Use of Agency Service Agreements in ADA Paratransit Delivery (2021)

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3 agreement practices. The purpose of the survey was to pre-screen transit agencies who were willing to participate in in-depth interviews for case examples and to provide details about their current practices. The transit agencies selected for the survey ranged in size, geographic area, governance, and whether they were known to have agency service agreements. Thirty-nine agencies responded (Figure 2). Of the 39 transit agencies who responded to the survey, 21 responded that they have either informal (unwritten) or formal (written) agency service agreements. In general, transit agencies were willing to discuss their practices, but they did not share the executed agreements. They explained that some of the details were consid- ered confidential and/or they were uncomfortable circulating them. The terminology that transit agencies used for survey responses differed widely among agencies. Use of the terms agency service agreement, agency trip, and agency fare as presented in this digest are not used consistently in the industry. Some transit agencies use the term agency trip or agency fare to describe the rider using the service. In this study, this should not be confused with the meaning of agency fare, which describes the amount charged per ride by the transit agency. Some transit agencies also use the term agency service agreement to describe a coordination plan. As defined in this study, an agency service agreement is an agree- ment between a transit agency and a social service agency in which the transit agency provides beneficiaries of the social service agency with transportation in exchange for a pre-negotiated fare. This differs from a coordination plan, which is defined as a plan in which a local, regional, or state-wide government identifies how they will best pro- vide for the transportation needs of people with disabilities, seniors, or residents with low incomes. For example, if a transit agency leases a van to a social services agency for their riders to go on outings, this may be part of a coordination plan, but is not an example of an agency service agreement. This is because the transit agency does not schedule trips, provide a driver, or provide any additional services. Despite differences in terminology, responses from transit agencies shed light on their agreements; how and why they negoti- ated their agreements; and how they work with their riders and social service agencies. The survey results led to in-depth interviews with transit agencies and eight case examples that highlight current practices associated with agency service agreements. During the interviews, some transit agencies identified resources from whom they sought guidance and support. Thus, these resources were also interviewed so that other transit agencies may become aware of their offerings. For example, the Wisconsin Department of Transportation (WisDOT) provides guidance to transit agencies in Wisconsin on structuring agency service agreements. The Pennsylvania Public Transportation Association (PPTA) supports public transit agencies across Pennsyl- vania as they advocate for public transportation and mobility. The case examples provide the context for why the transit rep- resentatives sought agency service agreements with social service agencies and how they negotiated them; whether they have formal or informal agreements; various pricing options and parameters; solutions for coordinated and cooperative arrangements; resources such as scheduling tools and ticketing systems; and their challenges, keys to success, lessons learned, and accomplishments as presented by the representatives. CHAPTER 2 CASE EXAMPLES/PRACTICES In-depth interviews resulted in eight case examples/practices of current agency service agreements from representatives across the country. Transit agencies ranged in size from systems with fewer than 20 vehicles to over 2,000 and from small rural areas of 35,000 people to large cities over 1.5 million. Transit agencies were chosen to illus- trate various aspects of the agency service agreements as well as the various populations that the transit agencies serve through these agreements. The various aspects of agency service agreements include why the transit representatives negotiated their agreements and/or developed their practices; how the transit agencies negotiated their agreements; practices that they believe are innovative and effective; their agency fares; and ticketing and reconciling of accounts. The following transit agencies and representatives participated in in-depth interviews: • Wisconsin Department of Transportation (WisDOT) • City of Eau Claire Transit (ECT) • San Diego Metropolitan Transit System (MTS) Source: Thomson Consulting Note: 39 Respondents FIGURE 2 Survey map.

4 • Madison Metro Transit (Madison Metro) • Kitsap Transit (Kitsap) • Utah Transit Authority (UTA) • Pennsylvania Public Transportation Association (PPTA) • City of Gadsden Transit System (GTS) The first case example provides an overview of agency service agreements—what they are and why they exist according to Wis- DOT. WisDOT developed this document to support and guide transit agencies seeking agency service agreements. It provides definitions, accepted uses, and parameters. The case example presents the document and provides the context for which WisDOT developed this document. ECT, MTS, and Madison Metro provide insight into how they negotiated agency service agreements in response to managed care programs (MCPs) for Medicaid recipients being established in their states. ECT, MTS, and Madison Metro also presented how they ticket for their services and reconcile their accounts with social ser- vice agencies. Madison Metro provides the written process and form they use to sell tickets. This process negated the need for a formal agency service agreement. Kitsap and UTA demonstrate their innovative ways to partner with social service agencies. Kitsap, a small transit agency, helps provide service to people in rural areas. UTA, a large transit agency, works with the federal government to provide a local match for funding. PPTA and GTS provide public policy perspectives. PPTA provides an example of a state-wide organization that is advocating on behalf of the transit agencies to preserve their agency service agreements. GTS provides its public policy explanation for maintaining their agency fares at the same rate as their ADA complementary paratransit fares. Four of the transit representatives interviewed—WisDOT, MTS, PPTA, and GTS—discussed that their agency service agreement practices address NEMT and/or a medical assistance transportation program (MATP). NEMT and MATP are both state programs that are funded by Medicaid to provide non-emergency medical transporta- tion for Medicaid beneficiaries. NEMT is the largest federal source for human services transportation and is growing in this country (Cherrington et al., 2018, p. 5). The Affordable Care Act expanded Medicaid enrollment and more dependence on these programs. As this has been happening, some states have created MCPs for these passengers. According to the transit agencies interviewed, the pro- grams have shifted the population of many ADA complementary paratransit riders to private providers, thereby creating a significant loss in ridership. However, some of the transit agencies interviewed have developed agency service agreements to accommodate the former ADA complementary paratransit riders and others. All the case examples explain why and how their representatives established their highlighted practices. They include the motivating factor or original purpose for developing the agreement, a descrip- tion of the organization, the context, current agency fare, outcomes, and the lessons learned as reported in the in-depth interviews. The motivating factor helps put into context why and how each transit agency decided to negotiate their agreement. Most of the case studies identify fiscal constraints as their reason for seeking agency service agreements. While the case examples were chosen initially to present various aspects, they also shared many commonalities and other insights, which are highlighted in the conclusions. Wisconsin Department of Transportation Summary and Motivating Factor WisDOT was seeking the most efficacious model to support NEMT for riders while facing public transit fiscal constraints. As part of their strategy, they reached out to the Wisconsin Department of Health Services (DHS) to discuss funding sources and options to provide these services at a cost greater than the ADA complementary para- transit fare. WisDOT and Wisconsin DHS collaboratively agreed on standard language for agency fares, leading to the development of the following document. Practice WisDOT provides an overview of agency service agreements in “Fre- quently Asked Questions: WisDOT Agency Fares”—a document that provides guidance, definitions, and accepted uses for transit agencies developing agency service agreements. Description WisDOT is responsible for planning, building, and maintaining Wis- consin’s network of state highways and Interstate highway systems and supports all forms of transportation. The department shares the costs of building and operating county and local trans portation systems—from highways to public transit and other modes. WisDOT created “Frequently Asked Questions: WisDOT Agency Fares” to support and guide transit agencies in developing agency service agreements. Context In the 2010s, WisDOT became concerned about the cost of NEMT— a service that delivers people who lack access to transportation to their necessary but non-emergent medical appointments—and the financial impact it was having on transit agencies that provide ADA complementary paratransit services for these riders. Fares for ADA complementary paratransit rides are limited to charging twice the fixed-route fare and the demand for NEMT was growing. As WisDOT stated, “There was an ever-increasing demand on the ADA comple- mentary paratransit agencies for NEMT service and on their budgets.” Thus, in an effort to minimize the financial impact and to improve service for NEMT, WisDOT reached out to DHS to discuss funding sources and options for providing the service at a cost greater than the ADA complementary paratransit fare. During these meetings, they were able to agree collaboratively on standard language for agency fares—allowing transit agencies to charge more than the traditional ADA complementary paratransit fare for agency trips in the form of agency service agreements. This agreement ultimately became the document, “Frequently Asked Questions: WisDOT Agency Fares.” The frequently asked questions developed by WisDOT provide guidance, definitions, accepted uses, agency fare structure, fees, collection, background, and other key considerations for transit agencies contemplating and utilizing agency service agreements. According to WisDOT, they clarify for the transit agencies that they may collect more than the ADA complementary paratransit fare from social service agencies for agency trips. They also provide guidance for transit agencies as they consider developing agency service agreements for NEMT and other social service agencies that could benefit from such an agreement. For example, the frequently asked questions address the primacy of public transit and the need to demonstrate excess capacity—

5 transit agencies may only accommodate human service agency riders when capacity exists and vehicles are available. It provides param­ eters, such as the transit agency must accommodate ADA comple­ mentary paratransit users before it provides services to social service agency clients. These questions provide clarity and are a resource for guidance. They also provide a name and a phone number for more information. Outcomes • Frequently Asked Questions: WisDOT Agency Fares—an FAQ for transit agencies to establish agency service agreements; • Collaborative agreement with the Wisconsin DHS; • Efficient use of public funding; and • A lower cost option than private transportation for NEMT and others. Lessons Learned • Possible to meet needs of riders with disabilities beyond ADA complementary paratransit service requirements with public transit in cooperation with the Wisconsin DHS; and • Possible to work collaboratively with social service agencies. City of Eau Claire Transit Summary and Motivating Factor ECT in Wisconsin was facing a loss of funding for human services transportation from the county because of the privatization of the transportation service for adult family homes and family Medicaid organizations, which support frail elders and adults with disabilities. ECT approached the local social service agencies who were receiv­ ing federal funds to provide human services transportation. After holding “listening sessions” and developing relationships with the agencies, ECT ultimately executed agency service agreements to provide and expand human services transportation in the County. ECT uses their electronic billing system to audit and reconcile their accounts with the social service agencies. Practice ECT developed partnerships and agreements with managed care organizations (MCOs): adult family homes and family Medicaid organizations. Description ECT offers a fixed­route system of 11 regular routes and three express bus routes that service the City of Eau Claire and portions of Altoona with a fleet of 22 buses. It also provides ADA complementary para­ transit demand­response transportation for those individuals who cannot access and/or navigate the regular route system. ECT has both formal and informal service agency agreements. Context In 2010, Wisconsin started privatizing human services transporta­ tion in counties throughout the state and incrementally stopped funding the counties to provide the service. The County of Eau Claire lost its funding in 2012; however, ECT continued providing transportation to adult family homes and family care organiza­ tions at the ADA complementary paratransit fare of $2.50 per trip. According to ECT, this situation became financially unsustainable and in 2015 the city approached social service agencies that were receiving funds from the State of Wisconsin for transportation about charging agency fares. ECT started to build relationships with the social service agencies by holding listening sessions with the agencies to discuss their trans­ portation needs. The city worked directly with the agencies and the agencies communicated with the clients. As the listening sessions continued, ECT and the agencies became partners, negotiating an agreement for $9.00 per ride that took effect from January 1, 2016. The current agency fare is $9.50 and the actual cost/trip is $21.00. ECT also receives state and federal subsidies for these rides. At the same time as the listening sessions were going on, ECT cultivated its relationship with the county and took on a leadership role for service outside the urban area. They were able to expand outside the city and became the first to take on both urban ADA complementary paratransit service and county­wide disabled and elderly service in the county. This allowed service in the county to expand. They also added Sunday service and daily hours went from 6 am to 6 pm to a 24­hour service. ECT works closely with their private contractor who provides the service to ensure the ridership information is accurate. They audit the billings and use their electronic billing system that can be tweaked to interface with the ECT’s system. The private contractor checks that the riders are ADA complementary paratransit eligible and agency fare clients. When asked about lessons learned, ECT stated, “We should have implemented an agency fare immediately when family care organiza­ tions took over the care responsibilities for Medicaid clients from the county. We waited 4 years to implement.” Outcomes • Partnerships and agreements with adult family homes and family Medicaid organizations; • Expanded county services (days and hours of operation); • Provide service to more individuals; and • First in the county to provide both urban ADA complementary paratransit service and county­wide service for seniors and people with disabilities. Current Agency Fare $9.50 (not including state and federal funding subsidies) Lessons Learned • Communicate with agencies; • Use billing system as a mechanism for auditing; and • Build relationships through listening sessions and work collaboratively. San Diego Metropolitan Transit System Summary and Motivating Factor The California Legislature approved AB 2394 that shifted funding from local transit agencies to managed care providers (MCPs) to provide transportation for California Medicaid (Medi­Cal) recipients. This resulted in a loss of $3.5 million annually for ADA comple­ mentary paratransit services provided by MTS. MTS responded in

6 a two-pronged approach: (1) to re-direct Medi-Cal riders to MCP service; and (2) to negotiate agency service agreements to recoup costs to provide this service. After relentless work trying to get the attention of the MCPs and transportation brokers, MTS negotiated agency service agreements to become an approved provider for the MCPs and provide NEMT transportation to social service agencies with agency fares ranging from $21 to $26. Practice MTS implemented agency service agreements with Medi-Cal MCPs to compensate MTS at/near Medi-Cal rates. Description San Diego’s MTS is the public transit service provider for Central, South, Northeast, and Southeast San Diego County. It provides light rail and bus service to 271,000 daily riders. Its ADA complemen- tary paratransit services provide next-day service upon request to eligible individuals. MTS has both formal and informal agency service agreements. Context As part of the Affordable Care Act, Medi-Cal expanded in California and the state implemented eight MCPs for its recipients—developing Health Maintenance Organization (HMO) type health plans. Medi-Cal is California’s Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of the federal poverty level. More than half of San Diego County Medi-Cal recipients are enrolled in one of the MCPs. Historically, MTS and the San Diego County Health and Human Services Agency had a memorandum of agreement called the Medi-Cal Administrative Activities Program that established a rate to be reimbursed by Medi-Cal for the ADA complementary para- transit service provided by MTS. The program reimbursed MTS for 50% of MTS costs per trip for eligible Medi-Cal trips. These trips represented 40% of MTS’s ADA complementary paratransit access trips, and 84% of the trips were to the San Diego Regional Center and other adult day care centers. The reimbursement/revenue paid to MTS from this program was: FY16: $2.7 million (171,373 trips @ $15.72); FY17: $3.5 million (210,913 trips @ $16.34); and FY18: $3.5 million (202,875 trips @ $16.61). In March 2016, AB 2394 shifted funding for Medi-Cal transporta- tion services from transit agencies to MCPs effective October 1, 2017. Medi-Cal communicated this to the MCPs in May 2017; however, it was not until March 2018 that San Diego County notified MTS that the funding would no longer be distributed. This shift happened with no notice and was retroactive to October 2017. This resulted in an unexpected revenue shortfall for the transit agency of $3.5 million. In an effort to recoup this shortfall, MTS pursued two immediate strategies: (1) re-direct Medi-Cal riders to MCP services; and (2) nego- tiate new agency service agreements. The first strategy initiated by MTS focused on the riders receiving Medi-Cal. MTS attempted to contact the Medi-Cal riders using multiple direct mailings, phone calls, brochures on the vehicles, and dispatch scripts to re-direct them to MCP services. The campaign conveyed the message that transportation provided by the MCPs would save the clients $4.50 per trip (which was the current cost of a one-way ride on the service). Furthermore, this strategy would provide certain advantages to MTS, most notable of which was a potential decrease in ADA complementary paratransit ridership by 50%. MTS sought to shift its ADA complementary paratransit riders to MCPs. If successful, these MCPs would provide transportation instead of the transit agencies; MTS could save 100,000 trips or $2.8 million in contract savings ($28/ride); and MTS could save an additional $400,000 in fuel savings. MTS could also potentially reduce the size of the fleet by 10% to 20%. This strategy was met with min- imal success. According to MTS, clients did not opt to change their transportation provider. The second strategy was to negotiate agency service agreements and the agency reported it was very successful. MTS approached the MCPs to use MTS as an approved Medi-Cal provider and negotiate an agency fare that they believed was reasonable. This was not an easy task, and MTS stated it had to work relentlessly to get the atten- tion of the MCPs and transportation brokers. As of May 2019, MTS had developed agreements with half of its providers for agency fares ranging between $21 to $26 per trip. After much work and several rounds of negotiations, some MCPs and designated brokers now purchase and distribute ADA comple- mentary paratransit passes to eligible clients for MTS services. Other MCPs are invoiced on a monthly basis for what MTS believes are cov- ered Medi-Cal trips. Every month, the MCPs review the report and determine whether the trips provided by MTS meet the eligibility requirements for reimbursement. Other MCPs provide trips to MTS through its transportation web portal. Next Steps As MTS continues to develop agreements with the MCPs, MTS is educating other transit agencies and advocating for legislative change. MTS believes that the agreements are scalable, and any size transit agency could benefit. MTS is also seeking legislative change that allows for the transit agency to be designated as an approved provider—similar to NEMT but recognizing the unique differences and allowing public transit agencies to seek authorization on a post- trip basis and invoice accordingly. Outcomes • Agency service agreements with Medi-Cal MCPs to compensate MTS at/near Medi-Cal rates; • Agency fares greater than general public ADA complementary para transit rate/fare; and • Seeking legislative relief to address issues stemming from AB 2394. Current Agency Fares $21.00 to $26.00 depending on agreement Lessons Learned • Medi-Cal clients slow to change ride habits; and • Agency service agreements are scalable. Madison Metro Transit Summary and Motivating Factor Madison Metro is in Dane County, Wisconsin. Dane County was transitioning to Wisconsin’s Family Care model—a long-term care program for Wisconsin’s frail elders and adults with disabilities

7 who are eligible for Medicaid. This upended a long­standing inter­ governmental agreement with Dane County for cost­sharing. Madison Metro met with their stakeholders to explore transportation options for people with developmental/intellectual disabilities and devel­ oped a process to sell agency fare tickets to MCOs for agency trips. The current agency fare is $33.75 per trip. Practice Madison Metro partnered with MCOs and Include, Respect, I Self­ Direct (IRIS, a self­directed program for Wisconsin’s frail elders and adults with disabilities) to implement flat agency fare ticketing for agency rides. Description Madison Metro operates a bus service throughout the City of Madison and its immediate suburbs with a fleet size of approx­ imately 215  buses. It provides ADA complementary paratransit service to persons with disabilities who cannot access the public transit system due to their disability. ADA complementary paratransit service operates during the same hours of Madison Metro’s fixed­route system and riders must be eligible to use this service. Madison Metro has both formal and informal agency service agreements. Context In 2015, the State of Wisconsin passed legislation expanding the Family Care structure—a long­term care program for Wisconsin’s frail elders and adults with disabilities who are eligible for Medicaid— to every county. In 2016, Metro Transit started preparing for Family Care implementation in 2018. Family Care shifted the respon­ sibility of agency rides to MCOs and IRIS agencies from Dane County. This ended a long­standing cost­sharing agreement between Dane County and Madison Metro. It also represented a potential revenue loss of $3.9 million to Madison Metro. Meanwhile, Dane County was successfully transporting 60% of its young adults with developmental/intellectual disabilities coming out of high school to work settings and jobs in the communities through its relationship with Madison Metro. To support the continued success and maintain this priority for transporting young adults, both Dane County and the City of Madison convened stakeholder committees. Dane County initiated a Section 5310 funded 6­month project to explore transportation options for people with developmental/intellectual disabilities under Family Care and the City of Madison convened the 12­month Ad Hoc Paratransit Medicaid Waiver Funding & Policy Committee. The committee included the city alders, Transit and Parking Commission (TPC) members, ADA Transit Subcommittee to TPC members, and ADA complementary paratransit customers. Following these com­ mittee meetings, Madison Metro initiated meetings with Family Care agencies, MCOs, and IRIS agencies in 2017 to: • Inform them about ADA complementary paratransit services; • Negotiate cost agreements; and • Coordinate Family Care transition activities. Madison Metro met separately with MCOs and IRIS agencies. Agreements were exchanged; but none was ultimately signed. Rather, Madison Metro facilitated the purchase of agency fare tickets for their common clients. They established a method for the MCOs and IRIS to purchase agency fare tickets using Medicaid funds at a rate of $33.75. ADA complementary paratransit fares are not available for purchase with Medicaid funds and remain an out­of­pocket fare at $3.25 for ADA riders. During the in­depth interview, Madison Metro stated that when they negotiated a reasonable fare with IRIS and the State of Wis­ consin, they relied on ADA USC 49 Part 37.131 (c), “The entity may charge a fare higher than otherwise permitted by this paragraph to a social service agency or other organization for agency trips (i.e., trips guaranteed to the organization).” Madison Metro based the agency fare on their prior­year audited financials and shared the information with IRIS and the state. During negotiations and preparations, Madison Metro also took the opportunity to stress the concept of more efficient ways to meet transportation needs to the state, IRIS, MCOs, and other stakeholders. Client representatives learned that there are times when fixed­route service or another community service satisfied the client’s needs more efficiently and effectively than using Madi­ son Metro’s ADA complementary paratransit service. The level of revenue from agency fares has remained high ($1.4 million in 2018) since the ticket purchase method was initiated with IRIS. The most recent figures are declining slightly but remain at more than $100,000 per month. In comparison, the rate of cost­ sharing under the agreement with Dane County was approximately $20 per trip and now the agency fares garner $33.75 per trip. Ridership declined in 2018 by 47% which is attributed to Family Care implementation. It remains to be seen whether the agency fare revenue can be sustained or whether ridership has stabilized. According to Madison Metro, there is certainly the possibility that, as individuals eligible for long­term care services come off waiting lists and are added to Family Care, ADA complementary paratransit demand may increase. Outcomes • Partnerships with IRIS and MCOs; • Flat agency fare ticketing for agency rides; • Process for ticket purchase (month by month); • Agency fare payments authorized and managed by IRIS and MCOs; • Authorization of payment prior to using the ticket avoids policing of agency funded trips by the transit agency; • Effective use of 6­month Section 5310 funded project to explore transportation for people with developmental/intellectual dis­ abilities; and • Increased awareness of transportation resources without sole reliance on Madison Metro. Current Agency Fare $33.75 per trip and established in fare tariff Lessons Learned • Stakeholder input can result in excellent partnerships; • Ticket purchases and processes can replace agency service agreements;

8 • Education about the array of transportation resources (including the possible use of fixed-route services in certain situations) is an ongoing and essential process; and • Rides are never turned away but travel planning options may result in a better fit for a particular ride and yield efficiency for the rider. Kitsap Transit Summary and Motivating Factor In 1999, a Washington State initiative eliminated some funding for public transit agencies, causing Kitsap Transit to reduce their ADA complementary paratransit service area to 3/4-mile around the fixed- route service. People who lived beyond this area would no longer have access to public transit. In response, Kitsap Transit worked with social service agencies and developed VanLink. VanLink is a special program/partnership whereby Kitsap Transit issues vans to the social service agencies to provide agency trips. The social service agency provides the driver. The van is parked at the social service agency and they drive their clients to medical appointments, shopping, or work without advance scheduling or reservations with Kitsap Transit. The cost for the rider is $2/trip or possibly less if the rider has a monthly pass. Practice VanLink is a special program/partnership whereby Kitsap Transit issues vans to social service agencies to provide agency trips. Description Kitsap Transit serves Kitsap County in the Seattle metropolitan area and provides bus service on 40 fixed routes, a passenger ferry (Foot Ferry), a vanpool system, worker-driver services, and dial-a-ride ser- vices. They have a fleet of 120 buses. Kitsap Transit also provides ACCESS, a shared ride ADA complementary paratransit service within Kitsap County for qualified passengers unable to use the fixed-route buses. Kitsap has formal agreements with VanLink users. They issue vans to social service agencies to provide transportation for their riders. Context In 1999, the State of Washington decreased the cost of registering cars (a.k.a. car tabs) resulting in decreased funding for public tran- sit, which caused Kitsap Transit to reduce their ADA complementary paratransit service area to 3/4-mile around the fixed-route service. Clients who lived in the outlying areas that had services would no longer have access. To help serve this population, Kitsap Transit developed VanLink, a special program, whereby they issued vans to social service agencies for their use to help transport the elderly and people with physical and intellectual disabilities. The social service agency provides the driver. The van is parked at the social service agency and they drive their clients to medical appointments, shop- ping, or work without advance scheduling or reservations. Represented agencies include Easterseals, Special Olympics, volunteer caregivers, mental health facilities, rescue missions, and veterans homes. VanLink issues the van to the social service agency and the agency has flexibility and control over the client’s transportation. Riders do not have to use ACCESS, Kitsap’s ADA complementary paratransit service, which requires reservations in advance for senior citizens and riders with physical disabilities. Instead, the social service agency uses a Kitsap Transit van to transport its clients. Outcomes • VanLink, a special program whereby Kitsap Transit issues vans to social service agencies; • Kitsap Transit provides, fuel, maintenance, insurance, and training for the drivers; • Social service agencies provide the driver; and • Social service agencies prepare the schedules and operate the vans to meet their client’s needs. Current VanLink Fare $2.00 per ride or monthly pass Lesson Learned • Efficient and effective to have a social service agency manage the van and the schedules; and • Kitsap Transit advertises VanLink on its website (http://www. kitsaptransit.com/faqs/vanlink-faqs#question63) and provides answers to Frequently Asked Questions. Utah Transit Authority Summary and Motivating Factor In 2010, UTA wanted to re-negotiate agency fares to recoup costs for agency trips. UTA was utilizing their ADA complementary para- transit service and charging $68/month for a discounted unlimited monthly pass for agency trips. The situation was becoming unsus- tainable financially and UTA decided to eliminate discounted fares for agency trips and negotiate agency fares. Meanwhile, the Utah Division of Services for People with Disabilities (DSPD) was seeking increased transportation for housing, job resources, transportation, and residential care clients; and DSPD was facing a class-action law- suit for the waiting lists for support and rides. To resolve the prob- lems they were both facing, UTA decided to work closely with DSPD. They developed a strong relationship and partnered to agree upon a new agency fare that increases annually. To help DSPD pay for these services, UTA is providing the required federal match for human ser- vice agency trips. Practice UTA and DSPD partnered to negotiate agency fares and have UTA provide a federal match for human service agency trips. Description UTA provides public transportation throughout the Wasatch Front of Utah, which includes the metropolitan regions of Ogden, Park City, Salt Lake City, and Tooele operating fixed-route buses, flex-route buses, express buses, ski buses, three light rail lines, a streetcar line, and a commuter rail train. UTA has more than 400 buses, 400 van- pools, 114 light rail vehicles, 53 commuter cars, and 18  loco- motives. These provide ADA complementary paratransit services for passengers deemed eligible for the service. UTA has both formal and informal agency service agreements. Context In 2010, UTA and DSPD partnered to address the need for more transportation and to provide funding for social service agencies that provided housing, job resources, transportation, and residential care.

9 At the time, DSPD social service agencies had long waiting lists for rides and they were facing a class­action lawsuit to address the wait­ ing lists for support and rides. Meanwhile, UTA was using its ADA complementary paratransit service to provide agency trips. UTA was charging $68/month for discounted unlimited monthly passes and agency trips totaled about 70% of their ADA complementary para­ transit ridership. As this situation became unsustainable financially, UTA decided to eliminate discounted fares for agency riders and fol­ low USC 49 Part 37.131 (c) that states, “The entity may charge a fare higher than otherwise permitted by this paragraph to a social service agency or other organization for agency trips (i.e., trips guaranteed to the organization).” UTA knew that DSPD had an obligation to pro­ vide transportation options to help people gain access to commu­ nity services, activities, and resources; and that DSPD was also facing the class­action lawsuit. These circumstances encouraged UTA and DSPD to work together to solve the problem. As the relationship developed, DSPD and UTA discussed the costs of the transportation and the need for DSPD to provide a local match of 28% to qualify for federal funding. To overcome this obsta­ cle, UTA and DSPD worked together to find a way that UTA could qualify to provide the required match. UTA stated that by identifying themselves as a quasi­state and quasi­federal government entity, UTA was able to satisfy the 28% match. DSPD and UTA sought sup­ port from the Center for Medicaid and Medicare Services (CMS) and CMS approved the model. As a result, UTA currently has an agree­ ment with DSPD for $16 million of which $11.6 is considered revenue from DSPD and $4.5 million (28%) is considered the local match and provides a saving for DSPD. Furthermore, as part of this partnership, UTA and DSPD were able to agree to an increase of 9.7% for the agency fare annually and move closer to the true cost of the trip. UTA stated this partnership is a “win/win.” An ongoing concern is that UTA still faces the challenge that they do not have a no­show policy with DSPD riders. The only conse­ quence is to suspend the rider’s subscription and require them to schedule the day before the service. Outcomes • UTA and DSPD partnered to address long waiting lists and fund­ ing sources for agency trips; • UTA funding fulfills the federal required match of 28%; • UTA agency fare increases by 9.75% annually; and • Goal to be reimbursed for the entire cost of the ride. Current Agency Fare $23 per day Lessons Learned • Partnership provided “win/win” for transit and social service agencies by establishing an agency service agreement that pro­ vided $23/day agency fare and a federal match of 28%; and • Need for a no­show policy. Pennsylvania Public Transportation Association Summary and Motivating Factor PPTA is taking a public position against a recently passed law. Pennsylvania approved legislation for the Department of Human Services (DHS) to provide a Medical Assistance Transportation Pro­ gram (MATP) through a state­wide or regional full­risk brokerage system. This new legislation will reduce service formerly provided through the coordinated delivery of public transportation, including agency service agreements, across the state. PPTA is advocating on behalf of transit agencies to the state legislature to reconsider this legislation. PPTA states that MATP brokerages will be more expen­ sive than the current system and that there are documented failures of this model. Practice PPTA advocates for transit agencies across Pennsylvania as agency service agreements are affected by new MATP brokerage legisla­ tion. PPTA provided a Call to Action: Impact of MATP Brokerages in PA as well as a Position Paper: Impact of Recent Changes to the MATP. Description PPTA’s mission is to be the foremost advocate for public trans­ portation and mobility in Pennsylvania, and to be of support to all association members in achieving their defined missions. PPTA’s goals are: • To develop and maintain communication with federal, state, and local governments in order to foster and promote an awareness and support for public transportation and mobility of citizens throughout the state; • To build public understanding and support for public transporta­ tion by promoting the value of public transportation and mobility services at every opportunity; • To advocate investment in public transportation services, equip­ ment, and infrastructure; • To provide a forum for members and other key stakeholders to interact, exchange information and ideas, and improve mobility services; and • To promote equitable and fair representation of all members and to provide response member services. Context In June 2018, the Pennsylvania State Legislature adopted HB 1677 directing DHS to provide MATP through a statewide or regional full­risk brokerage system. This legislation shifted the service that includes agency service agreements and oversight away from local transit agencies. According to PPTA, MATP represents more than 30% of the shared ADA complementary ride/paratransit programs in Pennsylvania. In the interest of public transit agencies, PPTA has been advocating to stop and study the issue before the service is contracted out to private providers. As part of its advocacy strategy, PPTA prepared a Call to Action: Impact of MATP Brokerages in PA and a Position Paper: Impact of Recent Changes to the MATP. This research provides information for the legislature as they prepare to privatize MATP and focuses on the effects it will have on transit agencies and agency trip riders. The research highlights TRB industry standards, which show that state brokering agreements result in a 40% reduction in coordinated trips.

10 PPTA stated that the impact of this loss of ADA complementary para- transit revenue and service will result in a cost of $31.5 million to the state. In addition, if ADA complementary paratransit does not recover any MATP trips, it will cost the state $63.8 million. During the interview, the PPTA executive director stated that the former model gave Pennsylvania transit “the distinction of the 5th lowest average MATP trip cost in the nation, while providing the greatest number of MATP trips.” Local involvement in manage- ment and services had been key for Pennsylvania transit agencies to keep their MATP costs down and to provide cost-effective and efficient service delivery, with a one-stop-shop for consumers for all public transportation. As stated by PPTA, “Brokerage has occurred in other states; however, no known example demonstrates success nor maintains local control of services. There have, however, been many documented failures of this model, such as in Texas, where costs increased 400%, customer service complaints increased by 300%, and ridership declined by 50%.” PPTA also asserts that the MATP model erodes consumer protections, such as safety, training, drug and alcohol testing, and insurance standards required of public transit systems. Next Steps HB 1677 removed public transit as the coordinators of services requiring the use of regional brokers to provide MATP. The state released Request for Applications (RFAs) for brokers, received responses in April  2019, and was planning contract negotiations for summer 2019. PPTA urges the administration and the general assembly to take steps and vote for bills (HB 986 and SB 390) “to stop the award of the RFA and to study the complex issues and ramifications of brokerage on the nation’s most coordinated public transit program.” This legislation was supported by more than 100 legislative cosponsors at the time this study was completed. Outcomes • Call to Action: Impact of MATP Brokerage in PA • Position Paper: Impact of Recent Changes to the MATP stating: – A projected reduction in the geographic service area and hours of service, meaning seniors and persons with disability will see a reduction in the available service by transit agencies; – A projected loss of coordination and efficiency; – Projected reduced levels of service; – Projected lack of local input and control; – Projected increased costs for transit agencies resulting from a significant loss in service productivity; – Projected increased agency fares; and – Potential safety issues, including loss of consumer protections. Current Agency Fares $13.00 to $45.00 (depending on zone) Lesson Learned PPTA estimates that removing MATP from the state’s coordinated system will result in the need to increase revenue funding by 23% or $31.5 million; or, in the worst case, by $63.8 million state-wide. City of Gadsden Transit Services Summary and Motivating Factor To treat all its riders equally and fairly, it is GTS policy to maintain the same fare for agency service agreement riders as for ADA eligible complementary paratransit riders. GTS works closely with social service agencies to ensure that riders receive the same service that their ADA complementary paratransit community receives. Further- more, GTS has enlarged their ADA complementary paratransit service parameters for agency trips. Practice GTS’s public policy is to provide service to social service agencies at the same fare as ADA complementary paratransit service (agency fare = ADA complementary paratransit fare). Description GTS in Alabama provides adequate, safe, and efficient transportation services to the general public, including those with special needs at a low cost. This includes services for people who are disabled, senior citizens, commuters, people with limited access to transportation, and the general public with a fleet of approximately 20 vehicles. They seek to meet all needs of the transit community, recognizing financial and physical capacity constraints while working within federal, state, and local guidelines. Context GTS has ad hoc agreements with social service agencies to provide NEMT, as well as service for people who attend senior centers, adult daycare, rehabilitation centers, and vocational centers. Transportation is a shared service. ADA complementary paratransit eligible riders and social service agency riders ride on the same vehicles. Some social service agencies buy tickets, make reservations, and make cancellations for their riders. At GTS, the social service agency pays the same fare as the ADA complementary paratransit rider: $.75. GTS works closely with social services agencies to ensure that riders receive the same excellent service that their ADA complemen- tary paratransit community receives. Their key to success includes having open lines of communication between social service agencies, riders, and GTS. They treat each social service agency as an individual entity. GTS has discussions with their riders so that they can best accom- modate their individual needs. They also have discussions with social service agencies. They are aware that companions and attendants may accompany the rider to ensure that there is a responsible person at the rider’s destination. These communications help GTS to be pro- active as they meet the needs of their riders. GTS has enlarged its ADA complementary paratransit parameters to meet the needs of riders who are represented by social service agencies. As part of their effort to treat everybody equally and fairly, they are not charging a higher fare for the rides coordinated with social service agencies. Outcomes • Provides service to social service agencies at the same fare as ADA complementary paratransit service;