation could be combined or shared among agencies, including at a minimum shared purchase of vehicles and maintenance of such vehicles. O.C.G.A (4): An analysis of the areas which might appropriately be consolidated to lower the costs of program delivery without sacrificing program quality to clients, including shared use of vehicles for client trips regardless of the funding source for the respective trip. O.C.G.A (5): An analysis of state of the art efforts to coordinate rural and human services transportation elsewhere in the nation, including at a minimum route scheduling so as to avoid duplicative trips in a given locality. O.C.G.A (6): A review of any limitations which may be imposed by various federally funded programs and how the state can perform within those limitations as it reviews possible sharing opportunities. O.C.G.A (7): An analysis of how agency programs impact and interact with state, local or regional transportation services performed on behalf of the general public through state, local or regional transit systems. O.C.G.A (8): An evaluation of potential cost-sharing opportunities available for clients served by committee agencies so as to maximize service delivery efficiencies and to obtain the maximum benefit on their behalf with the limited amount of funds available. O.C.G.A (9): An analysis of possible methods to reduce costs, including, but not limited to, greater use of privatization.

5 CONTENTS Executive Summary...1 Analysis of RHST Programs...3 Current State of Coordination...5 Options to Share Capital and Operating Costs...7 Options to Consolidate Resources...9 Technology Deployment and Integration...11 Federal Limitations to Coordination...13 HST Impact on Public Transportation...15 Cost Sharing Opportunities...17 Other Methods to Reduce Costs...19 Recommendations to Increase Coordination...21 appendices (under separate cover) Appendix A: FY14 Detailed RHST Program Costs Appendix B: Shared Purchasing of Insurance and Maintenance Appendix C: Cost Efficiency Methodology

6 COORDINATING RURAL AND HUMAN SERVICES TRANSPORTATION IN GEORGIA EXECUTIVE SUMMARY 2015 REPORT BACKGROUND In 2010 the General Assembly tasked the Governor s Development Council (GDC) with developing an annual report addressing nine areas and identifying methods to increase rural and human services transportation (RHST) coordination and cost-effectiveness. The report is developed in collaboration with the RHST Advisory Subcommittee and goes to the Governor s Office of Planning and Budget (OPB) by September 1st and the General Assembly by January 15th. In 2015 the General Assembly removed the reporting requirement. This will be the fifth and final RHST report. GEORGIA S RHST NETWORK The Georgia Department of Transportation (GDOT), Department of Human Services (DHS) and Department of Community Health (DCH) administer RHST services $146 million in state and federal funds is spent annually on operations providing 8.2 million trips for eligible Georgians to necessary services (e.g., medical appointments, jobs, training, etc.) Given RHST population growth, approximately $188 million in operational funds will be needed to provide approximately 10.6 million trips by 2030 This growth may outpace funding creating a need for efficiencies; efficiencies created through coordination should be re-invested in the system to accommodate this growth PROJECTED RHST GROWTH Projected growth in RHST populations creates a need for efficiencies Operational Costs (in millions) $188 $146 Passenger Trips (in millions) TODAY 2030 PROJECTED TODAY 2030 PROJECTED 1

7 COORDINATING RURAL AND HUMAN SERVICES TRANSPORTATION IN GEORGIA EXECUTIVE SUMMARY 2015 REPORT FINDINGS Coordination creates cost efficiencies by reducing vehicle miles and hours Significant coordination exists between GDOT-sponsored rural public transportation (RPT) systems and DHS/DCH (NET); this creates savings of approximately $1 million annually Further coordinating RPT and DHS services would create additional efficiencies of approximately $100,000 annually; additional coordination is possible with existing resources Further coordinating RPT and NET services would create additional efficiencies of approximately $1.5 million annually; a new funding source and regulatory changes would be required This $1.6 million in potential coordination efficiencies would cover a small portion of the $42 million additional dollars needed to accommodate growth The best method to improve coordination is to consolidate RPT and DHS and/or NET provider networks; consolidating RPT and DHS networks is more feasible Current coordination efforts result in $1 million in savings annually Additional RPT and DHS coordination is possible with existing resources Further RPT and NET coordination would require new funding and regulatory changes FINDINGS RECOMMENDATIONS Coordinate RPT and DHS services by using capital funds (FTA 5339) as an incentive for newly coordinating systems to purchase vehicles and by providing technical support Coordinate RPT and NET services where feasible over the long term by providing vehicles and technical support and evaluating key policies such as the establishment of regional RPT systems and liquidated damages Provide additional vehicles, incentives, and technical support 2

8 ANALYSIS OF RHST PROGRAMS O.C.G.A (1): An analysis of all programs administered by participating agencies, including capital and operating costs, and overlapping or duplication of services among such programs, with emphasis on how to overcome such overlap or duplication. Three state agencies administer RHST services in Georgia: the Georgia Department of Transportation (GDOT), the Department of Human Services (DHS) and the Department of Community Health (DCH). Total operational costs for FY14 were $146.4 million, representing a 2% increase since FY12. Only GDOT directly purchases capital (e.g., vehicles); DHS and DCH (through their Non- Emergency Medical Transportation (NET) brokers), purchase trips from operators that provide vehicles. In FY14 GDOT expended $7.3 million on capital. This is consistent with expenditures in prior fiscal years that ranged from $6.2 to $8.3 million. A full list of programs sponsored by each agency can be found in Appendix A (provided under separate cover). Previous RHST reports show overlap primarily occurs at the transportation provider level when agency programs are contracted to three or more providers in the same service area. Contracting with separate providers reduces opportunities to share trips with common origins and/or destinations, thereby reducing service efficiencies. Consolidating providers where feasible, is the most costeffective way to address this issue. This issue is further discussed under the Options to Consolidate Resources and Recommendations sections. FY14 TOTAL OPERATING COSTS: $146.4 MILLION $90 $85.6 $80 $70 $60 Local Millions $50 $40 $35.6 State Federal $30 $25.2 $20 $10 $0 GDOT DHS DCH 3

9 Operational costs and capital costs have remained stable since FY12 More than two-thirds of all RHST funds are federal, and most state funds are used as match RHST overlap occurs when agencies have multiple providers serving the same area $ Where feasible, consolidating providers is the most cost-effective method to address overlapping services

10 CURRENT STATE OF COORDINATION O.C.G.A (2): (An examination of) the means by which transportation services are coordinated among state, local, and federal funding source programs. RHST services are coordinated when HST agencies (i.e., DHS and DCH) place clients on public transportation systems. Two perspectives are provided, HST agency use of rural public transportation (RPT) systems, and HST agency use of urban, fixed route public transportation systems. In FY15 there were 111 counties offering RPT service; the map on the adjacent page shows these systems in different shades of blue based on the level of coordination with HST agencies. Counties in light blue offer RPT service only, in these counties DHS and DCH have separate networks and agency coordination is not in place. Shown in medium blue are RPT systems that coordinate with one of the two HST agencies, or, 2-agency coordination. Most of these RPT systems coordinate with DHS, a key reason further coordination with DHS is the best short term approach to improving coordination practices. RPT systems in dark blue coordinate with both HST agencies, representing the fullest level of coordination, 3-agency coordination. In total, 22% of all counties offering RPT services do not coordinate services, 56% coordinate with one HST agency and 22% coordinate with both HST agencies. This shows the majority of RPT systems provide trips for HST agencies (78%), a significant degree of coordination statewide. The GDC estimates the existing level of coordination between RPT providers and HST agencies saves approximately $1 million annually. There are 23 counties served by fixed route public transportation systems in the state. Of the fifteen major systems serving these counties, all but two are used by one or both HST programs. These systems are good examples of the challenges HST agencies have in utilizing fixed route systems. The GRTA Xpress system, for example, has origin points at park-and-rides, generally requiring a vehicle to access, and serves high density portions of major job markets. Most HST clients do not have access to a vehicle and less than a quarter of HST trips are for employment. These factors make the Xpress system an unlikely option for HST agencies. In contrast, both HST agencies are able to use urban systems in Georgia s largest cities and metro areas like Atlanta, Columbus, Savannah and Athens, as transit accessibility increases with higher population and employment densities. From this, HST agencies make use of urban, fixed route public transportation systems when these systems provide access to trip destinations and are accessible to their clients. 5

11 FY15 HUMAN SERVICES TRANSPORTATION COORDINATION WITH RURAL PUBLIC TRANSPORTATION 3-AGENCY COORDINATION (RPT + DHS + NET) 2-AGENCY COORDINATION (RPT + DHS OR NET) NO AGENCY COORDINATION IN PLACE (RPT ONLY) NO RPT SERVICE Coordination between HST agencies and RPT providers saves Georgia approximately $1 million annually. Most RPT systems (78%) coordinate their services with HST agencies. FY15 HUMAN SERVICES TRANSPORTATION COORDINATION WITH URBAN FIXED ROUTE PUBLIC TRANSPORTATION 3-AGENCY COORDINATION (FRPT + DHS + NET) 2-AGENCY COORDINATION (FRPT + DHS OR NET) NO AGENCY COORDINATION IN PLACE (FRPT ONLY) NO FRPT SERVICE HST agencies most frequently use urban fixed route systems in Georgia s largest cities these systems provide better access to HST clients. 6

12 OPTIONS TO SHARE CAPITAL AND OPERATING COSTS O.C.G.A (3): (An examination of) the means by which both capital and operating costs for transportation could be combined or shared among agencies, including at a minimum shared purchase of vehicles and maintenance of such vehicles. This analysis focused on opportunities for public and private RHST providers to purchase key elements of transit service (e.g., vehicles, maintenance, insurance) in bulk. It was found that public RHST providers have sufficient bulk purchasing opportunities. For example, GDOT and the Department of Administrative Services (DOAS) both have vehicle contracts providing savings off of retail for different types of vehicles appropriate for RHST services. Additionally, many counties have their own maintenance garages or maintenance/insurance contracts that leverage services for other county vehicles that help achieve cost savings. for private providers to demonstrate that expansion would provide savings. While savings are plausible, legislation would be required to expand access and a lack of demonstrable savings suggested a different approach was necessary. A review of practices from other states found that private consortiums represent the best opportunity to increase bulk purchasing among RHST providers. Several examples exist where transit providers throughout a state formed consortiums to purchase maintenance and insurance; brief summaries can be found in Appendix B. Consolidating providers, which is discussed in the following section and is a recommendation of this report, would also improve bulk purchasing opportunities. The primary opportunity to increase bulk purchasing is for private RHST providers who do not have access to the same contracts as public entities. The GDC evaluated options to expand DOAS contracts to private RHST providers and found a lack of fleet information and maintenance costs 7

13 Public RHST providers have sufficient access to bulk purchasing $ The best opportunity to improve bulk purchasing is for private entities currently buying at retail prices Private sector consortiums are the best method to increase bulk purchasing power, see Appendix B 8

14 OPTIONS TO CONSOLIDATE RESOURCES O.C.G.A (4): An analysis of the areas which might appropriately be consolidated to lower the costs of program delivery without sacrificing program quality to clients, including shared use of vehicles for client trips regardless of the funding source for the respective trip. Consolidating RHST provider networks is the most appropriate method to increase cost efficiencies. Where provider consolidation does not occur, each of the three RHST services, GDOT-sponsored rural public transportation (RPT), DHS services, and DCH s NET service, have separate provider networks. By consolidating to one or two provider networks (thereby placing DHS clients, NET clients, or both on the local RPT provider), trips can be combined onto the same vehicle reducing vehicle miles and hours, and creating cost efficiencies. Leveraging a 2014 USDOT study that quantified the service efficiencies of coordinating RHST services in North Carolina and South Carolina, the GDC was able to estimate cost efficiencies of greater coordination in Georgia. By coordinating RPT and DHS services (i.e. by consolidating providers), a 3% cost efficiency is possible. If RPT and DHS services were fully coordinated statewide, cost efficiencies would be approximately $100,000 annually. If NET services were also fully coordinated (i.e., one provider network for all three services) cost efficiencies would increase to 7%. In terms of dollars, this would translate to an additional efficiency of $1.5 million annually. Notably, coordinating NET services is more challenging than DHS services given higher NET trip volumes and longer trip distances that often cross RPT boundaries. A new funding source for vehicles and regulatory changes would be needed to achieve Coordinating RHST services through provider consolidation creates operational and cost efficiencies additional RPT and NET coordination. In contrast, DHS trips are shorter and more often stay within county boundaries making them more feasible to coordinate. Additional RPT and DHS coordination is possible without new funding and regulatory changes. From this, the GDC recommends coordinating RPT and DHS services in the short term and adding NET trips over the long term where feasible (see Recommendations). The same USDOT study used to evaluate efficiencies also found that travel times could increase by 10% after services are coordinated. Whether this presents a level of service (LOS) issue depends on agency and/or local definitions of LOS, which differ throughout the state. Notably, it is possible to increase travel times without negatively impacting ontime performance (i.e. the arrival time can be shifted back). 9

15 CONSOLIDATION EFFICIENCIES The following examples show the potential value of consolidating resources between service providers operating in the same service area. 1. NON-CONSOLIDATED PROVIDER RESOURCES Currently, there is no coordination in 22% of counties offering RPT services. In these counties there are three separate provider networks, which creates inefficiencies. RPT DHS DCH 2. PARTIALLY CONSOLIDATED PROVIDER RESOURCES Coordinating RPT and DHS providers increases efficiencies by 3%. If executed statewide, this could translate to efficiencies of approximately $100,000 annually. Additional coordination is possible with existing resources. + 3% COST EFFICIENCY IMPROVEMENT COORDINATED RPT & DHS DCH 3. FULLY CONSOLIDATED PROVIDER RESOURCES Coordinating all RHST services increases efficiency by 7%. If executed statewide, this could translate to efficiencies of approximately $1.5 million annually. A new funding source and regulatory changes would be required. COORDINATED RPT, DHS, & NET + 7% COST EFFICIENCY IMPROVEMENT 10

16 TECHNOLOGY DEPLOYMENT AND INTEGRATION O.C.G.A (5): An analysis of state of the art efforts to coordinate rural and human services transportation elsewhere in the nation, including at a minimum route scheduling so as to avoid duplicative trips in a given locality. The use of technology to track, schedule and bill RHST trips is common nationwide and assists in streamlining previously paper-driven processes. Often, agencies administering RHST programs deploy technology platforms specific to their clientele and needs. For example, state DOT s often procure technology platforms with route scheduling functions (among others) while HST agency (e.g., DHS, DCH) technologies often focus on eligibility and trip verification. This same approach has been taken in Georgia as each of the three RHST agencies has technology platforms specifically suited to their needs. GDOT s RouteMatch technology, containing a suite of functions from route scheduling to reporting, was deployed among all rural public transportation (RPT) providers statewide starting in 2011 and is now complete. The DHS technology platform, which focuses more on trip assignment and verification, has been deployed in ten of twelve regions. Full deployment is expected in DCH s two NET brokers have each developed technology platforms, and these have been deployed for several years. As a result, 95% of RHST trips statewide are supported by innovative technology platforms. This represents a substantial increase from 2012 when the GDC first evaluated technology deployment. At that time, 58% of trips were supported by technology. All RHST trips are expected to be supported by technology in To maximize the benefit of these technologies, integration interfaces between them should be deployed for RHST providers that coordinate services. Integration interfaces seamlessly transfer trip requests from NET broker and/or DHS technology platforms to the scheduling engine in RouteMatch and vice versa to confirm trips. This eliminates manual data entry, lowers administrative costs, and reduces data inaccuracies. Integration interfaces, where costeffective, have been fully deployed between RouteMatch and NET broker technology platforms. An opportunity exists to integrate the DHS technology platform with RouteMatch in the approximate 80 counties where these services are coordinated. It is recommended this take place after DHS TRIP$ software is fully deployed which is expected by the end of Different technology platforms are needed to meet each agency s unique needs; integrating platforms lowers administrative cost and improves data accuracy 11

17 RHST agencies are rapidly deploying technologies that streamline critical transportation functions THE NUMBER OF RHST TRIPS SUPPORTED BY TECHNOLOGY INCREASED TO 58% 95% 100% OF ALL RHST TRIPS WERE SUPPORTED BY TECHNOLOGY IN 2012 IN 2015 OF RHST TRIPS WILL BE SUPPORTED BY TECHNOLOGY IN

18 FEDERAL LIMITS TO COORDINATION O.C.G.A (6): A review of any limitations which may be imposed by various federally funded programs and how the state can perform within those limitations as it reviews possible sharing opportunities. Sharing opportunities refer to options to place clients sponsored by different federal and/or state RHST programs on the same vehicle. Reviews of federal regulations show there are no regulations precluding the sharing of vehicles. In fact, guidance issued by the Coordinating Council on Access and Mobility (a federal coordinating body established by President Bush via Executive Order in 2005) recommended that vehicle sharing take place and clarified that federal cost principles do not restrict this practice provided the shared use does not compromise services to the purchasing program s primary beneficiaries. This means, for example, that a vehicle purchased through GDOT s rural public transportation program (RPT) can serve DHS and Medicaid (NET) clients, but must retain the ability to serve the general population, the primary beneficiaries of the RPT program. Research of federal regulations revealed two issues that hinder, but don t prevent coordination. The first is Medicaid s assurance of medical transportation which means that once an individual is determined to be eligible for Medicaid transportation, the trip must be provided. This assurance in part means there is little ability to limit trip distance, despite efforts by DCH and the NET brokers to mitigate the impacts (e.g., identify medical services in closer proximity). Long distance trips are particularly difficult for public transportation systems to provide given that limited resources can be tied up for much of the day and the tendency for RPT providers to serve primarily single county areas. Encouraging the establishment of regional RPT systems is one way to increase the likelihood that NET and RPT services will be coordinated. A second issue is the sheer number of unique RHST programs. The Government Accountability Office estimated in 2012 that 80 federal programs can potentially fund RHST trips. In Georgia, approximately ten programs constitute the majority of federal RHST funding and three state agencies are responsible for administering these funds. Many of these programs have their own eligibility, reporting and other compliance requirements. These requirements complicate the job of RHST providers that coordinate trips (i.e., provide trips for more than one RHST agency). These providers must track clients, record trip data and bill to different RHST agencies. Software can simplify these required processes and has been deployed or is being deployed by all RHST agencies. Further, when software programs deployed by different RHST agencies are integrated with one another, data transfer can be streamlined and data accuracy can improve. The integration of these software platforms where cost-effective is recommended and addressed in the Technology Deployment and Integration section. 13

19 $ Federal funding agencies have supported coordination by encouraging clients from different programs to share trips on a common vehicle However, the sheer number of federal funding sources supporting RHST services complicates coordination nationwide 14

20 HST IMPACT ON PUBLIC TRANSPORTATION O.C.G.A (7): An analysis of how agency programs impact and interact with state, local or regional transportation services performed on behalf of the general public through state, local or regional transit systems. Human services transportation (HST) agencies (i.e., DHS and DCH) have important impacts on public transportation systems when they purchase trips (i.e. coordinate services). The coordination of services is a largely positive, symbiotic relationship allowing HST agencies to purchase trips at affordable rates while also benefiting public transportation systems. When HST agencies coordinate services with rural public transportation (RPT) operators, the resulting service is 3%-7% more cost-effective than when the services are provided separately. In addition, the local government (i.e. county or regional commission) offering the RPT service further benefits since HST revenues can be used as local match for Federal Transit Administration (FTA) 5311 funds. If the local government is a county, that county can either use HST revenues in place of their local match (reducing the county s cost to provide RPT services) or continue to use their local funds allowing the HST revenues to leverage additional FTA 5311 funds (getting more RPT service at little to no additional cost). Either way, the result is a more efficient service that better leverages federal resources and minimizes costs to the Georgia taxpayer. Urban transit agencies offer two types of service, fixed-route transit and Americans with Disabilities Act (ADA) complementary paratransit. The use of fixed route transit, such as rail or scheduled bus service, is a win-win scenario where HST agencies purchase trips at the lowest cost typically available to them, and fixed route transit providers collect additional revenues with no additional marginal costs. This practice should be maximized, and discussions with HST agencies suggest that it is. The interaction between ADA complementary paratransit and HST agencies is more complex as ADA paratransit service is provided in response to a trip request, thus, each trip imposes a marginal cost to the transit provider. ADA trips are expensive and federal law caps fares at twice that of fixed route services. As a result, transit agencies provide substantial subsidies for each ADA trip. Some Georgians are also duallyeligible, i.e., they meet ADA eligibility requirements and that of another HST program, most often Medicaid (NET). When an NET broker directs dually-eligible clients to an ADA paratransit provider and pays the ADA public fare, transit agencies must cover the remaining, and significantly larger portion, of the costs. In response to this, DCH requires NET brokers to negotiate with ADA paratransit providers. NET brokers and ADA paratransit providers have attempted to negotiate mutually beneficial rates for services, but no agreements have been reached. It is recommended that these negotiations continue so that both parties can find a mutually beneficial arrangement that appropriately shares the cost of these trips between the sponsoring entities. 15

21 Coordinated RPT systems in the Middle Georgia Regional Commission better leverage federal funds % FEDERAL 55% FEDERAL FUNDS FUNDS 45% LOCAL FUNDS SHARE OF OPERATING COSTS IN 5 COUNTIES THAT DO NOT COORDINATE SERVICES 28% LOCAL FUNDS SHARE OF OPERATING COSTS IN 3 COUNTIES COORDINATING RPT AND DHS SERVICES 16

22 COST SHARING OPPORTUNITIES O.C.G.A (8): An evaluation of potential cost-sharing opportunities available for clients served by committee agencies so as to maximize service delivery efficiencies and to obtain the maximum benefit on their behalf with the limited amount of funds available. This report has identified that coordinating services, i.e., placing clients sponsored by different RHST programs on the same transportation provider, can increase cost efficiencies. However, since clients are sponsored by more than one RHST program, and as a result more than one state agency is paying for the service, there is also a desire to ensure each agency is paying its fair share. For example, when DHS or DCH s NET brokers place their clients on a rural public transportation (RPT) provider, the RPT provider and GDOT (as the sponsoring state agency) want to ensure DHS or DCH pay a rate that covers the full cost of the trip. Similarly, DHS and DCH want to ensure the rate charged is only what is required to pay for their client. Cost allocation models are designed to address this issue by clearly showing how much a trip on a rural public transportation (RPT) provider costs and how much sponsoring agencies like DHS and DCH should pay to cover those costs. These models are often in the form of spreadsheets that track a provider s administrative, operating and capital costs and use these historical costs to project costs by different units, such as a cost per mile or cost per hour. While simple in concept, these models require a considerable amount of data and consistent methods in collection and reporting to be effective. They can be costly to deploy statewide and the cost is a primary reason Georgia, along with many states, do not have cost allocation models at this time. Given that over 75% of RPT providers coordinate services with DHS, DCH or both, there is no pressing reason to deploy a cost allocation model at this time. The deployment of a model would be most appropriate if concerns arise over allocating costs fairly among the sponsoring RHST agencies. 17

23 Cost allocation models ensure RHST agencies pay their fair share when coordinating services 18

24 ADDITIONAL METHODS TO REDUCE COSTS O.C.G.A (9): An analysis of possible methods to reduce costs, including, but not limited to, greater use of privatization. Coordinating services by consolidating provider networks has been identified as the most effective way to reduce trip costs. However, two additional trip cost reduction methods warrant consideration, privatization and telemedicine. While there is no guarantee that privatization will reduce costs where systems are publicly run, it is likely that greater use of private RHST providers, particularly in the provision of rural public transportation (RPT) services, could result in greater coordination and increased efficiencies. This is because private providers have their own vehicle fleet, and a key limitation to greater coordination is identifying a provider with sufficient vehicles to take on more trips. To identify whether there are opportunities to increase privatization, data have been collected from each agency regarding the use of private providers. The data show that 45% of GDOT s RPT network is operated by private providers compared to 59% for DHS and 95% for DCH s NET network. DHS and DCH s NET brokers utilize private providers more often since they don t purchase vehicles and since they provide services in all of Georgia s counties, some of which have no public transportation options. While the data illustrate that most of the state s RHST providers are private, it also shows room for increased privatization. As local RPT sponsors (e.g., counties) and RHST agencies review options to coordinate services, the use of private providers should be evaluated. The increased application of telemedicine also has the potential to save transportation costs by reducing the number of trips or their distance. Telemedicine has been a focus of recent agency efforts by the Department of Public Health and DCH, among other agencies. By leveraging private resources (e.g., network of participating physicians and IT resources) such as those developed by the Georgia Partnership for Telehealth, the state has been successful in improving access to telemedicine for Georgians. This is particularly important given recent closures of rural hospitals which has increased the need for transportation to medical services. Continued efforts to increase the application of telemedicine, where feasible, should be encouraged. Increasing privatization may improve coordination private operators provide additional vehicles, which are often needed to coordinate services 19

25 Telemedicine can reduce transportation costs; state and private partners in Georgia continue to expand on its use 20

26 RECOMMENDATIONS TO INCREASE COORDINATION The GDC has developed two sets of recommendations, one pertaining to methods to increase coordination between RPT and DHS services, and a second related to RPT and NET services. Distinguishing between these two sets is necessary given that greater logistical challenges are posed by coordinating NET trips and as such, additional coordination methods would be necessary. While five years of research help guide these recommendations, they are most heavily informed by the interviews conducted during the 2014 report. These interviews indicated the following three barriers to coordination: 1) the need for more vehicles; 2) a better understanding of coordination benefits, both education and incentives encouraging local systems to evaluate coordination options are necessary, and; 3) the need for technical assistance (e.g., to teach systems how to use existing route scheduling software to accommodate additional trips without compromising service quality). Similar issues have been identified and addressed in other states that have successfully coordinated RHST services, especially North Carolina, which coordinates all RHST services statewide. To address the need for vehicles, the North Carolina Department of Transportation (NCDOT) uses all of the state s FTA 5311 funds for capital (primarily vehicles) and administration. In contrast, around 25% of Georgia s 5311 funds are used for these purposes. NCDOT has also conditioned the receipt of federal funds (by local RPT systems) on coordinating services. In part based on this condition, NCDOT has offered technical expertise by allocating funds to local RPT systems to develop coordination plans and by making staff available to advise and review them. The three barriers mentioned above would need to be addressed regardless of whether RPT systems coordinated services with DHS or NET, and are at the heart of the recommendations to coordinate RPT and DHS services. Given that NET trip volumes are greater, distances are longer, and contractual terms unique to these services, two additional recommendations to coordinate NET services are also provided. Additional coordination between RPT and DHS services is possible with existing resources; additional coordination with NET services would require a new funding source and regulatory changes 21

27 RECOMMENDATIONS TO FURTHER COORDINATE RPT AND DHS SERVICES 1. Provide additional vehicles and incentives by conditioning the receipt of FTA 5339 Bus and Bus Facilities funds via one of the following three options (note, newly coordinating RPT systems would be given first priority under each option): a. Make FTA 5339 available exclusively to coordinated RPT systems b. Provide a larger state match for FTA 5339 funds for RPT systems that coordinate services c. Create a criterion scoring coordinated RPT systems higher when awarding FTA 5339 grants Note: Option a. would be the most effective, but also creates equity concerns with systems that chose not to coordinate, making it less feasible. Each additional option becomes slightly less effective relative to option a. but is more feasible. 2. Educate RPT systems about coordination benefits (e.g., better leverage federal funds, increase cost efficiencies) and provide technical assistance via one of two options: a. With existing GDOT staff b. With new GDOT staff and/or contractor assistance Note: Additional staff may be necessary given existing workloads and the likely need to travel to RPT systems for hands-on assistance. If contractor services are necessary, the Rural Transportation Assistance Program (RTAP), an existing funding source, is a potential source of funds. In this case, the efficiencies gained by coordinating the services would be reduced by the amount invested in staff/contractor assistance. RECOMMENDATIONS TO FURTHER COORDINATE RPT AND NET SERVICES Both of the issues relevant to coordinating RPT and DHS services would again need to be addressed with one important difference. Given longer NET trip distances and greater trip volumes, a new funding source for vehicle purchases would be needed and new staff and/or contractor assistance would be required, existing staff resources would not be sufficient. In addition to addressing vehicle and education/technical assistance needs, the following two issues should also be explored: 1. Evaluate DCH liquidated damages: Both GDOT and DCH could jointly evaluate DCH s liquidated damages to determine the categories (e.g., damages assessed for late arrivals) that are the greatest deterrents for RPT providers and seek amounts/categories that are mutually acceptable. 2. Explore the establishment of regional RPT systems: Regional RPT systems have shown a greater ability to coordinate services, especially NET services which more frequently cross county lines. GDOT could explore opportunities to incentivize the establishment of regional systems noting that local government agreement would be necessary. 22

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