Transportation Reimbursement for Day Program Services (January, 2004)

Reimbursement Rates for Community Agencies Providing Transportation Services to and from Day Program for Persons with Developmental Disabilities

Introduction

The cost of transportation has become an increasingly important fiscal issue to many community-based agencies that provide supports to persons with developmental disabilities. These community agencies provide residential and day program services in which transportation pay a significant role. A Transportation Work Group was formed by the Finance Committee of the Statewide Advisory Council on Developmental Disability Services to examine the cost of transporting persons to and from their day programs. The Work Group sought to develop a recommendation for a new transportation reimbursement methodology that would allow the State of Illinois' reimbursement for the service to be identifiable and reflective of current year costs.

Every day in Illinois, over 30,000 persons with a developmental disability travel to and from their day programs.⁽¹⁾ This report focuses on the cost to provide transportation to and from day program supports only. Residential transportation and other transportation services provided to, or arranged by, community agencies for individuals with developmental disabilities, other than that which is required to get individuals to and from day program services, are not included in this analysis and the recommendations contained in this report.

The recommendation is intended to apply only to transportation reimbursement to and from Developmental Training and Regular Work. The methods used, and the costs incurred, by community agencies for transporting persons to day programs such as Supported Employment or "At Home Day Program" are considered to be sufficiently different and the transportation reimbursement for these other forms of day program will be address when a review of those methodologies are examined. All references to the rates or the number of persons affected are based on data and rates in effect on July 1, 2003 without the two percent reserve.

The Transportation Work Group recognizes that a standardized method for calculating transportation reimbursement will not mirror specific provider experiences. Community providers and families, the stakeholders seeking a solution to the day program transportation issue, should critique the recommendation based on whether it produces a result that is workable and provides incentive for continued movement toward the most efficient modes of transportation available in their areas.

Readers of this report should be aware that the Transportation Work Group and the members of the Finance Committee considered this recommendation to be only one part of a two-part process. The second part is the development of a reimbursement methodology to calculate Developmental Training and Regular Work rates that are sensitive to individual-specific program needs. The Finance Committee has held discussions on this topic several times over the course of the past few years. A Day Program Work Group of the Finance Committee is expected to have a recommendation prepared as a companion piece to this report. Taken together, and implemented simultaneously, these two components will continue to set a course for a reimbursement structure for day program and transportation services to persons with a developmental disability in Illinois that is consumer-based and responsive to the support needs of individuals.

Background

The costs associated with transporting persons to and from day programs has historically been included in the rate paid to the community agency providers. Though specific references concerning the actual reimbursement amount or percent of the total Medicaid Waiver day program rate intended to cover the cost of transportation are scarce, the Department of Human Services (DHS) has held that the day program rate paid to community agencies is "bundled," i.e., that the rate includes reimbursement for all of the services associated with providing day program supports such as capital, staffing, administration, and transportation.

Section 119.200 (d) of Administrative Rule 119, "Minimum Standards for Certification of Day Training Programs," states, "Transportation required for individuals shall be the responsibility of the provider." ⁽²⁾ This reference clearly implies that providers of day program services are expected to be "responsible" for getting persons transported to and from their day programs, but has not precluded day program providers from arranging and/or paying for transportation services, rather than physically providing the service itself.

GRAPH Here

Over the years, residential providers and day program providers, parents and guardians have utilized various means and resources available to get persons to and from their Developmental Training and Regular Work day programs. Methods have included using local mass transit lines (both fixed routes and on-demand bus or van resources), agreements between residential and day program providers on which entity will provide the transportation service, and parents either driving their children to the day program or arranging for the transportation. In theory, the transportation system should naturally gravitate to more efficient operation over time, as less expensive or more convenient options are sought out. The Transportation Work Group is committed to encouraging the exploration and adoption of more efficient means of transporting persons to and from day programs within their communities through the reimbursement recommendation.

Transportation, unlike many other supports and services needed by individuals with a developmental disability, can have a wide range of delivery possibilities. Depending on individual circumstances, the most efficient method of getting to and from Developmental Training or Regular Work will differ from person to person.  For example, an individual's personal needs (ambulation, medical, behavioral, cognitive), and where the person lives (larger residential setting, smaller residential setting, at home with natural and family supports, or in an urban area where government-operated transit options are available, or a rural area where they are limited) all affect the optimal transportation modes. The many combinations of persons with a developmental disability, their individual needs, and the circumstances in which they live make it difficult to develop a single transportation reimbursement solution that can be applied universally across a state as large and as diverse as Illinois.

Principles

During the discussions of the issues, problems, and possibilities for reimbursing the cost of transportation services for people to get to and from their Developmental Training and Regular Work day programs, the Transportation Work Group developed a set principles around which they felt the recommendation should be built. These principles are:

• People receiving service should have a choice of transportation providers. Where possible, and to the extent feasible, the transportation reimbursement recommendation should allow persons with a developmental disability to have options for getting to and from their day programs. These options should include all facets of available transportation, e.g., family, mass transit, and community agency-provided.
• People should not have to ride more than an hour to reach their destination. Consistent with the guidelines in Administrative Rule 119, the Transportation Work Group agreed that the transportation reimbursement recommendation should not require persons to ride for more than one hour to or from their day program destination.
• People needing help to access and use transportation should be provided attendant-assistance. Based on a standardized assessment criteria, the transportation reimbursement recommendation should provide for reimbursement for attendant-assistance in addition to the reimbursement provided for such things as capital, operating expenses, etc.
• Transportation services should be reimbursed separately from the day program reimbursement. Given the array of possible alternatives for getting persons to and from their residential locations to their day program sites, the Work Group believes that separating the transportation reimbursement from the day program rate will allow for the greatest flexibility, consumer choice and, ultimately, the greatest efficiency to provide this service.
• The reimbursement rate for transportation should be standardized rather than provider-specific. For several reasons, the Work Group believes that reimbursement for transportation services should be standardized across all providers rather than being determined on a provider-by-provider basis. These reason include a desire to remain consistent with the philosophy behind other reimbursement methodologies (CILA Rate Model) and the desire to build-in efficiency incentives into the reimbursement methodologies used by the State.
• Public policies should encourage federal, state, county, township, and municipal transportation agencies to expand or create public transit options that include people with developmental disabilities. Transportation is a service needed by more than just persons with developmental disabilities in every community. Separate systems supported by federal, state, and local tax dollars targeted to persons with developmental disabilities is costly and inefficient. Enhancing the availability of public transportation systems used by all members of a community, including persons with a developmental disability, is the desired long term solution that addresses several service issues, including the integration of individuals with developmental disabilities into their communities.

In recognition of the immediate need to address the fiscal issue associated with getting persons to and from their day programs, and the vision of an integrated, accessible, and public-supported transportation system, the Transportation Work Group recommends a parallel approach be adopted.

• Short Term: A Department of Human Services, Division of Developmental Disabilities (DHS/DDD) rate structure that addresses a variety of transportation options including family-provided transportation, public and para-transit options, and provider-operated transportation where other options are not available. For the new rate structure to allow for the greatest flexibility, the reimbursement for transporting persons to and from their day programs should Aunbundled@ from the day program rate. The rate structure should recognize that the cost of transporting persons differs depending on their individual needs and circumstances. The new rate structure should be sensitive to the needs of individuals, yet be standardized and limited to a manageable range of optional reimbursement levels.
• Long Term: The DHS/DDD rate structure should provide incentives to move from provider-operated transportation to local government-operated transportation (County, Township or Municipal) and to foster the expansion or creation of public transit options where they are currently inadequate or non-existent. DHS/DDD and the provider community should work together to better coordinate and expand the partnership between the developmental disability service system and state and local mass transit authorities.

The Research

Staff from the Department of Human Services, Division of Developmental Disabilities, Bureau of Community Reimbursement, conducted the research for the Transportation Work Group.

Consolidated Financial Report (CFR) Analysis

Cost reports from Developmental Training provider agencies for Fiscal Year 2001 were reviewed. An analysis was conducted to determine the reported average transportation cost per client, per each five-hour program day. Data submitted by individual community agencies were omitted from the analysis if the resulting per client transportation cost calculated was outside two standard deviations from the reported mean of $3.20.

Cost report data for 49 Developmental Training provider agencies fell within the restrictions of the standard deviation test. Using only these agencies' cost report data, the analysis found that the agency-reported transportation cost per client, per five-hour program day, ranged from $0.05 to $12.59. The weighted average transportation cost equaled $2.90 per person, per day. This reported amount represents the weighted average cost for all clients and their transportation needs, e.g., ambulatory and non-ambulatory; driver-only and attendant-assisted.

Given the findings of the CFR analysis, the Transportation Work Group agreed that agency cost report data was not a good source at this time for establishing transportation reimbursement rates for persons to travel to and from day programs.

Public Mass Transit Systems

The Transportation Work Group expressed a desire for the DHS/DDD rate structure to provide incentives for community agencies to move from provider-operated transportation systems to mass transit systems (county, township or municipal) over the long-run wherever possible, and to expand or create public mass transit systems where they are currently inadequate or non-existent.

At present, there are 32 counties in Illinois with no public transportation system in place and 12 counties with transportation systems present only in city locations. Many of the State's counties that do have systems are not able to adequately address the service needs of the population with developmental disabilities. This fact, and the blend of "fixed route" versus "on-demand response" statistics and availability, made it difficult to find a direct link between the Illinois Department of Transportation (IDOT) mass transit district (MTD) data and the appropriate reimbursement rate for community agency providers supplying day program transportation services.

The Work Group concluded that DHS should work with the Illinois Department of Transportation (IDOT) and other entities around the State to coordinate public mass transit resources making them more accessible to persons with developmental disabilities for both transportation to and from day programs, as well as for all other aspects of their daily lives. For areas where public transit systems are currently available, the Work Group recommended DHS/DDD adopt a reimbursement methodology that would a encourage agencies to exploit their use and reward these agencies for their efforts to incorporate public transit systems into their client supports.

Medicaid "Service Car" Reimbursement

	Chicago	Non-Chicago
Base Rate, Per Trip	$7.73	$6.76
"Loaded" Mileage	$0.72	$0.49
Attendant Rate	$1.55	$1.55

Source: Illinois Department of Public Aid

Illinois Department of Public Aid (IDPA) Medicaid Transportation

The Illinois Department of Public Aid (IDPA) reimburses providers of transportation services for the Medicaid-eligible population when the transportation is to and from a Medicaid State Plan service. This reimbursement, typically referred to as "Medicar" or "Service Car," cover the cost of transporting clients to doctor or therapy appointments or other similar, eligible services. Day program services are not covered under the Medicaid State Plan and, therefore, the cost associated with transporting persons to and from them are not eligible for billing directly to IDPA.

DHS/DDD staff reviewed the reimbursement rates for Medicar and Service Car billings with IDPA staff to determine whether it would be appropriate to adopt them as the methodology for reimbursing transportation to and from day program. This review yielded an opinion that the Medicar and Service Car rates are not intended to be applicable to transportation done in groups the size involved in day program transportation. DHS/DDD could "discount" these Medicar or Service Car rates to make them more applicable to size of the transportation group involved, but determining the discounting factor would be difficult, if not arbitrary.

School District Data

Department staff obtained statewide data from the Illinois State Board of Education (ISBE) on the average cost of transporting children to and from school. These data did not include costs from the City of Chicago public school system and this was considered to be a significant gap in the data.

Average XPTN Cost Per Pupil - School Year 2001 to 2002

	Cost
Standard Transportation
No. of Eligible Students	1,018,682
Total Expenditure Reported	$365,558,323
Average Cost Per Pupil	$358.85
Special Transportation
No. of Eligible Students	68,621
Total Expenditure Reported	$223,467,394
Average Cost Per Pupil	$3,256.55

Source: Illinois State Board of Education. State of Illinois, excluding City of Chicago public schools.

The "Average Cost Per Pupil" data were available for both standard transportation and Special Education students. During school year 2001-2002, the average annual statewide cost per standard transportation student was $359 and the average cost per Special Education student was $3,257. ⁽³⁾

The Transportation Work Group concluded that the school district data provided a good base of information from which some general conclusions could be drawn, but like the Department of Public Aid Medicaid transportation data, these data would require significant adjustment to be made as sensitive to the specific needs of individuals as was desired.

Sample Survey of Community Agency Providers

Seventeen community agencies were surveyed. At a minimum, two agencies from each of the eight networks in the State that provide Developmental Training and/or Regular Work were selected to answer a detailed survey about their transportation costs and operation. The information collected from these agencies covered nearly 3,700 persons attending day programs - estimated to be more than 15 percent of the total number of persons who attend these two types of day programs. These agencies provided a wide range of information, including data on their capital and operating costs, the modes of transportation used by the individuals they transport, and their vehicles' depreciation schedules.

By the time the Transportation Work Group was able to review the data from the community agency survey, several basic premises of the recommendation had been formulated. As a result, the Work Group looked at the information gathered from the community agencies more as validation to confirm the reimbursement logic being developed rather than as a direct input source to the methodology. Even so, the survey results played a significant role in determining several of the values adopted in the recommendation.

The survey requested community agencies provide a range of information on both passenger utilization and transportation costs and, in many instances, asked that the data be provided by vehicle type. The vehicle type options provided in the survey were: "Minivan," "Large Van (7-15 passengers)," and "School Bus." Much of the survey's data were compiled using these three vehicle classifications.

• Passenger Data: One of the premises of the reimbursement logic the Task Force sought to confirm from the survey data was that persons living in smaller residential settings generally used smaller vehicles to get to and from day programs. While certainly not expected to be universally true, it was surmised that because of the more geographically dispersed nature of CILAs and other small residential settings, as opposed to the concentrated number of persons living in larger ICF/DDs and State-Operated Developmental Centers (SODCs), providers would use smaller vehicles to transport this population. Though not overwhelming, the results of the survey tended to support this concept.
  • Smaller Residential Settings: The survey showed that 61.3 percent of persons residing in CILA homes and 73.5 percent of persons living in ICF/DD 4&6 bed homes traveled to and from day programs in "minivans" or "large vans." Large vans were defined on the survey as 7-15 passenger vehicles. Only 10.7 percent of the 1,277 persons covered in the survey that live in these two setting types received day program transportation via a school bus-type vehicle.
  • Larger Residential Settings: Of the 787 persons covered in the survey that live in ICF/DDs other than 4&6 bed sites (16 beds and fewer and more than 16 beds), 57 percent were reported to be traveling to and from their day programs in either large vans or school buses, with the majority of these being reported as school bus-type vehicles.
  • Family Homes: More than thirty-four percent of the persons included in the survey results (1,268) were reported to be living in family homes. Of these persons, public transportation was reported as the most frequent single mode of transportation (28.6%) to and from day programs. "Large van" accounted for 20.6 percent and "school bus" was reported for 19.5 percent of this group=s transportation.

Passenger Data: Reported Modes of Transportation by Resident Location

Resident Location	No Response	Family XPTN	Mini or Large Van	School Bus	Public XPTN	Private Contract
Family	3.1%	14.0%	21.3%	19.5%	28.6%	13.5%
CILA	0.7%	0.1%	61.3%	10.7%	15.9%	11.4%
ICF 4 & 6	1.0%	0.0%	73.5%	0.0%	13.3%	12.2%
ICF 16 or Fewer	0.7%	0.0%	26.8%	38.6%	16.8%	17.2%
ICF > 16	3.1%	0.7%	23.6%	33.2%	3.1%	36.3%
Other Group	0.9%	0.0%	26.0%	8.3%	30.6%	34.3%
Other/NEC	15.4%	7.3%	20.1%	43.6%	11.1%	2.6%
No Response	17.4%	8.7%	0.0%	39.1%	21.7%	13.0%

Source: Transportation survey of community agencies, July 2003.

• Driver and Attendant Assistant Data: The survey asked providers to list the number of drivers and attendant assistants used in transporting persons to and from their day programs, their rates of pay, and their fringe benefit percentages. The average driver wage rate reported was $9.59 per hour with an average fringe benefit add-on cost of 25.7 percent, for a total average driver wage and fringe cost of $12.05 per hour. All reported hourly driver wage rates fell within two standard deviations from the reported mean and, therefore, no community agency responses were eliminated from the driver cost analysis.

  The average reported attendant assistant wage was $8.80 per hour with a 26.2 percent fringe benefit add-on for a total average attendant assistant wage and fringe cost of $11.11 per hour. All reported hourly attendant assistant wage rates also fell within two standard deviations from the reported mean and, therefore, no community agency responses were eliminated from the attendant assistant cost analysis.

Operating Expenses

Community agencies were asked to provide data on their operating expenses for both owned and leased vehicles. Very few agencies reported having leased vehicles and operating expenses data for owned vehicles was only received for 10 of the 17 agencies. Of these, the average cost per mile was reported to be $0.49 and $0.48 for "minivans" and "large vans," respectively. The data received on agency owned and leased school bus-sized vehicles was even more sparse and variant. Two agencies reported operating expenses for leased school bus-sized vehicles and five reported expenses for owned bus vehicles. The reported operating expenses for vehicles of this size ranged from a low of $0.07 to a high of $3.08 per mile.

• Miles Per Trip: The weighted average length of a one-way passenger trip between the residential and day program locations was reported to be 12.15 miles. Average passenger trip lengths reported by agencies ranged from a low of 4.0 miles to a high of 22.9 miles.
• Elapsed Time Per Trip: The weighted average elapsed time of a one-way passenger trip between the residential and day program locations was reported to be 32 minutes. Average passenger trip times reported by agencies ranged from a low of 10 minutes to a high of 59 minutes.
• Capital Cost for Vehicles: The survey asked community agencies to report costs for owned and leased vehicles, by vehicle type. The survey asked agencies to define their vehicle sizes in terms of
  minivan," "Large van," or "school bus." The reported weighted average purchase price and annual lease cost of vehicles shown in the table below. Vehicle ownership among community agencies responding to the survey significantly out-numbered the community agencies reporting leased vehicle expenses. Just over 70 percent of the community agencies responded that they have purchased Alarge vans@ for the purpose of transporting persons to and from day programs.
• Depreciation of Vehicles: The average life of the three vehicle types reported by community agencies in the survey were 6.5 years for "minivans," 6.14 years for "large vans," and 6.6 years for "school bus."

Reported Vehicle Expense: Purchase Price and Annual Lease Cost

Type of Vehicle	Owned Vehicles Purchase Price	No. of Agencies Reporting Owned Vehicles	Annual Cost of Leased Vehicles	No. of Agencies Reporting Leased Vehicles
Minivan	$23,959	9	$4,200	1
Large Van	$32,780	12	$4,239	3
School Bus	$69,210	5	$29,880	2

Source: Transportation survey of community agencies, July 2003. N = 17.

The Recommendation

Creating a reimbursement methodology to address the wide and varied transportation expenses realized by families and community agencies providing supports to persons with a developmental disability has proven to be a difficult task. What seems logical as a method for one group of persons may not work for a similar group living in a different part of the State or living in a different type of residential setting. Some transportation expenses are determined as much by factors such as urban versus rural geography as they are by the size of the vehicles being used or the ambulation capabilities of the persons being supported.

The same transportation reimbursement rate does not work for everyone, but the need to limit the reimbursement alternatives to a reasonable range of options is an administrative reality.

A trade-off exists between the ease and accuracy of implementation and the number of different rate options created. The more individual-need criteria used in establishing transportation reimbursement rates, the more information that is required to be collected from community agencies and the greater the chance that errors or inaccuracies will occur in the setting of rates and the billing for services. Therefore, a balance must be struck that provides a manageable number of reimbursement levels representing a sufficient range of the transportation methods being used in the community while maintaining a reasonableness in the degree of detail that is required to be effectively administered.

The recommended methodology allows day program providers to take advantage of the range of transport options in their area in order to seek the most efficient means available, while maintaining the provider's ultimate responsibility to ensure the persons in enrolled in their day programs receive transportation services. The recommendation creates an individualized transportation rate founded on some basic support need information for the person (ambulation, attendant-assistance, etc.), while offering a set standardized reimbursement levels. It allows reimbursement to be available for parents and guardians who have been, or would choose to, provide transportation to and from day programs.

The reimbursement rates produced are created using a set of cost components, assigned values, and general assumptions that can be updated and debated over time. The recommended methodology is not a perfect solution to the transportation to and from day program problem, but is submitted as a good faith effort and initial first step in addressing the transportation concerns of persons with developmental disabilities, their families and guardians, and day program and residential providers.

Community Agency Transportation Reimbursement

The method described below uses values and assumptions to calculate a "per person, per trip" reimbursement for community agencies who provide or arrange for the transportation of persons to or from day programs. Values are obtained from a variety of sources, most predominately the Illinois Department of Transportation (IDOT) and its data from mass transit districts in the State.⁽⁴⁾ Information from the community agency survey is used, as well as certain values such as wage rates and fringe benefit percentages used in other existing methodologies. A basic assumption in the methodology is that day program transportation occurs 240 days during the year. This assumption is used throughout the recommendation.

Capital Component (Vehicle)

The Transportation Work Group met with staff from the IDOT to explore the data sources that could be used for establishing day program transportation reimbursement rates. These discussions yielded a set of vehicle specifications and values used by IDOT in their "Para-transit Vehicles for the Elderly and Persons with Disabilities" program, (referred to as the IDOT 5310 grant program.) This program provides lift-equipped passenger vans to not-for-profit agencies serving senior citizens and persons with disabilities. Community agencies complete and submit an application to IDOT to request a vehicle be provided to their program. IDOT reports that approximately125 vans were purchased and given to qualifying community agencies in Fiscal Year 2003.

Capital Component (Vehicle)

Methodology	Light Duty 8 Beds or Fewer	Super Medium Duty More than 8 Beds
IDOT (5310) Vehicle Value	$46,631	$87,687
Vehicle Value Discount Multiplier	80%	80%
Vehicle Value, Reimbursement Base	$36,505	$70,150
Depreciation (Years)	6.0	6.0
Program Days Per Year	240	240
Transportation Trips Per Day	2	2
Depreciation, No. of Trips	2,880	2,880
Capital Reimbursement, Per Trip	$12.68	$24.36

The fiscal and programmatic limits of the IDOT 5310 grant program, and the fact that a significant number of DHS community providers of day programs do not operate as not-for-profit entities, precludes DHS from making the assumption that all community agencies can take advantage of this program and that a capital component, therefore, is not needed in the reimbursement methodology. The 5310 grant program vehicle specifications and values do, however, provide a good source for the reimbursement methodology's capital component since they allow DHS to adopt a standard set of values used and regularly updated by reliable source.

The recommended methodology adopts the IDOT vehicle specifications and value for a "Light Duty Paratransit Vehicle" (See Addendum # 1) for persons residing in settings of eight or fewer beds and the specifications and value for a "Super Medium Duty Paratransit Vehicle" (See Addendum #2) for persons residing in settings with more than eight beds. These values are discounted to 80 percent of the IDOT new vehicle purchase price to account for some minium resale revenue to the community agency and are assumed to be fully depreciated over six years in which there are 240 program days each year. All IDOT vehicles include wheelchair lifts in the equipment specifications and referenced values, therefore, no additional add-on is required to account for this expense.

Operating Expense Component

Data from the Illinois Department of Transportation (IDOT) on local mass transit district (MTD) operating expenses was obtained and used as a proxy value in the recommended methodology.⁽⁴⁾ These data include budgeted expenses by cost center and were adjusted to exclude the staff and administration wage and fringe benefit expenses. A statewide weighted average "per mile" operating cost was calculated after adjusting the data to comply to a "two standard deviation from the mean" test. The statewide average operating expense was calculated to be $1.93 per mile for mass transit district vehicles. The average one-way trip to and from day programs is assumed to be equal to ten miles. These data were used to establish an "Operating Expense Per Trip" of $19.30 for "Super Medium Duty" vehicles assumed to be used for persons living in settings with more than eight persons. The IDOT MTD per mile expense of $1.93 was discounted by a factor of .5 (50%) to establish an Operating Expense Per Mile of $0.965 for "Light Duty" vehicles, or $9.65 per trip.

Operating Expenses

Methodology	Light Duty 8 Beds or Fewer	Super Medium Duty More than 8 Beds
Operating Expenses Per Mile	$0.965	$1.93
No. of Miles Per Trip	10	10
Operating Expenses Per Trip	$9.65	$19.30

Staff Expense Component 

Staff expenses related to transportation reimbursement to and from day programs focus on two components: driver costs and attendant-assistant costs for persons with high levels of medical or behavioral needs.

• Vehicle Driver: Driver expenses are assumed to be comprised of one staff person, per vehicle, paid at the Fiscal Year 2004 CILA Rate Model Direct Service Person (DSP) wage rate of $10.25 per hour plus 20 percent for fringe benefits. Driver time is assumed to equal 75 percent of the maximum allowable transportation time documented in Administrative Rule 119, or 45 minutes under the present maximum. Driver cost reimbursement is included in all community agency provided transportation rates calculated by the recommended methodology.

Driver Reimbursement

Methodology	Light Duty 8 Beds or Fewer	Super Medium Duty More than 8 Beds
Driver Hourly Wage	$10.25	$10.25
Fringe Benefit Percent:	20%	20%
Driver Wage w/Fringe	$12.30	$12.30
Max. Travel Time (Hours), Rule 119	1.0	1.0
Trip Time Multiplier	.75	.75
Average Trip Time (Hours)	0.75	0.75
Driver Reimbursement, Per Trip	$9.23	$9.23

• Attendant-Assistant:  Attendant-Assistant costs are assumed to be comprised of one staff person, per vehicle, paid at the Fiscal Year 2004 CILA Rate Model Direct Service Person (DSP) wage rate of $10.25 per hour plus 20 percent for fringe benefits. Attendant-Assistant time is assumed to equal 75 percent of the maximum allowable transportation time documented in Administrative Rule 119, or 45 minutes under the present maximum.

Attendant Assistant Reimbursement

Metholodogy	Light Duty 8 Beds or Fewer	Super Medium Duty More than 8 Beds
Attendant Assistant Hourly Wage	$10.25	$10.25
Fringe Benefit Percent	20%	20%
Driver Wage with Fringe	$12.30	$12.30
Max. Travel Time (Hours), Rule 119	1.0	1.0
Trip Time Multiplier	.75	.75
Average Trip Time (Hours)	0.75	0.75
Reimbursement Per Trip	$9.23	$9.23

Administration

The recommendation adds 10 percent of the aggregate total of capital, operating expenses, driver reimbursement, and attendant-assistant costs (when applicable) to the reimbursement for administration. This reimbursement is intended to cover all aspects of the coordination and execution of transporting persons to and from day programs that is not covered under the cost centers of capital, operating expenses, driver reimbursement, and attendant-assistant costs, including the additional duties associated with billing for day program transportation reimbursement.

Vacancy Factor

Since participants in Developmental Training and Regular Work day programs do not generally attend the program 100 percent of the time, a "vacancy factor" of eight percent has been added to recognize the fact that the cost associated with providing transportation services does not change because on any given day there is one less person riding along. The structure of the reimbursement methodology assumes a total incurred cost which is divided by a fixed number of persons being transported (see "The Divisor" section below). Because of this, and because the fixed number divisor adopted is equal to 100 percent of the ridership capacity (ambulatory and non-ambulatory specific), a vacancy factor equal to eight percent has been added.

The Divisor - Number of Persons on Board

The aggregate per trip costs computed for the components identified (capital, operating expenses, driver, attendant-assistant, and administration) is divided by the number of persons assumed to be sharing the cost for each trip to and from day programs to get a "per-person, per-trip" reimbursement amount. According to the IDOT "Para-transit Vehicle Specification Summary," the rider capacity of the "Light Duty Para-transit Vehicle" is reported to vary given the amount of wheelchair locations built into the vehicle as desired by the community agency. These rider capacities are reported as shown in the table.

Rider Capacity: IDOT Vehicle Specifications

Light Duty Vehicle	Super Medium Duty Vehicle
11 Seated Passengers	22 Seated Passengers
2 Wheelchair & 6 Seated Passengers	2 Wheelchair & 18 Seated Passengers
3 Wheelchair & 2 Seated Passengers	5 Wheelchair & 8 Seated Passengers

Source: Vehicle specifications according to IDOT "Vehicles for Elderly and Disabled Persons" (5310) grant program.

Given the range of possible vehicle configurations, the recommendation adopts a standard of 100 percent of the passenger seat capacity for ambulatory riders and 60 percent of the passenger capacity for non-ambulatory riders for these two vehicle types. Note that the resulting passenger divisors do not assume that only ambulatory or non-ambulatory individuals are riding in any particular vehicle as a group exclusive of the other. Rather, the assumption is that in some combination of ambulatory and non-ambulatory persons, there are between 6.0 and 10.0 passengers on a "Light Duty" vehicle, and between 12.6 and 21.0 passengers on a vehicle of "Super Medium Duty" size, depending on the ambulatory or non-ambulatory combination on board.

Passenger Capacity Assumptions

Passenger Category	Light Duty 8 Beds or Fewer	Super Medium Duty More than 8 Beds
Ambulatory	10.0	21.0
Non-Ambulatory	6.0	12.6

The Table of Rates: Community Agency Transportation

The methodology recommendation described above produces a "Per Trip:"transportation reimbursement look-up table for community agency providers of the service. The transportation reimbursement value within the table for which any given individual is eligible is dependent upon three factors:

• Whether the individual lives in a residential setting where eight or fewer persons with a developmental disability reside, or in a setting with more than eight persons living together.
• Whether the individual is ambulatory or non-ambulatory.
• Whether the individual requires an attendant assistant to accompany them on the vehicle due to behavioral or medical conditions.

These three conditions, when grouped in various combination and subjected to the assumptions adopted in the reimbursement recommendation, produce the "Per Trip Reimbursement." To compute a daily reimbursement per person, the per trip rates are multiplied by two. Assuming 240 days of day program per year, produces an annual reimbursement per person for community providers of day program transportation.

Transportation Reimbursement By Setting Type, Community Provider Agencies

Per Trip Reimbursement

	No Attendant	Yes Attendant
Setting: 8 Beds and Fewer
Ambulatory	$3.75	$4.84
Non-Ambulatory	$6.25	$8.07
Setting: More than 8 Beds
Ambulatory	$2.99	$3.51
Non-Ambulatory	$4.99	$5.86

Some rounding may occur.

Per Day Reimbursement

	No Attendant	Yes Attendant
Setting: 8 Beds and Fewer
Ambulatory	$7.50	$9.69
Non-Ambulatory	$12.49	$16.15
Setting: More Than 8 Beds
Ambulatory	$5.98	$7.03
Non-Ambulatory	$9.97	$11.71

Some rounding may occur.

Per Year Reimbursement

	No Attendant	Yes Attendant
Settings: 8 and Fewer
Ambulatory	$1,799	$2,325
Non-Ambulatory	$2,999	$3,875
Settings:  More than 8 Beds
Ambulatory	$1,436	$1,686
Non-Ambulatory	$2,393	$2,811

Some rounding may occur.

Family Transportation Reimbursement

An important feature of the transportation recommendation is the ability for parents or guardians to receive reimbursement for getting their children or other loved ones to and from day programs. There are approximately 1,300 persons currently attending fee-for-service day programs who are receiving no DHS-funded residential supports or are receiving some respite-like supports within the family home.⁽⁵⁾ These individuals get to and from their day programs either by the transportation service supplied by the day program provider, using public mass transit systems, by their parents or guardians, or by some other community or family entity. It is an important feature of the transportation recommendation that this group of individuals and their family members be given the opportunity to be reimbursed for providing day program transportation service.

As previously noted, all transportation reimbursement, to this point, has been included in the total day program rate. In other words, day program reimbursement has been a "bundled" rate. Therefore, parents or guardians who have either provided or paid for transportation services have not had an avenue to receive reimbursement unless passed on to them by the day program agency. The day program transportation reimbursement recommendation changes that for persons residing in community settings.

Calculation of Per Trip Rate

Several options were explored for determining a basis for calculating the reimbursement rate for parents or guardians. These options included using an assumed number of miles per trip to and from the day program in combination with a per mile reimbursement rate, a flat rate based on costs incurred as a result of a survey of parents and guardians, and using mass transit district data. After reviewing these options, it was determined that data from the Illinois Department of Transportation on local mass transit district (MTD) operating budgets provided the best source documentation.⁽⁴⁾

Family and Guardian Transportation Rates

Description	Rate
Avg. MTD Base Fare	$1.46
Multiplier	2
Vacancy Factor	1.08%
Per Trip, Family	$3.15
Per Day, (x2)	$6.30
Per Year, (x240)	$1.514

The IDOT operating budget data provides the "Base Fare" cost within each of the State's 40 MTDs. The Base Fares represent the cost assessed riders per trip. The Base Fares reported ranged from $0.50 to $8.50 (the latter being an average of a range of fares reported within one MTD). The Statewide average, after eliminating those MTD Base Fares which fell outside two standard deviations from the mean, equaled $1.46 per trip.

The recommended transportation reimbursement for persons residing in family settings is based on an "On Demand" rate, or the rate charged to persons who telephone a request for transportation (referred to as PACE, or ACCESS in some parts of Illinois). A multiplier of two was used and applied to the Statewide average "Base Fare" determined from the IDOT data. Because some persons living in family settings will be using community agency provided transportation and will likely not attend 100 percent of the time, the eight percent vacancy factor is included in the family transportation recommendation to cover the fixed costs incurred when persons are absent.

The "Per Trip, Family" transportation reimbursement rate to and from day programs is recommended to be, therefore, $3.15. Assuming two trips per day, 240 day program days per year, the annual reimbursement rate for persons residing with parents and guardians is calculated to be $1,514.

Conclusion

The recommended methodology described in this report is one part of a two-part process for addressing the community agency provider and family setting reimbursement needs related to day program supports and transportation. This report described the reimbursement recommendation for getting people to and from their day programs. The recommendation assumes that the transportation reimbursement will be "unbundled" from the day program rate which is currently paid to the providers of day program services. Unbundling these two components is expected to foster greater flexibility which will ideally bend the service delivery system toward the most efficient transportation options available. Under an "unbundled" reimbursement system for day program services, residential and day program providers can work with each other to identify and use the best transportation alternative for their particular circumstance with the knowledge of the rates the Department is paying for the service.

Part two of the process to unbundled transportation from day services is the development of a day program reimbursement methodology that is sensitive to the programmatic needs of individuals. Readers of this report should be aware that this second component is an equally important part in the overall recommendation. Development of a methodology that adjusts the value of its reimbursement components, (e.g., as staffing levels) based on individuals needs determined by ambulation, medical, or behavioral conditions, is necessary prior to implementing the new transportation reimbursement system.

Combined these two new reimbursement mechanisms will address the developmental disability system's short term need for a more cost reflective reimbursement structure. Recommendations on the longer term solutions of improved mainstream transportation availability and community integration for persons with developmental disabilities will be left to a future work out team.

End Notes

⁽¹⁾ Developmental Training and Regular Work only. Based on:

1. estimated 3,500 persons in program 310 Developmental Training Grant from provider survey, October, 2002
2. 7,000 persons in program 31U, Developmental Training Fee-for-Service, "POS Rates Update," Third Quarter, FY03
3. 3,300 persons in program 380 Regular Work Grant, ROCS, June 2002
4. 900 persons in program 38U, Regular Work Fee-for-Service, "POS Rates Update," Third Quarter, FY03
5. 1,200 persons in program 31S, Developmental Training - SODC Residents, "POS Rates Update," Third Quarter, FY03
6. 6,000 persons residing in ICF/DD attending Developmental Training, "Long-Term Care Rates Update," First Quarter, 2002.

⁽²⁾ Section 119.200 (d) of Administrative Rule 119, "Minimum Standards for Certification of Day Training Programs."

⁽³⁾ Illinois State Board of Education, Pupil Transportation and Claiming Reimbursement System, FY2003, School year 2001-2002.

⁽⁴⁾ Illinois Department of Transportation, Division of Public Transportation, Downstate Bureau Operating Budget Analysis

⁽⁵⁾ POS Rates Update, March, 2003. Does not include persons enrolled in Home-Based Supports.

Acknowledgments

In addition to their duties as members of the Finance Committee to the Statewide Advisory Council on Developmental Disabilities, the following persons served on the Transportation Work Group and their efforts contributed significantly to this report:

• Gus Van Den Brink, Sertoma Center, Chairperson
• Lynn O'Shea, Association for Individual Development
• Chris Burnett, Illinois Association of Rehabilitation Facilities
• Mark Klaus, Charleston Transitional Facility
• Rick Prykrop, Saint Rose CSN
• Ron Wisecarver, Peoria ARC

The following Department of Human Services staff researched transportation data and statistics, made countless telephone calls to private and public entities, developed the community agency survey, analyzed the survey results, documented the findings, and prepared this report:

• Mike Blazis, Long Term Care Rates Unit
• Jim Keys, CILA Rates Unit
• Steve Rudolph, Manager, Long Term Care Rates Unit
• Scott Kimmel, Chief, Bureau of Community Reimbursement