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26 transit professionals to provide service that meets local work toward a common goal of continuing to improve needs. The first brokerage was initiated in 1994 after two the brokerages. years of discussion, with others following over the next few Interagency agreements--By contracting with other years. All of the brokerages are public transit operators. governmental entities, as opposed to a competitive pro- curement, OMAP has been able to ensure coordination by involving transit agencies as brokers. Relationship Between Stakeholders Local level flexibility--As with most large and diverse states, Oregon has a wide variety of transportation In 1991, OMAP initiated discussions with TriMet, which cul- needs. Solutions in Portland may not work in the cities minated with an agreement for management of the brokerage of Bend or Salem. This approach recognizes that the that has been in place since 1994. TriMet management stated local level is the best place to determine needs and a ser- that relations among OMAP, ODOT, and TriMet were excel- vice model(s). In addition, TriMet works directly with lent, because all parties have a common goal. Communication caseworkers to ensure the most appropriate mode. is rarely a problem, because all parties work closely together Cost-effective--The broker is always seeking the low- to solve problems. ODOT provides seed money to brokers as est cost per trip and has a variety of options available. needed to ensure successful implementation. Use of fixed-route service--The brokers appear to be taking advantage of fixed-route services and this has State Level Service Delivery Model resulted in significant savings. Service standards--TriMet determines the service stan- OMAP has placed control of the service at the local level. By dards for the NEMT program (over and above state allowing these regional brokers the flexibility to operate a pro- minimum levels). TriMet uses its own standards to gram that meets the needs of the community, coordination has ensure a quality service. flourished. The regional brokerages are all operated by transit Contract oversight--TriMet is aggressive in monitor- agencies. Each agency uses its own approach to the provision ing service--frequent field observations, inspections, of NEMT. Brokers are paid based on an average trip cost, and communication with caseworkers can only be done which is calculated quarterly. All billing is done electronically. at the local or regional level. Fair/reasonable payment for service--The cost of the service is closely monitored to ensure that the payment TriMet Coordination Activities per trip is reasonable for all parties. TriMet maintains a separate "contact center" for each program and a separate contracted operation owing to the complexities TEXAS--TEXOMA AREA PARATRANSIT SYSTEM, and differences of each program. Until recently, the services SHERMAN AND DENNISON were managed by two different entities. Last year, both cen- ters were contracted to one management firm. The centers are Introduction on TriMet property with TriMet staff working alongside the The Texoma Area Paratransit System (TAPS) is a nine- contractor, allowing for ease of service monitoring. county rural transit agency and a small urban operator for the cities of Sherman and Dennison in north Texas. The service Customers call the NEMT Contact Center, which then area population is approximately 110,000. The agency is pre- assigns trips to one of 50 subcontractors (some are exclusive dominantly demand-response with a series of commuter to TriMet, whereas others, such as taxicabs, pick up other fixed-route services serving various employment sites in the passengers). Selection of the contractor and mode is depen- Dallas/Ft. Worth metropolitan area and the Dallas Area Rapid dent on need (most appropriate mode) and cost. Fixed-route Transit's (DART) light rail station in Plano. ridership for NEMT is 35% of total ridership, down from 50% as a result of the elimination of certain groups from the TAPS contracts with the Medicaid Transportation Program Medicaid program. These groups had a very high level of (MTP) in nine counties (four under subcontract) and has coor- fixed-route use. TriMet does not conduct a formal assess- dinated a wide range of types of human service transportation ment of the ability of Medicaid clients to ride fixed-route for more than 20 years. TAPS is similar in size and coordina- transit (unlike the ADA program), preferring to "take the tion levels to a number of other rural agencies in Texas. word" of the customers. Management feels that this approach, coupled with communication with case workers Texas has a long history of coordination at the local level, and field observation, is more effective and less intrusive. especially in rural areas, where many of the agencies have a 30-year history of coordinating Medicaid, Title III Aging Activities That Affect Coordination transportation, job access, and other programs with public transit. Almost all of the rural transit agencies in the state Communication and trust--OMAP, TriMet, and coordinated at least one other human service program, and ODOT have an excellent working relationship and most more than one.

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27 Relationships Between Stakeholders service operator. It is not clear at this point how this procure- ment will affect coordination with public transit, nor is it clear The Texas Legislature has taken a unique approach to the how fixed-route usage will be increased. coordination of transportation at the state level. In 2003, the state legislature passed legislation requiring the Texas Health and Human Service Commission (HHSC) (responsi- State Level Coordination ble for Medicaid, Title III, and other programs) and the Texas Workforce Commission (TWC) to cede control of As stated previously, the rural transit agencies have evolved their transportation programs to TxDOT. However, HHSC into very highly coordinated transit agencies that compare and the TWC retain policy control over their programs (i.e., favorably with other states. TxDOT has recently imple- HHSC is still the single state agency responsible for Medic- mented a planning requirement for 24 designated areas cov- aid). To date, TxDOT has transferred the entire MTP staff ering the entire state. All major agencies and stakeholders (more than 150 individuals operating the 8 call centers), as are involved. It is not clear how the results of these meet- well as seven staff members to support the software used by ings will affect or influence Medicaid transportation (pro- TxDOT. The program has remained basically the same as it cured outside the influence of this planning process) and the was when it was at HHSC. No other programs have been other programs. It should also be noted that without Medic- affected at this time. aid transportation, there is little left to coordinate because MTP contributes the vast majority of human service fund- ing and customers. State Medicaid Service Delivery Model Texoma Area Paratransit System Coordination TxDOT operates the regional brokerages directly (using state Efforts to Date employees), and each region uses multiple operators to cover their regions. In essence, TxDOT is directly involved in the TAPS is a fully coordinated transit agency that, in addition to day-to-day operation. Clients call their designated TxDOT public transportation, contracts with TxDOT to operate Med- regional broker who verifies client and trip eligibility and then icaid transportation. The recent changes place a sub-broker determines the most appropriate mode. The MTP office then between TAPS and TxDOT. TAPS also assists a number of schedules the trip and contacts (or posts on the web) the most senior centers and the TWC. Employment transportation is appropriate service operator at 5:00 p.m. the day before the trip. coordinated directly with employers and employee organiza- tions. TAPS also works with other small agencies to assist Use of fixed-route service by TxDOT is low in the major them in their transportation needs. cities where most of the population resides. In the 1980s, more than 50% of urban Texas Medicaid clients using MTP TAPS has taken the initiative to coordinate NEMT with rode on fixed-route; currently, it is below 15%. public transit for its entire 20-year existence. Management believes that "all coordination is local" in that all of the activ- The previous approach implemented in the late 1990s by ities necessary for coordination have been conducted at the the Texas Department of Health was to conduct competitive local level. During those 20 years, TAPS was required to procurements throughout the state. The RFP standards devel- engage in a competitive procurement conducted by MTP oped previously by the Department of Health for drivers, and, at this time, has retained its contract. TAPS must work vehicles, maintenance, and safety were considerably lower with two separate TxDOT MTP managers and two different than that of most of the public transit operators. As a conse- TxDOT public transit coordinators. Now it must also work quence, some of the rural public transit agencies that had with an MTP sub-broker. been operating MTP service for 20 years lost their contracts based on price. This resulted in a net loss of coordination in Innovation to Enhance Coordination parts of the state, whereas other rural operators continued to operate in a coordinated manner. This loss continued with the TAPS and one of its TxDOT MTP field managers have initi- most recent procurement (discussed here). ated a pilot program in four of the TAPS counties. TAPS sells bus passes for travel within each county. The MTP office in The new RFP issued as this study was being completed Dallas purchases discounted passes and distributes them to indicates that TxDOT is beginning to level the playing field riders with demonstrated need. The customer then calls TAPS by making operating requirements more stringent. The RFP for their trip and is treated as any other customer. This elimi- does not require coordination, although it is encouraged. nates the need for expensive invoicing and processing for TxDOT has designated the 24 council of government regions both the operator and the MTP. It allows the transit provider as MTP regions. It is conducting a competitive procurement to to control the scheduling process, which also enhances their select one operator or sub-broker who will receive the calls productivity. Record keeping is kept to a minimum as well. from TxDOT (the broker) to be responsible for all service in Lastly, it allows the MTP customers to gain a familiarity with the region. These trip requests will then be forwarded to the the agency.