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CHAPTER 5 Types of Transportation Services to Recognize Four Categories Describe Transportation Services To be able to compare the costs of various transportation services, different kinds of trans- portation services must be recognized. Human service transportation now is delivered in four distinct ways, which can be called "types" or "modes" of transportation services: Community transportation. Case management transportation. Travel services for individuals. Managed care transportation. Examples of the services that would be included under each type or mode of human services transportation are described in this chapter. Community Transportation This category includes the following functions and their related costs: Trips provided for members of the general public or clients of human service agencies who could travel on a group basis (even if they are the only traveler on the vehicle at the moment). Trips provided by paid staff and volunteers who have been trained to provide transportation services. Efforts associated with eligibility determination, scheduling, arranging, or billing for trans- portation. The purchase of specific individual transportation services from existing public or private transportation providers via contract or other arrangements. The purchase of bus tokens, passes, or tickets for distribution to riders. Personal care by attendants or interpreters who accompany eligible riders while traveling in community transportation mode. Payments made to riders to help defray the costs of their travel using community transportation services. Other activities and expenses if authorized and applicable. For example, Medicaid sometimes reimburses expenses for long-distance intercity bus and commercial air fares and lodging and subsistence expenses when these expenses are required to obtain out-of-town medical care. Expenses like these are not common for other programs. For the purposes of this project, air fares and overnight lodging and subsistence expenses are not included in the long-distance travel expenses commonly considered as community transportation expenses. Case Management Transportation This category includes transportation in which agency staff transport individuals and provide other services during the time at which the individual or group is being transported. Trips are 14

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Types of Transportation Services to Recognize 15 typically provided in agency-owned vehicles or staff-owned vehicles. This category is distin- guished from directly operated community transportation, in which the staff member providing case management transportation may perform specifically planned case management or thera- peutic functions while providing the transportation services. Generally the person providing the transportation would be a social worker or case worker whose primary role is not that of provid- ing client transportation but of providing case management or therapeutic functions. This type of transportation includes the following: Transportation of clients in staff-owned vehicles. Transportation of clients in agency-owned vehicles that are not specifically dedicated to community transportation. Lodging, meals, and parking expenses associated with case management transportation, as well as other expenses if authorized and applicable. Note that if case management services are not being performed during the trip, it may be more cost effective for the human services agency to have the client transported by a community trans- portation service and to use the case manager's or social worker's time for services that require their professional training. Travel Services for Individuals This category includes the following: Transportation services designed to be offered to one individual at a time (although careful analysis might show that community transportation could be a more cost-effective option in a number of cases). Any direct payment to an individual client to subsidize his or her use of a private automobile to facilitate program-related purposes, including Gasoline subsidies paid directly to the client, family member, friend, or volunteer; Car maintenance or repair expenses; Cost of vehicle modifications to incorporate adaptive technologies; Purchase of vehicle liability insurance on behalf of clients; and Financial stipends to support an individual's ongoing transportation needs (e.g., pay- ments for employment and employment-related transportation for a specific amount of time). Mileage reimbursements or other fixed-rate reimbursements paid directly to clients. Mileage reimbursements paid to family, friends, or volunteers for providing transportation to eligible clients. Car rental expenses. Costs associated with personal care attendants or interpreters who accompany the eligible client while traveling in specific individual transportation mode. Lodging, meals, and parking expenses associated with specific individual transportation. Other expenses if authorized and applicable. Managed Care Transportation This category includes transportation provided as part of an overall client health care plan (either a short-term or long-term care plan), under which the provider agency is obligated to provide client transportation. Transportation expenses often are part of a fixed payment or "cap- itated payment" made to the service provider by the funding source. Examples of this type of transportation include the following: Direct operation of provider-owned vehicles to provide transportation services to individual clients. Purchase of transportation from public or private transportation service providers.