Introduction
This interim report presents the findings to date of the Transportation Rate Work Group's review of transportation reimbursement issues. The Work Group's charges were to:
- Identify and recommend changes in the methodology that could have a short-term and immediate effect of enhancing services and supports in the community services system in ways that advance the adequacy, quality, and quantity of this part of the system to the forefront.
- Identify additional areas of potential changes in the reimbursement methods that could be considered for the longer-term.
The reader is referred to the Statewide Advisory Council (SAC) Rate Committee Interim Report Overview of Rate Committee for a discussion regarding the overall framework of the following principle charges:
- Develop rate proposals that are adequate, fair, and equitable.
- Create statistical models for each rate component or sub-component by identifying the data elements and processes.
- Break proposals into part that can be independently implemented.
- Develop rate proposals that are "shelf ready" to implement as opportunities to do so are presented.
This paper reflects an overall recommendation followed by two major sections of findings and recommendations from the Work Group:
- Recommendations - Section 1 includes items the Work Group has reviewed.
- Additional Review and Research Recommendations - Section 2 reflects items the Work Group has identified but additional work is recommended
Background
Transportation is an extremely broad topic. Transportation encompasses nearly all aspects of one's daily life. Simply put, "it is hard to go anywhere and do anything if you can't get there from here." The importance of transportation cannot be understated. Indeed, travel to and from one's daily activity is common and central for virtually everyone, whether one is working, going to school, involved in routine daily activities, shopping or running errands, or seeking entertainment and recreation. Individuals with a disability or someone with economic limitations are clearly at a disadvantage and obtaining and using transportation takes a greater share of one's time and resources.
Both federal and Illinois' legislation have been passed in recent years regarding many initiatives, such as "United We Ride," and mandating the coordinated planning of transportation systems. Illinois' Public Act 93-0185 was enacted in July 2003, "To create the Interagency Coordinating Committee on Transportation (ICCT) to research and provide recommendations on ways to broaden and reduce duplication of transportation service coverage to help disadvantaged populations gain adequate access to work, work-related services and life-sustaining activities for health and well-being." The ICCT's work culminated in the January 24, 2006 report: Interagency Coordinating Committee on Transportation Report to the Governor and General Assembly of Illinois.The ICCT's review of transportation issues and development of greater coordination of regionalized planning systems continues to make "top down" progress. The ICCT Clearinghouse staffed and operated by the Illinois Institute for Rural Affairs (IIRA) at Western Illinois University is a good resource for learning more. The reader is encouraged to review the: ICCT Clearinghouse's Transportation Coordination Primer.
The Transportation Work Group was formed to examine transportation services rates in the developmental disability system. The Work Group considered the broad program categories that currently include transportation funding. Transportation for residential supports is already a part of the Community Integrated Living Arrangement (CILA) rate and is among the CILA supports and issues that the CILA Rates Work Group was formed to address. The reader is referred to the CILA Rate Work Group Interim Report at the Division's web page for the Statewide Advisory Council Rate Committees for more information on that group's review of CILA residential transportation elements and issues.
Day program transportation is part of the day program rate and is funded for individuals in Home-based Supports Services (HBSS) reimbursement from within their HBSS total monthly allotment, to the extent that HBSS-enrolled individuals utilize day programs. For other types of transportation, HBSS-enrolled individuals also have within the same total monthly HBSS allotment a standard mileage amount (currently $0.38/mile) that is limited to $500 per month for non-day program.
The Work Group has examined utilization in day programs and determined that the Developmental Training (DT) and Regular Work (RW), which have the same statewide rate and a requirement for the provider to be responsible for transportation, also have the largest number of persons utilizing them, as shown in the table below. Consequently, the Work Group members agreed to focus its attention on these programs first.
FY2008 Day Program Full-Time Individual Equivalent Utilization By Funding Type
| Funding Type |
DT |
Regular Work |
SEP |
All Other |
| CILA |
6,184 |
569 |
292 |
376 |
| HBSS/DT Only |
4,136 |
112 |
39 |
0 |
| Purchase of Service |
279 |
7 |
21 |
0 |
| ICFs/DD & SODC |
6,916 |
0 |
NA |
0 |
| Total |
17,515 |
688 |
352 |
376 |
Note:
- The Home-Based Support Services (HBSS) Program (type "H") has replaced Developmental Training Only funding type and figures are combined for purposes of this presentation. In 2008, there were 3,149 DT Only and 987 HBSS FTE individuals.
- The figures do not represent the actual number of individuals served in these programs as many individuals may attend both DT and RW, for example, on a part-time basis and would be counted multiple times in each program and overstate enrollment.
- All Other Day Programs include "At-Home" Day Program and "Other" Day Program, which are only available to individuals enrolled in CILA, and All Other also includes Adult Day Care.
As shown for FY2008, after subtracting the ICFs/DD and SODC figures, there are approximately 11,287 FTE individuals currently receiving DT/RW services under the Medicaid Waiver. This includes 10,260 FTE individuals attending DT/RW who are enrolled through the CILA, "day program only," and Purchase of Service (POS) programs (e.g., Community Living Facilities) and 1,027 FTE individuals funded through the HBSS program. Although Intermediate Care Facilities for individuals with a developmental disability (ICFs/DD) DT is not a focus of the Work Group, it should be noted that an additional 6,916 individuals who reside in ICFs/DD or state-operated settings also receive DT supports but through a rate methodology (with a transportation component included) that is specific to residents of these settings. It is reasonable to consider that any day program transportation rate model resulting from the Work Group's efforts could also be applied to the ICFDD DT.
It has been estimated that approximately $736 per person per year is included in the DT/RW Medicaid Waiver statewide rate of $11,429. This estimate is based on an extrapolation using the $806.40 dedicated for ICFs/DD DT daily transportation that is 6.44% percent of the ICFs/DD DT annual average FY2008 rate of $12,520 (as adjusted for comparability with the Waiver DT by excluding the special transportation funding for 981 persons). The amount of funding in the Waiver DT rates associated with transportation is therefore estimated to be $6.1 million annually after excluding individuals who use family transportation (for which there is an alternate rate proposal in this paper) and HBSS-funded individuals whose funding is within their monthly stipend amount.
The Transportation Work Group has noted that there had been a very solid effort in January 2004, by an earlier work group that created the report: Transportation Reimbursement for Day Program Services - Reimbursement Rates for Community Agencies Providing Transportation Services to and from Day Program for Persons with Developmental Disabilities in 2004.The scope of the report was focused on transportation for Developmental Training (DT) and Regular Work (RW) Medicaid Waiver programs.
The 2004 report included a survey of the transportation practices of DT/RW providers around the state, a review of cost report information, a review of Illinois State Board of Education (ISBE) information, a review of the Illinois Department of Healthcare and Family Services (DHFS) non-emergency medical transport program, and a review of public mass transit information. That report's primary conclusion was that development of a rate methodology with a standardized approach was both administratively feasible and desirable to accommodate the wide variety of practices in use among DT/RW service providers and for an individualized approach to the wide variety of transportation-related needs of individuals. A DT/RW transportation rate model was developed, though it has not been implemented.
Findings
The 2008-2009 Transportation Work Group has reviewed the 2004 report. The Work Group concluded that replicating the earlier survey would not be a good use of time and staff resources.
However, for a perspective on costs comparison and changes over time, the Work Group did review more current Illinois State Board of Education (ISBE) information. The Work Group compared the ISBE 2001-2002 per person figures to the FY2008 reported costs. In 2001-2002, ISBE reported the per pupil special education transportation at $3,257 and the average cost for the regular (non-special education/non-vocational) at $359 per pupil. In 2008, ISBE reported the per pupil special education transportation at $3,716 and the average cost for the regular (non-special education non-vocational) pupil at $419 per pupil. Compared to the 2001-2002 school year data from ISBE in the original 2004 Transportation report, these 2008 costs reflect 16.8% and 14.1 % increase in regular and special education, respectively. The Work Group concluded that the transportation cost of individuals in DT/RW programs is expected to be within the range of the non-special and non-vocational regular transportation and the special education costs per pupil. Though simply adopting these rates is not a satisfactory approach to an individualized rate, this information does provide an indication that transportation is expensive and costs increases are a fact of life.
The Work Group also considered the 2004 Report's discussion of the possibility of funding day program transportation through the Medicaid Non-emergency Medical Transportation (NEMT) service car system, which is funded through billings to the Illinois Department of Healthcare and Family Services (DHFS). This program provides non-emergency transportation for a limited number of individuals to travel to/from Medicaid State Plan services, such as appointments with physicians or therapies. A few years ago, HFS considered making changes to its program by seeking to implement a statewide-brokered system, but the proposal was withdrawn and the reimbursement for non-emergency medical transportation has not changed in the past few years. The Division of Developmental Disabilities' DT program, though a Medicaid Waiver program, is not a State Plan entitlement service. The Work Group concluded that attempting to make DT a State Plan service would create an entitlement for day services that exceeds the current Medicaid Waiver eligibility capacity. This line of review was discontinued.
The continuing lack of available, flexible, mass public transit services in many parts of Illinois and the fact that many individuals with a developmental disability cannot utilize mass transit are clear indications that this is not a feasible alternative at this time. It remains that transportation supports need to be developed or enhanced and specifically geared to meeting the day program needs of individuals with developmental disabilities.
The Work Group notes since the release of the 2004 report that the costs of providing transportation have dramatically increased, as one can infer from the education-related transportation cost increases mentioned above, by changes in the Consumer Price Index described below, and anecdotally by the recent past year's spikes and wide fluctuations in gasoline and fuel costs experienced by consumers and businesses alike.
In addition, the ability to hire and retain staff and staff costs necessary to compete for workers, are persistent issues in developmental disabilities services. The Work Group notes and supports the findings of the Wage and Fringe Benefit Work Group regarding the need to pay competitive wages through an increase in DSP wages using Bureau of Labor Statistics data on wages and fringe benefits. The reader is referred to the Wage and Fringe Benefit Interim Report at the Division's web page for the Statewide Advisory Council Rate Committees for more details on this.
The Work Group members have concluded that the 2004 Report's overall approach to developing a specific rate methodology for transportation was sound and it provides a solid foundation and has value as a starting point for the Work Group. The Transportation Work Group has agreed that the assumptions and values should be reviewed and updated.
The Work Group recommends that transportation funding should be developed as a separate rate methodology, independent from the development of a rate methodology for the DT and RW programs. The estimated amount of base transportation funding currently in DT or RW programs could be a potential source of funds to at least partially offset the expected greater cost of a distinct DT/RW transportation rate methodology.
In making this decision, the Transportation Work Group recognizes that it is deferring until a later time a review of transportation issues for other day programs such as Supported Employment or for other programs involving individual transportation funding such as Home-Based Support Services (HBSS). The Transportation Work Group also acknowledges that transportation elements in CILA residential programs are being deferred to the CILA Rates Work Group.
OVERALL RECOMMENDATION
The members of the Statewide Advisory Council Rate Committee Transportation Work Group support the continued participation of the Department and the Division in the Statewide ICCT planning and coordination efforts, but the Work Group considers the fact that a significant level of transportation services (and funding) are already in place in the Developmental Disabilities community services systems for Developmental Training (DT) and Regular Work (RW) programs and that this provides an immediate opportunity to affect a positive change in the developmental disabilities service system. As a short-term objective, transportation should be a specifically identified and funded program separated from the DT/RW program and it should have its own distinct rate and rate methodology.
-
Recommendations
The Work Group has conducted a review of a number of items from the 2004 Transportation Report proposed rate methodology and it has identified recommendations for changes. The following recommendations for a day program transportation rate comprise a single rate and rate methodology. Cost projection information is given following recommendation #8 below for the proposal as a whole. Costing out the separate components has not been performed. An additional recommendation (#9) follows regarding reimbursement for family-furnished transportation.
-
Vehicle (Capital) Component
The capital component in the proposed Day Program Transportation model intends to address the cost of vehicles. In the 2004 report, the vehicle cost was based on the Illinois Department of Transportation (IDOT) 5310 grant standard values for either a "Light-Duty" vehicle for 10 seated passengers capacity (or 6 seated and 2 persons using a wheelchair, or 2 seated and 3 wheelchair capacity) or a "Super Medium Duty" vehicle for 22 seated passenger capacity (or 18 seated and 2 persons using a wheelchair, or 8 seated and 5 wheelchair capacity). The 5310 grant program provides lift-equipped passenger vans to not-for-profit agencies serving persons with disabilities. The IDOT-furnished values provide a reliable source of standardized and annually updated values for vehicles. In the 2004 proposal, 5310 program vehicle types/sizes were associated with setting sizes in which the individual resides, such as for 8 or fewer persons for the light-duty and for 9 or more persons using the super medium-duty vehicle. This setting/vehicle size proposal provides an administratively simple means of determining the applicable per diem rate to be paid without the burden of billing for each person's one-way travel by a specific type of vehicle.
Providers do not necessarily utilize the IDOT 5310 vehicle grant program nor are the grants readily available to them. Funding a vehicle component in the rate methodology could provide an incentive to more providers to seek grants or alternative sources of vehicles. However, on the other hand, the utility of this should be reviewed. If IDOT or other grants were to become more widely available, this component's funding could be revised or eliminated at some future point as a "prudent buyer" approach to the use of state resources.
The IDOT Vehicle Value is discounted by 80% to account for a resell or retention (continued use of the vehicle) value at the end of the useful life of the vehicle at the end of 6 years. The vehicle is assumed to make two round trips per day per passenger. The annual days of operation are assumed to be 240 days and two round trips per day are assumed for purposes of calculating a per diem rate.
Recommendation: Update values and assumptions of the Vehicle component. Vehicle values for 2009 are not currently available but the IDOT 2008 values of $50,000 and $90,000 for light-duty and super medium-duty vehicles were available. The values rate of change in the IDOT values from 2003 to 2008 was 9.6% for small vehicles and 2.6% for large vehicles, or annualized percentage changes of 1.9% and .5%, respectively. These approximations were used to update these values to 2009 in the table below.
Calculation: The table below illustrates an IDOT Vehicle Cost Per Trip by size of vehicle/setting size to be $50,950 then discounted by 80%. The result is divided by the number of trips over six year's useful life at two round trips per day x 240 days = 2, 880 trips. A similar calculation was performed on the larger vehicle cost.
Capital Component (Vehicle)
| Methodology |
Light Duty
8 Beds or
Fewer |
Super Medium Duty
More than 8 Beds |
| IDOT (5310) Vehicle Value |
$50,950 |
$90,450 |
| Vehicle Value Discount Multiplier |
80% |
80% |
| Depreciation Years |
6.0 |
6.0 |
| Program Days Per Year |
240 |
240 |
| Transportation Trips Per Day |
2 |
2 |
| Depreciation, Number of Trips |
2,880 |
2,880 |
| Capital Reimbursement Per Trip |
$14.15 |
$25.13 |
-
Vehicle Operating Expense
The vehicle operating cost per diem in the original Work Group's report was based on IDOT data on standard operating costs per vehicle mile from local mass transit districts surveys in Illinois in 2003. Updated data from IDOT are not presently available in a usable form for the current year. Alternatively, the Work Group has considered the use of the Consumer Price Index (CPI) Public Transportation Index as a reasonable alternative to represent the change in operating costs from 2003 to 2009 and it does provide a means to update the original 2003 data. The index does not specifically address only "operating costs" and an Illinois-specific version of this index has not been identified. The Work Group believes the U.S. version of this index is a reasonable proxy for cost changes. The table below provides a comparison of the Public Transportation Index to the overall CPI, all urban consumers, all items index.
Consumer Price Public Transportation Cost Index Compared to the CPI
| Public Transp. |
2003 |
2004 |
2005 |
2006 |
2007 |
June, 2008 |
Overall
Change |
| Index |
205.6 |
205.4 |
217.6 |
217.8 |
233.408 |
264.681 |
|
| % Change |
|
-0.10% |
5.94% |
0.09% |
7.17% |
13.40% |
28.74% |
CPI - All
Items |
2003 |
2004 |
2005 |
2006 |
2007 |
June, 2008 |
Overall
Change |
| Index |
184.3 |
190.3 |
196.8 |
201.8 |
210.036 |
219.964 |
|
| % Change |
|
3.26% |
3.42% |
2.54% |
4.08% |
4.73% |
19.35% |
Note: The 2003-2007 indices in this table are calendar year end December. The index for 2008 is June.
The 2004 work group report calculated $1.93 per trip for large vehicles based on an IDOT survey of Illinois Mass Transit Districts (MTDs).
The 2004 provider survey collected information on the average passenger round trip travel distances. The result was just over 20 round trip miles. The 2004 model assumption of 10 miles per one-way is based on this survey data. The cost per mile for smaller vehicles was assumed at 50% of the larger vehicle cost.
Recommendation: The CPI Public Transportation Index from 2003 to June 2008 (start of FY2009) reflects a 28.74% change that can be applied to the historical operating costs from the original IDOT data. The use of the 10 miles one-way assumption is continued.
Calculation: Large capacity vehicle: $1.93 per mile x 1.2874 CPI Change = $2.48/mile x 10 miles per trip = $24.85/trip.
Small capacity vehicle: $1.93 per mile x 50% size adjustment x 1.2874 CPI Change = $1.24/mile x 10 miles per trip = $12.42/trip.
The table below presents the Vehicle Operating Cost Per Trip:
Vehicle Operating Cost Per Trip
| Operating Expenses |
Light Duty
8 Beds or Fewer |
Super Medium Duty
More than 8 Beds |
| Operating Expenses Per Mile |
$1.24 |
$2.48 |
| Number of Miles Per Trip |
10.0 |
10.0 |
| Operating Expenses Per Trip |
$12.42 |
$24.85 |
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Driver Reimbursement
The Driver Cost Component of the proposed Transportation model addresses the driver hourly wages, fringe benefits and per trip travel time. Each of these will be presented in detail in items A and B below, but are summarized in the following table of driver reimbursement per trip.
Driver Reimbursement Per Trip
| Driver Reimbursement |
Light Duty
8 beds or Fewer |
Super Medium Duty
More than 8 Beds |
| Driver Hourly Wage |
$14.59 |
$14.59 |
| Fringe Benefit Percentage |
29.43% |
29.43% |
| Driver Wage W/Fringe |
$18.88 |
$18.88 |
Maximum Travel Time
(Hours), Rule 119 |
1 |
1 |
| Trip Time Multiplier |
154% |
175% |
| Average Trip Time |
1.54 |
1.75 |
Driver Reimbursement,
Per Trip |
$29.08 |
$33.05 |
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Driver Wages and Fringe Benefits
The Work Group discussed what job classification other than the original proposal's use of the Direct Support Person (DSP) might be appropriate for drivers. The Work Group reasoned that because of their interactions with individuals, drivers must be DSP trained. Drivers are not a dedicated full-time function in day programs. Drivers typically work as DSPs in the day program after their transportation functions are concluded.
Currently the fringe benefit allowance of 20 percent is used in the CILA Model and other rate methodologies and is intended to cover the required employer paid payroll taxes (Social Security and Medicare), state and federal unemployment taxes, and worker's compensation insurance. This current allowance level precludes providers from funding benefits such as health, dental or vision insurance or retirement savings benefits. Providers have a difficult time recruiting and retaining staff without being able to provide competitive employer sponsored benefits.
The Wage and Fringe Benefit Work Group has recommended the use of the Federal Bureau of Labor Statistics (BLS) projected wage for the Standard Occupational Classification series 21-1093, Social and Human Service Assistants. The Wage and Fringe Benefit Work Group recommends an hourly wage of $14.59/Hour. The Wage and Fringe Benefit Work Group has also recommended the adoption of the fringe benefit allowance of 29.43% derived from the June 2008 BLS News "Employer Cost for Employee Compensation" for the Midwest Division, North Central Region (IL, IN, MI, OH, and WI).
Recommendation: Increase the Driver/DSP hourly wage using the BLS projected wage from the Standard Occupational Classification for the series 21-1093, Social and Human Service Assistants, to $14.59/Hour. With 20% fringe, this value becomes $17.51/Hour and with 29.43% fringe the wage is $18.88/Hour.
Calculation: See the table above for the hourly wage and fringe benefit calculation.
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Driver Time
The 2004 proposed rate methodology assumed that the one hour maximum travel time permitted under the DT Rule 119 would be less on average per person, and it assumed a 45 minute travel time average. A .75 adjuster was applied to the calculation driver time. While it is perhaps true that travel time for an individual may not exceed one hour and could feasibly average 45 minutes (the basis for the .75 adjuster), the average was not measured and could just as likely be another value. Regardless, the Work Group concluded that basing driver time on an estimation of passenger time does not reflect the amount of driver time of the driver. The 2004 provider survey collected information on average driver time and this information was reconsidered. Agencies had been asked to conduct a time study for a single day and to report the total amount of time (in nearest 1/4 hour) of drivers for transporting to and from the day program, including the time for loading and unloading passengers. Agencies had also been asked to separately report the total amount of time (in nearest 1/4 hour) of drivers for vehicle fueling, service, maintenance, and cleaning time. The results are reported in the table below.
Driver Travel and Vehicle Service Time (In Hours) Results from 2004 Provider Survey
| Total & Average Hours Reported |
Light Duty
8 Beds or Fewer |
Super Medium Duty
More Than 8 Beds |
| Total hours and driver time to and from day program (including loading and unloading) |
452.65 |
550.75 |
| Total hours driver time for fueling, vehicle maintenance, cleaning, servicing, etc. |
96.12 |
119.37 |
| Number of round trips per day |
357 |
382 |
| Average hours of driver time to and from day program |
1.27 |
1.44 |
| Average hours of driver time for fueling, vehicle maintenance, cleaning, servicing, etc. |
1.54 |
1.75 |
As the table indicates, the average driver time in hours per round trip was 1.54 for the smaller light-duty vehicles and 1.75 for the larger super medium-duty vehicles.
-
Attendant/Assistant Additional Staff
Some individuals may require additional staff during transportation to assist them because of their behavior or medical care needs. In the 2004 rate proposal, cost assumptions for the Attendant/Assistant were the same as for the driver, i.e., DSP wages, fringe benefits and travel time. These values have been updated as above in the driver reimbursement section and are shown in the table below for Attendant/Assistant reimbursement.
Attendant/Assistant Reimbursement
| Driver Reimbursement |
Light Duty
8 beds or Fewer |
Super Medium Duty
More than 8 Beds |
| Driver Hourly Wage |
$14.59 |
$14.59 |
| Fringe Benefit Percentage |
29.43% |
29.43% |
| Driver Wage W/Fringe |
$18.88 |
$18.88 |
Maximum Travel Time
(Hours), Rule 119 |
1 |
1 |
| Trip Time Multiplier |
154% |
175% |
| Average Trip Time |
1.54 |
1.75 |
Driver Reimbursement,
Per Trip |
$29.08 |
$33.05 |
However, in order to determine which individuals need these additional supports, the 2004 methodology proposed the use of the Health Risk Screening Tool (HRST) to identify individuals using the scores from the behavior or physiological items from the HRST. At that time a large number of individuals were funded by CILA, used day program services, and had HRST data. Today, this continues to be true of CILA-funded individuals, but HRST data is not available for the growing number of individuals receiving HBSS services.
The benefits to using the HRST are the relative ease in collecting the information and in using it as a simple mechanism to assign additional staff funding to individuals with identified support needs. Collecting this information on at least all individuals for whom additional supports are believed to be necessary could be readily implemented.
It has become somewhat common practice for the Division to fund individualized add-ons to day programs and a similar approach could be adopted for transportation as well. Until such time as a means to identify additional support needs, the Work Group recommends cost projections and rates could be established as they were in 2004, using the 20.5% of individuals requiring an Attendant/Assistant, based on 2004 figures for CILA.
The issue of evaluating assessment instruments and processes for validity and reliability will be addressed later in this paper in the Additional Review and Research Recommendations section.
-
Administration
The 2004 proposal recommendation was to add 10 percent of the aggregate total of vehicle cost, operating expenses, and driver reimbursement 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, including the additional duties associated with billing for day program transportation reimbursement separately. The basis for this 10% is that this is the same percentage as was originally used in setting CILA rates. The CILA Rate Work Group is continuing its discussions about this element. It is recommended to continue to use the 10% figure from the 2004 Report.
-
Vacancy Factor
Since participants in Developmental Training and Regular Work day programs may not attend the program 100 percent of the time a vacancy factor is proposed. The 2004 proposal called for a "vacancy factor" of eight percent (8%) to be added to recognize that the costs associated with providing transportation services do not change because on any given day there may be fewer persons transported. The rationale for this figure is that other rate methodologies (such as children's residential and ICFs/DD residential) use a 7% or 8% vacancy factor and this is simply adopted for this transportation methodology.
The structure of the reimbursement methodology assumes a total incurred cost that 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 rider-ship capacity, a standard vacancy factor equal to eight percent is proposed.
-
Number of Persons On Board/Passenger Capacity/ Ambulatory vs. non-ambulatory
The aggregate (total) per trip costs computed from each of the forgoing components assumes that costs will be shared for each trip to and from the day program. According to the IDOT "Para-transit Vehicle Specification Summary" from the 2004 Report, the rider capacity of the light-duty vehicle can vary given the community agency's designs for the number of passenger seating and wheelchair locations built into a vehicle. The table below illustrates the specifications according to the IDOT 5310 grant program.
Rider Capacity: Vehicle Specifications
| Light Duty Vehicle |
Super Medium Duty Vehicle |
| 10 seated passengers |
22 seated passengers |
| 2 wheelchairs and 6 seated passengers |
2 wheelchairs and 18 seated passengers |
| 3 wheelchairs and 2 seated passengers |
2 wheelchairs and 8 seated passengers |
Vehicle specifications according to IDOT "Vehicles for Elderly and Disabled Persons" (5310) grant program.
Given the range of possible seating configurations and excluding a vacancy consideration, rider-ship could vary from 100% to 50% for 3 wheelchair and 2 seat locations in the 10 passenger specification (i.e., 5/10) to approximately 60% for 5 wheelchair and 8 seat locations in the 22 passenger specification (i.e., 13/22). The actual configuration of any given vehicle to accommodate a given mix of ambulatory and non-ambulatory passengers cannot feasibly be determined for all vehicles that could be in use on any given day in supporting day program transportation.
Recommendation: The more conservative recommendation is to assume the 60% configuration in order to have a standardized rate calculation for non-ambulatory individuals and to use 100% for an ambulatory individual. Based on information for CILA in 2004, the percentage of individuals who are non-ambulatory is 12.8%.
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Summary Rate Calculation
In summary, the proposed rate methodology addresses the costs associated with providing transportation to and from day programs for individuals who may or may not be ambulatory, may or may not require assistance because of behavioral or medical needs, and may be transported by community day program agencies in smaller numbers from small residential settings of 8 or fewer (including to/from their own homes, or to/from family homes) or from larger settings of more than 8 and in larger numbers at a time.
Reimbursement to agencies for transportation may be paid per trip or per day and may be expressed, though not reimbursed, on an annual basis as shown in the following tables, which summarize the individual components described in the foregoing section of this paper.
Per Trip Reimbursement
|
Settings of 8 or Fewer
Without Attendant
|
Settings of 8 or Fewer
With Attendant
|
Settings of More than 8
Without Attendant
|
Settings of More than 8
With Attendant
|
| Ambulatory |
$6.61 |
$10.07 |
$4.70 |
$6.57 |
| Non-Ambulatory |
$11.02 |
$16.78 |
$7.83 |
$10.94 |
Per Day Reimbursement
|
Settings of 8 or Fewer
Without Attendant
|
Settings of 8 or Fewer
With Attendant
|
Settings of More than 8
Without Attendant
|
Settings of More than 8
With Attendant
|
| Ambulatory |
$13.22 |
$20.13 |
$9.39 |
$13.13 |
| Non-Ambulatory |
$22.04 |
$33.56 |
$15.65 |
$21.89 |
Annual Reimbursement
|
Settings of 8 or Fewer
Without Attendant
|
Settings of 8 or Fewer
With Attendant
|
Settings of More than 8
Without Attendant
|
Settings of More than 8
With Attendant
|
| Ambulatory |
$3,174 |
$4,832 |
$2,254 |
$3,152 |
| Non-Ambulatory |
$5,290 |
$8,054 |
$3,757 |
$5,253 |
The estimated annual cost projection and net cost projection for Waiver Developmental Training based on these rates and current FY 2008 utilization levels is shown in the table below in millions of dollars for individuals who are in CILA, individuals who reside in a Purchase of Service Residential setting who attend DT, and persons who have only received funding for DT. Additional cost projections for Regular Work, ICF/DD DT, and SODC DT are under development. It should be noted that this cost projection assumes no increase in HBSS funding so there is no increased cost to the state; the increase to HBSS would come from within the current monthly HBSS stipend. The following projection also makes assumptions about the number of persons utilizing a family transportation rate that is described in the next item of this paper. However, it is not assumed that 100% of individuals who are DT-only funded or who reside in intermittent CILA utilized family provided transportation. The number of persons and cost of using family provided transportation are not in the table below. This table also reflects assumptions about the number of persons who are ambulatory or not, and/or would have attendant/assistant supports.
Estimated Costs to Implement the Recommendations
|
CILA |
POS Residential |
DT Only |
Total |
| Number of Persons |
5,958 |
280 |
2,362 |
8,599 |
| Total Cost |
$22.7 M |
$0.9 M |
$9.0 M |
$32.6M |
Current Estimated
DT Transportation
Funding |
$4.3 M |
$0.2 M |
$1.7 M |
$6.2 M |
| Net Cost |
$18.5 M |
$0.7 M |
$7.3 M |
$26.5 M |
Differences due to rounding
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Family Transportation Per Trip
Most individuals attending day programs get to and from their day programs by the transportation service supplied by the day program provider and the funding for their transportation is included within the day program rate. However, some of these individuals may have their transportation actually provided by others or paid for by others, particularly their families. Transportation may be via a family member or friend's vehicle or some form of public or other community transportation may be used.
Parents or guardians or others on behalf of the individual who have either provided or paid for transportation services have not had an avenue to receive reimbursement, unless it was passed on to them through some arrangement with the day program agency. An important consideration for transportation reimbursement is the ability for parents or guardians to receive reimbursement for getting their children or other loved ones to and from day programs if they do not have transportation by the day program agency, by choice or for other reasons.
The Day Program Rate Work Group is proposing Developmental Training or Regular Work transportation reimbursement in situations where the agency does not provide the transportation and would not be entitled to bill for nor receive any transportation reimbursement.
The Day Program Rate Work Group has considered the 2004 recommendation to reimburse at an average mass transit district per trip rate. In 2004, the recommendation was to pay $1.46 per trip, the average "Base Fare" cost of Illinois MTDs from the IDOT survey data. As mentioned earlier, the more current IDOT data are not currently available in a usable format. Consistent with the discussion of the use of the CPI Public Transportation Index for updating vehicle operating costs in item 2 above, the historical Base Fare value has been updated to 2009 by the 28.74% change in the index to become $1.88 per trip. The rate formula in the 2004 proposal applied a multiplier of 2 to raise this average cost in an effort to recognize a "dis-economy of scale" of using family transportation and to accommodate a wide variation in the availability and cost of public transportation options such as fixed vs. on demand services. A vacancy factor of 8% was also suggested to offset fixed charges for purchased transportation that, because of absences, are not 100% utilized. The table below illustrates the recommended proposed rate for transportation reimbursement for individuals who use family transportation or pay transportation not provided by a day program agency.
Individual/Family/Guardian Provided or Purchased Transportation Rate
| Description |
Rate |
| Average MTD Base Fare (Updated) |
$1.88 |
| Multiplier |
2 |
| Vacancy Factor |
1.08 |
| Per Trip |
$4.06 |
| Per Day (x2) |
$8.12 |
| Per Year (240 Days) |
$1,949 |
The Projected Cost of Family/Guardian Provided Developmental Training Transportation
| Family/Guardian (includes Intermittent CILA) |
Total |
| Number of Persons |
1,014 |
| Total Cost |
$2.0 M |
| Current Estimated DT Transportation Funding |
$0.7 M |
| Net Cost |
$1.3 M |
Information from the 2008 PACE Blue Ribbon Committee Report, page 214, indicates the following per trip fares for comparison:
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Total Projected Cost
The total projected cost for DT transportation (the sum of items 8 and 9 above) is $34.6 million, less $6.9 million in funding already included in the DT rates, yields a net projected cost of $27.7 million. The FFP on the net projected cost would be $13.9 million.
2. Additional Review and Research Recommendations
This section discusses items for which additional review and research are needed.
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Specialized Needs and Individualized Assessment Processes
The Work Group has frequently discussed the need to have uniform, accurate, appropriate, reliable, and objective assessment tools and processes regarding identifying and addressing individualized needs through the rate.
It is imperative that efforts are made to employ or construct or adapt diagnostic and assessment instruments that can be properly and objectively used to accurately and reliably assess or measure one's needs in the following areas and to determine funding the specialized supports discussed below.
The reader is referred to the Statewide Advisory Council Rate Committee Interim Report for additional discussion regarding addressing specialized support needs including medical, behavioral, physical/personal care, ambulatory assistance, and alternative communication needs.
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Geographically Differentiated Wage Rates
Geographically differentiated wage rates for DSP based on BLS wage data have been discussed in the Wage and Fringe Benefits Work Group. As these discussions are continuing, the Transportation Work Group defers on this issue.
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Other Transportation
Transportation funding for Supported Employment (SEP) transportation, HBSS, other individualized transportation, and the availability and access to public transportation services are additional areas that the Transportation Work Group believes warrant further work and discussion in conjunction with other groups examining transportation including the Illinois Coordinating Council on Transportation, other rate Work Groups, and other Committees of the Statewide Advisory Council and the Division of Developmental Disabilities.
