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34 Propensity of Chronic Illness Affecting Older Adults Arthritis or Chronic Joint Symptoms 42.1% are 45 yrs-65 yrs 58.8% are 65 yrs or older Cancer Incidence Females Males Diabetes Ages per 100,000 persons Ages ,353 per 100,000 persons Ages ,817 per 100,000 persons Ages per 100,000 Ages ,264.4 per 100,000 Ages ,123.2 per 100,000 Age 20 or older - 8.7% Age 60 or older % 34

35 Medicaid Transit Passes Health and Human Service agencies have realized great savings by shifting Medicaid eligible participants (who are able) from costly paratransit services to less expensive fixed-route transit. Agencies may purchase monthly bus passes and distribute them to clients who have access to a bus route. The Medicaid Pass program is a win-win program. The rider gains greater mobility and increased independence that improves his/her overall quality of life. The transit agency sees increased ridership and revenues with few, if any, additional costs. And finally, the human service agencies substantially increase the cost-effectiveness of the transportation services purchased for Medicaid beneficiaries. Data from 2000 reports that 40 million people receive Medicaid services at a cost of $126 billion. (This figure excludes such Medicaid costs as nursing homes, hospitals, physicians, prescriptions, and home health care, which make the overall total $258.2 billion). However, it is projected that if 1% (400,000) Medicaid beneficiaries were switched to bus passes, Medicaid transportation could save an estimated $432 million. (This estimate is calculated by using the average cost of a monthly bus pass ($30) and an estimate of four paratransit trips per month ($120). Source: Medicaid Transit Passes: A Winning Solution for All by National Consortium on the Coordination of Human Services Transportation Note: More information on Medicaid Transit Passes can be found in Chapter 6 of the Medical Transportation Toolkit. 35

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37 Elder Services of Merrimack Valley, Inc. in Massachusetts has started a Medical Advocacy Program that combines throughthe-door transportation furnished by a volunteer who can also act as the older person s medical advocate, if requested. The program is targeted to older people and their spouses, working caregivers; and long-distance caregivers. The older person and the advocate prepare for the visit by going over questions the older person might have. The volunteer sits with the older person when the doctor or other medical personnel explains what the older person needs to do, for instance, what medications to take and how to take them, instructions on eating, and setting up the next appointment. The volunteer advocate makes sure the doctor or other medical personnel communicates effectively and answers any questions the older person has. If there is an adult child who is caretaker for the older person, the volunteer advocate is also trained to take notes in a journal that is left with the older person and informs the adult child of what the parent needs to do. If there are any prescriptions to be filled, the advocate will take the older person to the pharmacy. The program consists of approximately 24 volunteers both under and over age 60. Merrimack Valley identifies potential medical advocates through its standard initial interview for general volunteers. Those who appear to be likely medical advocates are given two two-hour specialized training sessions on topics such as an overview of the aging process; building positive relationships and business skills; confidentiality and ethics; guidelines for reducing risk on volunteer assignments ambulating with an older person and preventing falls and handling emergencies. The annual cost of the program is approximately $22,500. Twenty thousand dollars goes to the salary of one part-time coordinator. Of the remaining $2,500, $2,100 is for reimbursing the medical advocates for their travel at the rate of $0.375 per mile. (Not every advocate submits a reimbursement claim.) With funding from the National Family Caregiver Support Program, Merrimack Valley has been able to implement the Medical Advocacy Program for the twenty-three cities and towns in its service area. From December 2002 through December 2004, the medical advocates have filled approximately 650 requests and completed almost 2,000 hours of medical advocacy. Perhaps the greatest outcome of the program is the improved communication between the older person and the physician and health care provider. Source: Rosanne DiStefano, Executive Director and Mary DeRoo, Home Care Director, RN, MS org), Elder Services of Merrimack Valley, Inc. 37

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39 Example of Ridesharing for Medical Transportation Western Community Action in Marshall, Minnesota, has a rideshare program that uses volunteer drivers to take residents of its multicounty rural service area located in the southwestern corner of the state to medical appointments in Minneapolis, Rochester, or across the state lines to Sioux Falls, South Dakota, as well as Iowa and communities in between. These are long-distance trips that take from two to four hours. Ride requests are scheduled using computer software through a central dispatch office. Without ridesharing and volunteer drivers, the cost of transportation would be prohibitive for many older rural residents or residents of any age needing medical transportation. Source: Jeanette Aguirre, Transit Director, Western Community Action, Marshall, MN 39

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48 The State of Florida s Agency for Health Care Administration (AHCA) and Miami Dade Transit agreed to expand Medicaid transportation in an effort to reduce the rising costs of Medicaid Paratransit (door-to-door) transportation. Miami Dade Transit began making bus passes available to Medicaid eligible persons who could safely travel by bus in It was determined by comparing costs of paratransit trips and the cost of the monthly pass that savings would result after the third one-way trip on the fixed-route service. So to the following eligibility requirements were established... -A Medicaid recipient must have three or more verifiable medical appointments (6 or more round trips a month. -If they qualify, they will receive a monthly pass for a $1 co-payment. The pass has unlimited trips for one month. -To remain in the program, the Medicaid recipient must continue to have three more verifiable medical appointments each month. Once a person is accepted into the Medicaid Metropass Program, they are no longer in the Medicaid paratransit program (door-to-door service). In the beginning, the program averaged 4,800 users per month, a figure just over one percent of the total number of Medicaid recipients in Dade County. Now, between 5,000 and 6,000 people also just over one percent of all Dade County Medicaid recipients use the Metropass program. In 2002, Bus pass instead of paratransit savings for Medicaid came in at over $600,000 per month and revenues for Miami Dade Transit at $202,000 month. This calculates to an estimated annual Medicaid savings of $7.5 million per year and increased transit revenues of $2.4 million. As of 2005, the Medicaid Metropass program has accumulated savings in excess of $62,000,000. Source: Medicaid Transit Passes: A Winning Solution for All by the Consortium on the Coordination of Human Services Transportation (2004) & Harry Rackard, Manager 48

49 Coordinated Transportation Solutions, Inc. (CTS) in Connecticut is a not-for-profit transportation brokerage that has worked with the state s Departments of Transportation and Social Services to develop an innovative Medicaid Bus Pass program. In 1998, CTS saw the opportunity to incorporate a bus pass program into its Medicaid non-emergency medical transportation service because of the extensive public transit system. Connecticut s public transit services extended throughout its major cities and into most of the state s rural areas. Dave White, CTS President, quickly identified a problem the pass was good for one person while the Medicaid population that CTS served was predominately single adults with children. CTS met with Connecticut s Department of Transportation and suggested implementing a family bus pass that would allow one adult and up to three children under age 18 to use most of Connecticut s public transit options for the same price as an individual bus pass (then $35, now $45). The Connecticut Departments of Transportation and Social Services, along with Medicaid s Managed Care companies agreed to CTS s proposal. The program was quickly adopted for all Medicaid beneficiaries throughout the state. As a result, transit seats have been filled and there has been a reduction in the cost of providing non-emergency medical transportation services to the state s Medicaid population. CTS estimates that nearly one-half of all trips provided to its 110,000 covered Medicaid recipients are provided by the state s public transit operators. Medicaid beneficiaries are receptive to the program because it not only ensures their families access to medical appointments, but provides unlimited travel options throughout the state. Source: Interview with David White, CTS President, in April

50 The Healthy Community Alliance, a rural health network, and LoveInC, a faith-based organization, partnered to meet the needs of the New York communities they serve by sharing their transportation resources. The Healthy Community Alliance is a health network that serves 113,000 rural residents in portions of four Western New York counties. The Alliance was established in 1996 to provide services based entirely on identified community need. Such services include health risk assessments, mental health services, and transportation through a partnership with LoveInC. LoveInC is a national non-denominational Christian ministry with 120 affiliates in 30 states that seek to help those in need. The Alliance and LoveInC first crossed paths when both participated in a rural transportation needs assessment in This led to discussions of how they could work together to fill a tremendous transportation service gap in the communities served by both groups. The Alliance had been able to secure funds and purchase a van, but did not have the staff available to schedule and operate a transportation service. LoveInC had the volunteers to operate a vehicle, but did not have a vehicle to operate. So, the Alliance and LoveInC partnered with each other to create a vital community service that continues to grow. Residents of the community are the real beneficiaries of the partnership. LoveInC provides people with rides to medical appointments that are miles away from their homes, which include trips to and from dialysis and chemotherapy treatments. Source: Betty Accordino of Healthy Community Alliance, 50

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56 Rhode Island s RIte Care/RIte Share Transportation Program is an example of a state s coordination effort. The Rhode Island Department of Human Services and the Rhode Island Public Transit Authority (RIPTA) have partnered to provide accessible transportation for Rhode Islanders enrolled in the RIte Care/RIte Share health insurance program, which is Rhode Island s Medicaid managed care program. All beneficiaries enrolled in the state s managed care program are eligible for a bus pass, which is available for pick-up at local supermarkets. The Department of Health and Human Services also has a paratransit agreement in place between the state s Transit Authority and its Medicaid managed care plans to provide taxi cab and van rides to medical appointments. A member is eligible for the paratransit service if he/she lives at least 1 mile off of a bus route and the appointment must be for medical visit. A RIte Care member arranges for the transportation by calling his/her managed care plan s member services department. The member service representative obtains information regarding the transportation request, verifies eligibility and forwards the request to the Transit Authority. Source: Sharon Reniere, Assistant Administrator of Children s and Family Services 56

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70 I feel like a 1,000 pounds have been lifted off my shoulders, says Donna after discovering transportation options in her community. Like most people, Donna wasn t aware of the transit service until she desperately needed it. Living in Sanford, Maine, Donna, in her late 50s, had been driving herself to and from her own dialysis treatments three times each week. She receives her dialysis treatments in Biddeford, 17 miles away from her home. A social worker at the dialysis center attempted to arrange transportation for Donna through Medicaid, the public health plan jointly funded by the state and federal governments. Unfortunately, Donna s income surpassed the eligibility limit by $275. Eventually, Donna was connected with York County Community Action (YCCA). Transportation Director Connie Garber made sure had a ride to and from her dialysis treatments through the YCCA Volunteer Driver Program. Today, thanks to community transportation, Donna no longer ahs to fear and can instead concentrate on her health. She s the first to acknowledge the powerful change this transportation has made on her life. Source: Community Transportation: New Challenges, New Opportunities in Medical Transportation (Winter ) 70

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72 37 % of dialysis patients use a wheelchair or a walker, compared with 13 % for other county riders. 50 % of dialysis patients require some type of mobility device. At least half of the patients were transportation dependent meaning they are physi- cally unable to drive themselves, have no family members, volunteer group to provide transportation, are unable to take fixedroute public transit. Riders with such difficulties obviously take longer to board and disembark which impacts the efficiency of the transportation service. 72

73 County Ride provides public transportation in northeastern Colorado through the North Eastern Colorado Association of Local Governments (NECALG). County Ride provides service in an area encompassing over 9,500 square miles. There is only one dialysis center in northeastern Colorado. This means that some dialysis patients are traveling 180 miles round trip three times per week for treatments. Fortunately, Banner Health System, the provider of health services in the area, recognizes the benefits of partnering with community transportation. Banner Health has contracted with NECALG to provide transportation for its patients. Improved transportation has meant fewer complications in treatment, which would be more expensive for Banner to administer. Other areas of Banner s operations have benefited as well. Better discharge planning and fewer no shows further reduce administrative costs. 73

74 The St. Louis Veterans Administration (VA) Dialysis Center changed the times of its treatment shifts to accommodate the schedule of the local Disabled American Veterans (DAV) volunteer driver program, which provided rides to some of the dialysis center s patients. Veterans using the DAV to get to and from dialysis ran into scheduling problems because the facility s first treatment shift began before the volunteer drivers began transporting patients and the facility s last shift ended after the volunteers finished for the day. The facility remedied the problem by scheduling its first treatment shift later in the morning. This small change affected the entire facility s schedule nurses and doctors work schedules and all the patients appointment schedules. The staff felt the adjustments to their schedules were worth it if it meant that patient care was more efficient. So, prior to the initiation of treatment, a committee comprised of the VA Dialysis Center s doctors, nurses, and social workers meet to discuss each veteran s treatment plan. The committee attempts to coordinate all aspects of the veteran s treatment, which includes healthcare coverage eligibility, scheduling and transportation. Veterans using the transportation provided by the DAV, are scheduled for the morning shift, which is now in synch with the DAV schedule. Those using another means of transportation are scheduled for the afternoon shift. Source: Joseph Wildisen, the St. Louis VA Dialysis Center social worker 74

75 Medical Motor Service is a nonprofit provider and broker of specialized medical transportation services in Monroe County, New York. Besides transporting patients to and from dialysis, Medical Motor Services administers a program funded by Medicaid in which patients are directly reimbursed for arranging their own transportation through friends and relatives. Patients are reimbursed $7.50 per one way trip as opposed to the $12.50 it would cost for a medical taxi cab. Currently, Medical Motor Services reimburses for approximately 474 trips each month. After processing and other administrative costs, this program saves Medicaid about 10% off the cost of more traditional modes of dialysis transportation. The added flexibility allowed under this arrangement expands travel options, particularly for patients receiving dialysis late at night or coming from hard to route locations. Besides easing the burden on traditional transit services, the patient reimbursement program brings increased benefits for the patient s drivers. According to Bill McDonald, Executive Director of Medical Motor Services, It also provides a direct transportation subsidy to the household, which can help defray the cost of a car, for example. So it s a win/win proposition and growing in popularity. Source: Bill McDonald, Medical Motors Service 75

76 Rural Wayne County, New York, lacked dialysis transportation options for many of its most vulnerable citizens. Several local organizations took action. With strong support from the County Administrator, a grant was secured through the Wayne County Rural Health Network (WCRHN), which is sponsored by Wayne County ViaHealth. Viahealth is a regional nonprofit affiliation of hospitals, physicians and other health care providers. In January 2002, vehicles provided by Wayne Area Transportation Services (WATS) began taking patients to Geneva Dialysis at Geneva General Hospital. The Service now transports patients to several other locations with door through door service. In addition to help from the ViaHealth, WCRHN, and WATS, volunteers from the Retired Senior and Volunteer Program ride with the patients and act as escorts. Because they were included the planning process for the service, the area dialysis providers were extremely cooperative in the scheduling of treatment times. This is a wonderful example of several local agencies coming together to provide very necessary assistance to Wayne County dialysis patients and their families says Antje Dirksen, Transportation Planner for WCRHN. 76

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106 Part F PROVIDER AGREEMENT BY AND BETWEEN ANY HEALTH PLAN AND MEDICAL MOTOR SERVICE OF ROCHESTER AND MONROE COUNTY, INC. To access this sample contract, please contact Jordan Nichols at or

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117 State Medicaid Contacts Alabama Ms. Dorothy Powell Associate Director of Non-emergency Transportation 501 Dexter Avenue PO Box 5624 Montgomery, AL Tel: Fax: Alaska Mr. Dwayne Peeples Director 4501 Business Park Boulevard Anchorage, AK Tel: Fax: Arizona Mr. Anthony Rodgers Director of Health Care Cost Containment System 801 East Jefferson Street MD 4100 Phoenix, AZ Tel: Fax: Arkansas Mr. Roy Jeffus Director Division of Medical Services PO Box 1437, S-401 Little Rock, AR Tel: Fax: California Dr. Fulton Lipscomb, MD Chief Medi-Cal Program 714 P Street, Room 1601 Sacramento, CA Tel: Fax:

118 Colorado Mr. Brain Chadwick Acute Care Benefits Section 1570 Grant Street Third Floor Denver, CO Tel: Fax: Connecticut Mr. David Parrella Director 25 Sigourney Street Hartford, CT Tel: Fax: Delaware Ms. Joyce Pinkett Administrator PO Box 906 New Castle, DE Tel: Fax: District of Columbia Mr. Calvin Kearny Chief of Program Operations 2100 Martin Luther King Jr. Ave, SE -Suite 302 Washington, DC Tel: Fax: Florida Mr. John Austin AHCA Administrator Medicaid Program Development 2727 Mahan Drive, MS #20 Tallahassee, FL Tel: Fax:

119 Georgia Ms. Janine Gardner 2 Peachtree Street, NW - 35 th Floor Atlanta, GA Tel: Fax: Hawaii Ms. Angie Payne Acting Administrator of Med-Quest Division PO Box Kamokila Blvd., Room 518 Kapolei, HI Tel: Fax: Idaho Ms. Lynne Denne Unit Supervisor PO Box Boise, ID Tel: Fax: Illinois Dr. Anne Marie Murphy Administrator 201 South Grand Avenue, East 3 rd Floor Springfield, IL Tel: Fax: Indiana Ms. Melanie Bella Assistant Secretary 402 West Washington Street, Room W382 MS 07 Indianapolis, IN Tel: Fax:

120 Iowa Ms. Sue Stairs Program Manager Hoover State Office Building 1305 East Walnut Street Des Moines, IA Tel: Fax: Kansas Mr. Scott Brunner Director Docking State Office Building 915 SW Harrison Street, Room 651 South Topeka, KS Tel: Fax: Kentucky Mr. Russ Fendley Commissioner 275 East Main Street, 6W-A Frankfort, KY Tel: Fax: Louisiana Ms. Janet Womack Program Manager PO Box Baton Rouge, LA Tel: Fax: Maine Ms. Christine Gianopoulos Acting Director Statehouse Station # Civic Center Drive Augusta, ME Tel: Fax:

121 Maryland Ms. Judy Zeller Transportation Coordinator 201 West Preston Street, Room 136 Baltimore, MD Tel: Fax: Massachusetts Mr. Perry Fong Transportation Program Manager 600 Washington Street, Fifth Floor Boston, MA Tel: Fax: Michigan Mr. James MacPherson Transportation Specialist 400 South Pine Street PO Box Lansing, MI Minnesota Mr. John Kowalczyk Policy Consultant 444 Lafayette Road St. Paul, MN Tel: Fax: Mississippi Ms. Jan Larson Director of Bureau of Compliance and Financial Review 239 North Lamar Street, Suite 801 Jackson, MS Tel: Fax: Missouri Ms. Kim Johnson Medicaid Specialist PO Box 6500 Jefferson City, MO Tel: Fax:

122 Montana Ms. Gail Gray Director 111 North Sanders Street PO Box 4210 Helena, MT Tel: Fax: Nebraska Ms. Mary Steiner Interim Medicaid Administrator 301 Centennial Mall South, 5 th Floor Lincoln, NE Tel: Fax: Nevada Ms. Julie Cryderman Supervisor 1030 Bible Way Reno, NV Tel: Fax: New Hampshire Mr. Andrew Love Acting Transportation Coordinator 129 Pleasant Street Concord, NH Tel: Fax: New Jersey Ms. Ann Clemency Kohler Director PO Box 712 Trenton, NJ Tel: Fax:

123 New Mexico Ms. Rose Armijo Transportation Program Manager PO Box 2348 Santa Fe, NM Tel: Fax: New York Mr. Tim Perry-Coon Program Research Specialist 99 Washington Avenue, Room 606 Albany, NY Tel: Fax: North Carolina Mr. Andy Wilson Project Coordinator 2501 Mail Service Center Raleigh, NC Tel: Fax: North Dakota Ms. Yvonne Smith Deputy Director 600 East Boulevard Avenue Bismarck, ND Tel: Fax: Ohio Mr. Don Sabol Supervisor 30 East Broad Street, 27 th Floor Columbus, OH Tel: Fax: Oklahoma Ms. Linda Hughes Program Manager PO Box Oklahoma City, OK Tel: Fax:

124 Oregon Mr. Luis Carabello Dept of Human Services Transportation Coordination 500 Summer Street, E23 Salem, OR Tel: Fax: Pennsylvania Mr. Michael Noel Medical Assistance Transportation Program Manager PO Box 2675, Bertolino Building - 2 nd Floor Harrisburg, PA Tel: Fax: Puerto Rico Dr. Wendy Matos Director PO Box San Juan, PR Tel: Fax: Rhode Island Ms. Sharon Reniere Medical Care Specialist 600 New London Avenue Cranston, RI Tel: Fax: South Carolina Mr. Mumin Abdulrazzaaq Medicaid Transportation Program Manager PO Box 8206 Columbia, SC Tel: Fax: South Dakota Mr. Damian Prunty Program Manager 700 Governors Drive Pierre, SD Tel: Fax:

125 Tennessee Mr. David Stockett Senior Policy Analyst 729 Church Street Nashville, TN Tel: Fax: Texas Ms. Linda Altenhoff Director of Medical Transportation Transportation 1100 West 49 th Street Austin, TX Tel: Fax: Utah Dr. Scott Williams Executive Director PO Box Salt Lake City, UT Tel: Fax: Vermont Ms. Diana Carminati Director 103 South Main Street Waterbury, VT Tel: Fax: Virginia Mr. Bernie Pomfrey Transportation Manager 600 East Broad Street Richmond, VA Tel: Fax: Virgin Islands Ms. Karen Virgil Assistant Director 3730 Estate Altona, Suite 302 St. Thomas, US Virgin Islands Tel: Fax:

126 Washington Mr. Tom Gray Transportation and Interpreter Services Section Manager PO Box Olympia, WA Tel: Fax: West Virginia Mr. Jim Shedd Director Coordination Unit 350 Capitol Street, Room 251 Charleston, WV Tel: Fax: Wisconsin Ms. Emily Curtis Coordinator One West Wilson Street, Suite 550 Madison, WI Tel: Fax: Wyoming Ms. Iris Oleske State Medicaid Agent 154 Hathaway Building 2300 Capitol Avenue Cheyenne, WY Tel: Fax:

127 Part I TRANSPORTATION ATTACHMENTS TO MEDICAID STATE PLANS INCLUDES: GEORGIA, MINNESOTA AND NEW JERSEY To access this sample contract, please contact Maureen Hensley-Quinn at or

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242 New Challenges, New Opportunities in Medical Transportation

243 Non-emergency Medical Transportation and the Transportation Disadvantaged: A Critical Lack of Access to Needed Medical Care

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245 The Finest Kind of Public Service in Medical Transportation

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250 The Responding Network

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252 The Responding Network

253 National Conference on Transportation for America s Elders: mobility for life The National Conference on Transportation for America s Elders: Mobility for Life, is being held as part of the Community Transportation EXPO 2005 and is cosponsored by the Beverly Foundation. Join policymakers and practitioners from across the country in setting the agenda for the future of senior mobility at the Community Transportation Association s National Conference on Transportation for America s Elders: Mobility for Life. You re invited May 23 and 24 in St. Louis, Mo. to come and participate in this vital dialogue on senior transportation issues and innovations where we ll: Analyze current senior transportation practices and policies; Identify the strategies necessary to meet future senior transportation needs; Build an issues platform and procedures document for implementing these strategies; and Create the springboard for action at the upcoming White House Conference on Aging.

254 Trends in Healthcare Impact Trends in Medical Transportation

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256 A Conversation with the Ambulance Industry David Nevins Timothy Beals David Nevins Timothy Beals

257 David Nevins Timothy Beals David Nevins If there was additional investment in non-emergency medical transportation, I think people would be more likely to utilize them. David Nevins Timothy Beals

258 oices of the Marcella David Floyd and Family

259 people... Donna Mary Gladys

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