Coordinating rural and and human services transportation in Georgia, 2013

Governor's Development Council Coordinating Rural and Human Services Transportation in Georgia 2013 RHST Report Executive Summary
2013 Reporting Year: Coordinating Rural and Human Service Transportation in Georgia
FINAL REPORT
Prepared for the Governor's Office of Planning and Budget
Created by the Governor's Development Council and the Georgia Coordinating Council for Rural and Human Services Transportation August 2013
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Governor's Development Council

RURAL AND HUMAN SERVICES

TRANSPORTATION (RHST) 2013 REPORT

August 2013

EXECUTIVE SUMMARY

Background:

The RHST network provides eligible Georgians access to necessary services (e.g., medical, jobs, training, etc.) in 159 counties & 12 regions

Total RHST operational costs in FY 12 were $143.2 million
GA's RHST network provided 7.8 million trips in FY 11
Three agencies administer all RHST funds in GA - GDOT, DHS and DCH ("Big 3") 68% of funds are federal, almost all state dollars leverage federal funds
The number of Georgians who rely upon RHST services is expected to grow 29% faster than the general population
A 31% increase in funding will be needed by 2030 to satisfy the expected increase in demand

Millions

Total Operational Costs: $143.2 million

$90

$83.2

$80

$70

$60

$50

$40 $30

$30.4 $29.6

$20

$10

$0

GDOT DHS DCH

Local State Federal

GDC Role:

In 2010 the General Assembly designated the Governor's Development Council (GDC) with annual RHST reporting requirements in nine reporting areas Each year the GDC collaborates with stakeholders and the Advisory Subcommittee to make recommendations that increase coordination and efficiencies; this is the third year of reporting Data analysis regarding the efficiency and level of service impacts of recommendations is required, and those efforts are underway
Exisiting Levels of Coordination:

Previous years indicated GDOT's rural public transportation (RPT) systems are the backbone of GA's coordination efforts; this report evaluates the extent to which HST programs coordinate with them
112 counties provide GDOT-funded RPT; considerable coordination (i.e., resource bundling) occurs between the RPT provider and HST programs in these counties

Percentage of the 112 Counties Providing Rural Public Transportation (RPT)
That Coordinate with HST Programs (DHS & DCH)

100% 24%
80%
60% 53%
40%
20% 23%
0%

3-Agency Coordination (RPT + DHS + DCH trips)
2-Agency Coordination (RPT + DHS or DCH trips)
Agency Coordination Not In Place

o 3-Agency Coordination: In 24% of these counties, the Rural Public Transportation (RPT) provider contracts with both DHS and DCH to provide trips. Here, all Big 3 RHST agencies are placing trips on a single provider.
o 2-Agency Coordination: In 53% of these counties, the RPT provider contracts with either DHS or DCH to provide trips. Often the RPT provider is contracting with DHS.
o Agency Coordination Not in Place: In 23% of these counties, the RPT provider does not contract with HST programs. Here, HST programs contract with separate providers.

Consistent with the Governor's Vision:
The GDC's coordination effort is consistent with the
Governor's vision for a lean and responsive state government, to improve the movement of people,
increase access to healthcare throughout the
state, and improve intergovernmental
cooperation
Projected Growth in RHST Eligible Populations:
RHST populations are expected to grow 29% faster than the general population. To meet this increase in demand RHST funding would have to
increase from $143.2 million in 2012 to $187.2 million by 2030.
RHST Mission Statement:
Identify methods to increase cost-effectiveness
while maintaining or improving level of service

GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia 2013 RHST Report Executive Summary

RHST Advisory Subcommittee:
Dept. of Transportation Dept. of Human Services Dept. of Community Health Dept. of Behavioral Health
& Developmental Disabilities Dept. of Labor Dept. of Community Affairs Dept. of Education
Strategic Focus of 2013 Recommendations:
Enhance data collection, analysis and reporting
efforts
Evaluate administrative purchases and practices
for efficiencies and streamlining
Continue to evaluate the impacts of resource bundling
CONTACT: David Cassell Governor's Development Council 404-463-3007 www.grta.org/rhst1.php

Key Findings and Recommendations:
The 2013 RHST Report focuses on finding efficiencies in administrative purchases and practices while continuing to evaluate resource bundling:
Finding: Access to efficiencies via statewide contracts for vehicle purchase, maintenance and insurance is limited
o Department of Administrative Services (DOAS) has developed statewide contracts that offer bulk purchase savings
o Contracts not currently available to private capital held by non-profit/for-profit providers; an opportunity exists to extend access to these providers
Recommendation: Evaluate options to increase access to statewide vehicle purchase, maintenance and insurance contracts to lower capital and operating costs
Finding: The need for cost-effective capital is increasing o DHS stopped purchasing vehicles in 2007, as the DHS fleet ages and vehicles are retired, additional capital will be needed o GDOT/DOAS reinvests ("surplus") rural transit vehicles that have met their useful life; these surplus vehicles can be used for additional RHST trips o Surplus process does not currently prioritize RHST providers
Recommendation: Evaluate options to increase RHST provider access to surplus capital to respond to increasing capital costs and needs
Finding: As technology deployment is expanded by state agencies, administrative efficiencies can be leveraged
o GDOT, DHS and NET brokers have deployed or are deploying unique software systems that are necessary to accomplish agency goals (e.g. federal reporting)
o These unique systems create a need for manual data entry between them, opportunities exist to automate this process
o GDOT and NET brokers are already in the beginning stages of automation o Automating GDOT and DHS platforms would provide additional administrative
efficiencies once the DHS software is deployed statewide Recommendation: Integrate GDOT technology with NET and DHS platforms to reduce administrative costs; pursue NET integration first and DHS integration after their platform is implemented
Finding: Partners have requested additional data analysis regarding the service efficiency and level of service (LOS) impacts of resource bundling
o Several resource bundling implementation options were evaluated by RHST agencies during the 2013 reporting year
o At the time of evaluation, minimal facts existed regarding the service efficiency and LOS impacts of resource bundling on all RHST programs
o A more robust fact base is necessary prior to moving the resource bundling concept forward
Recommendation: Evaluate the service efficiency and LOS impacts of resource bundling and/or conduct site visits to areas without agency coordination
Next Steps:
GDC provides draft report to Advisory Subcommittee by July 1st Comments submitted to GDC within 30 days GDC submits final report to the Governor's Office of Planning & Budget (OPB) OPB routes final report to the General Assembly by January 15th

GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report
Report Purpose The Transportation Investment Act of 2010 calls for the Governor's Development Council (GDC), with assistance from the Georgia Coordinating Committee for Rural and Human Services Transportation (RHST Committee), to provide the Governor's Office of Planning and Budget (OPB) with an annual report identifying methods to increase the coordination of Georgia's rural and human services transportation (RHST) system. The purpose of the legislation and the resulting report is to ensure that the delivery of RHST services in Georgia is effectively serving the customers who rely on the system through the most cost-efficient utilization of taxpayer dollars. In accordance with Georgia law, a draft version of this report is to be provided to the RHST Advisory Subcommittee by July 1st, and a final report is to be provided to OPB no later than September 1st, annually. The GDC's annual reporting effort is also a critical part of achieving the Governor's Strategic Goals for Georgia. Achieving cost efficiencies in RHST delivery is consistent with Georgia's vision of a lean and responsive state government. Further, the following specific goals can be achieved by this reporting effort:
Improve the movement of people and goods across and within the state; Leverage public-private partnerships and improve intergovernmental cooperation for successful infrastructure development; Increase access to health services throughout the state; Improve access to treatment and community options for those with disabilities; and Build and maintain a quality state government workforce.1 This report satisfies the GDC's legislative requirements by providing an examination of the nine reporting tasks from the Transportation Investment Act that were assigned to the GDC in O.C.G.A. 32-12-5. The table on the following page identifies each task and the chapter in which it is addressed.
1 Governor's Office of Planning and Budget, Governor's Strategic Goals for Georgia, accessed via http://opb.georgia.gov, June 3rd, 2013.

GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report

Legislative Task
O.C.G.A. 32-12-5(1): An analysis of all programs administered by participating agencies, including capital and operating costs, and overlapping or duplication of services among such programs, with emphasis on how to overcome such overlap or duplication.
O.C.G.A. 32-12-5(2): (An examination of) the means by which transportation services are coordinated among state, local, and federal funding source programs. O.C.G.A. 32-12-5(3): (An examination of) the means by which both capital and operating costs for transportation could be combined or shared among agencies, including at a minimum shared purchase of vehicles and maintenance of such vehicles. O.C.G.A. 32-12-5(4): An analysis of the areas which might appropriately be consolidated to lower the costs of program delivery without sacrificing program quality to clients, including shared use of vehicles for client trips regardless of the funding source for the respective trip. O.C.G.A. 32-12-5(5): An analysis of state of the art efforts to coordinate rural and human services transportation elsewhere in the nation, including at a minimum route scheduling so as to avoid duplicative trips in a given locality. O.C.G.A. 32-12-5(6): A review of any limitations which may be imposed by various federally funded programs and how the state can perform within those limitations as it reviews possible sharing opportunities. O.C.G.A. 32-12-5(7): An analysis of how agency programs impact and interact with state, local or regional transportation services performed on behalf of the general public through state, local or regional transit systems. O.C.G.A. 32-12-5(8): An evaluation of potential cost-sharing opportunities available for clients served by committee agencies so as to maximize service delivery efficiencies and to obtain the maximum benefit on their behalf with the limited amount of funds available. O.C.G.A. 32-12-5(9): An analysis of possible methods to reduce costs, including, but not limited to, greater use of privatization.

Primary Locations in Report
Chapter 3 Chapter 5 Chapter 13
Chapter 6
Chapter 7 Chapter 13
Chapter 3 Chapter 13
Chapter 8
Chapter 9 Chapter 13
Chapter 10
Chapter 11
Chapter 3 Chapter 12

GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report
Table of Contents
Chapter 1: Defining RHST and RHST Coordination in Georgia ...................................................................................... 1 Chapter 2: The Need for Coordination RHST Demographic Growth.......................................................................... 3 Chapter 3: The Business Case for Coordination............................................................................................................ 4 Chapter 4: Performance Measurement Results ........................................................................................................... 7 Chapter 5: Analysis of RHST Programs........................................................................................................................ 10 Chapter 6: The Current State of Coordination............................................................................................................ 12 Chapter 7: Shared Vehicle Purchase, Maintenance, Insurance and Fuel Programs ................................................... 16 Chapter 8: Best Practices in Technology Utilization ................................................................................................... 20 Chapter 9: Federal Funding Program Limitations ....................................................................................................... 23 Chapter 10: HST Program Usage of Public Transportation Services ............................................................................. 26 Chapter 11: Cost Sharing Among Programs.................................................................................................................. 30 Chapter 12: Privatization Assessment & Other Methods to Reduce Costs .................................................................. 31 Chapter 13: Recommendations .................................................................................................................................... 33 Appendix A: RHST Committee Enabling Legislation ...................................................................................................... 40 Appendix B: Resource Bundling Modeling Exercise ...................................................................................................... 42 Appendix C: FY 12 Detailed RHST Program Costs .......................................................................................................... 45
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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report

Table of Figures

Figure 1.1: Figure 1.2: Figure 2.1: Figure 3.1: Figure 3.2: Figure 3.3: Figure 5.1 Figure 5.2: Figure 5.3: Figure 6.1:

RHST In Georgia........................................................................................................................................... 2 RPT Coordination with HST Agencies .......................................................................................................... 2 Georgia's Projected RHST Funding Needs (in millions) (FY 2030) ............................................................... 3 Unbundled Delivery System ........................................................................................................................ 4 Bundled Delivery System at the Local Level................................................................................................ 4 Cost Per Trip Comparison: Southwest Georgia vs. the Rest of the State.................................................... 5 RHST Operational Costs for FY 12 (in millions).......................................................................................... 10 FY 12 Operational Funding by Level of Government ............................................................................... 11 FY 12 Operational Funding by State Agency ............................................................................................ 11 Coordination between Rural Public Transportation (RPT) and Human Services Transportation ............. 12

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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report

Table of Tables

Table 1.1: Table 4.1: Table 4.2: Table 6.1: Table 7.1: Table 8.1: Table 9.1: Table 12.1: Table 13.1: Table 13.2: Table 13.3: Table B.1: Table B.2: Table C.1:

GDOT (RPT), DHS, and DCH (NET) Service Coverage ................................................................................1 Recommended Trip, Cost and Service Efficiency Measures ....................................................................8 Recommended Level of Service & Coordination Measures and Performance Results ...........................9 Technical Coordinating Group (TCG) Membership ................................................................................13 Vehicle Maintenance, Insurance, Procurement and Fuel Purchase Current Practices..........................17 RHST Technology Deployment ...............................................................................................................21 2013 Federal and State Program Limitations.........................................................................................23 RHST Privatization in Georgia.................................................................................................................31 Evaluation Criteria Assumptions ............................................................................................................37 Recommendation Evaluation Matrix (1 of 2) .........................................................................................38 Recommendation Evaluation Matrix (2 of 2) .........................................................................................39 Types of RHST Providers in Georgia .......................................................................................................42 Types of Rural Public Transportation Providers in Georgia....................................................................44 FY12 Detailed RHST Program Costs........................................................................................................45

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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report

Chapter 1: Defining RHST and RHST Coordination in Georgia

What is RHST?
Rural and Human Service Transportation (RHST) provides Georgians access to necessary transportation services such as medical appointments, senior services, jobs, and education/training throughout Georgia's 159 counties. The RHST system is supported by several federal funding sources which are matched by state and local funds. This system consists of rural public transportation (RPT), DHS

Table 1.1: GDOT (RPT), DHS, and DCH (NET) Service Coverage

Type of Transportation
GDOT Rural Public Transportation (RPT)

Counties Served2
112

DHS Transportation

147

transportation and Medicaid non-emergency transportation (NET) respectively, administered by three state agencies as follows. Table 1.1 shows the number of counties in which each type of service is provided.

DCH Medicaid NET Transportation

159

Source: GDOT, DHS, DCH Staff, December 2012March 2013

Rural public transportation (RPT) is historically funded by Federal Transit Administration (FTA) Section 5311 as

administered by GDOT. Most of the 5311-funded services are county-based, although there are some regional and

municipal systems. At the time of the research for this report (January 2013), there were 67 service providers in 112

counties in Georgia providing 5311-funded RPT. Virtually all of these services in Georgia are structured as "demandresponsive" meaning that the customer makes a call-in reservation 24 to 72 hours in advance. Services are provided by public entities (e.g., counties) and private entities, using both non-profit and for-profit contractors. Customers can access rural public transportation with no restrictions on the purpose of the trip; they can use these services to go to work, shopping, appointments, recreational activities, and more.

Department of Human Services (DHS) transportation is organized through DHS's 12 regional offices. Funding programs that support client transportation include Title IIIB funding for senior transportation, Temporary Assistance for Needy Families (TANF), and Social Service Block Grants. Eligibility for this transportation is generally based on a combination of the individual's disposition (e.g., age, income, presence of disabilities) and a verified lack of transportation. DHS also administers FTA Section 5310 funding which is used to support the operations of transportation provided by private subcontractors for seniors and the disabled. Trips for DHS eligible customers are also typically on a demand-response basis.

There are 94 DHS providers in 147 counties in Georgia. Services are provided by public entities (e.g., counties) and private entities, both non-profit and for-profit contractors, under contract to either the regional DHS office or a coordinating DHS contractor such as a Regional Commission or a Community Service Board. Many of the service contractors who provide RPT service also provide DHS transportation, thereby often coordinating trips of RPT customers and DHS customers (see Figures 1.2 on page 2 and 6.1 on page 14).

2 The number of counties served fluctuates during the year for both GDOT and DHS (e.g., as of the finalization of this report 114 counties had GDOT [RPT] coverage). Each RHST Report provides a snapshot of service and does not reflect these changes in real time. In recognition of this, where RHST Report data is used to identify areas for further analysis, the data should be updated.
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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report

Department of Community Health / Medicaid Non-Emergency Transportation (NET) is a program for Medicaid (lowincome) recipients eligible for transportation to covered medical appointments. DCH organizes NET transportation into 5 regions administered by a NET broker under contract to DCH. Currently, two brokers cover the five regions. Each broker contracts with one or more service providers in each county. NET service providers are public entities (e.g., counties) and private entities, both non-profit and for-profit contractors. In some counties, NET service providers are also providing RPT and/or DHS transportation. There are approximately 230 NET providers statewide.

This report also identifies other types of transportation for coordination opportunities, such as veterans transport and Americans with Disabilities Act (ADA)-required paratransit.
What is RHST Coordination?

Figure 1.1: RHST In Georgia
RPT

In the context of RHST, coordination can take on different

meanings depending on what is being coordinated. For example,

information about available resources can be coordinated into a central repository. Operational policies and practices can be

DHS

NET

shared among service providers. Service providers can co-procure

vehicles, training resources, maintenance, insurance, and fuel.

Service providers can utilize each other to serve trips in a more efficient manner. And, if one service provider is under contract to coordinate or provide 5311-funded RPT, DHS transportation and

RPT = Rural Public Transportation NET = Medicaid Non-Emergency Transportation
DHS = Department of Human Services

NET service (see Figure 1.1), the resulting coordination of trips (i.e., resource bundling) can lead to efficiencies. The

primary manner in which trips are coordinated occurs when HST programs place trips on RPT operators. Figure 1.2

shows the percentage of the state's 112 counties where RPT operators are present in which there is:

3-Agency Coordination (24% of the 112 counties): These RPT's provide rural public transportation trips under contract with GDOT as well as DHS and DCH NET trips. Here, all of the Big 3 RHST agencies are placing trips on a single provider. 2-Agency Coordination (53% of the 112 counties): In addition to providing GDOT rural transportation trips, these RPT's contract with one HST agency, either DHS or DCH (Figure 6.1 will show that the majority of these partially coordinated counties are contracting with DHS). Agency Coordination Not in Place (23% of the 112 counties): Only GDOT rural public transportation trips are provided by these RPT's (no HST program trips are placed on the RPT operator's vehicles). Here, HST programs contract with separate providers.

Figure 1.2: RPT Coordination with HST Agencies

100%

90%

24%

80%

70%

60%

50%

53%

40%

30%

20%

10%

23%

0%

3-Agency Coordination (RPT + DHS + DCH trips)
2-Agency Coordination (RPT + DHS OR DCH trips)
Agency Coordination Not In Place

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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report

Chapter 2: The Need for Coordination RHST Demographic Growth
Personal mobility needs in Georgia are changing in response to a growing and diversifying population. Figure 2.1 shows how RHST population growth will impact the need for RHST funds. RHST populations (low-income, persons with disabilities, aging population, individuals without cars or who choose not to drive) are projected to grow by 31%, which is greater than the 24% projected growth in the general population. This accelerated growth rate is largely due to the fact that the elderly constitute a higher proportion of the RHST population than the general population (e.g., DHS has funds specifically dedicated to elderly transportation). To keep pace with this increase in demand and provide a comparable level of service to today, a 31% increase in funds would be necessary.3

Figure 2.1: Georgia's Projected RHST Funding Needs (in millions) (FY 2030)

$250

$187.6
$200

$143.2

$41.6

$150

$29.6

$100

31%

$103.3

$83.2

$50
$30.4 $0
FY2012

$42.7 FY2030

GDOT DCH DHS

Sources (Funding Amounts): GDOT, DHS, and DCH staff Coordinated Council on Access and Mobility, Report to the President Human Services Transportation Coordination
2010 U.S. Census 2000 U.S. Census U.S. Census Interim State Population Projections

Based on this analysis, RHST populations are expected to grow 29% faster than the general population, demonstrating that RHST services will be uniquely impacted by the state's changing demographics. Perhaps most importantly, there is no assurance that federal, state and local funding sources will be able to keep pace with this growth. With the certainty of substantial growth in RHST populations, and a lack of certainty in future funding, there is a clear need to pursue coordination options that stretch the RHST dollar.

3 Projected dollars not adjusted for inflation

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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report

Chapter 3: The Business Case for Coordination
A critical goal of coordination is to improve cost-effectiveness. While research to quantify the impacts of coordination at the state level have been sparse4, analysis presented in the 2012 RHST Report showed that a concept called resource bundling holds this potential.5 As defined, resource bundling means directing some or all RHST funding sources to a coordinating entity, whether a broker or service provider, in order to increase the number of coordinated trips (i.e., trips that are combined onto a common carrier). It should be noted that resource bundling is one means to coordinate resources. Other means include, but are not limited to, the sharing of information, costs (e.g., cost allocation) and bulk purchasing. This report will demonstrate that resource bundling, as well as these other coordination methods, all have potential benefits and applicability in Georgia.

In practice, resource bundling can reduce instances of multiple, independently operating networks by establishing coordinated networks. For example, in an unbundled delivery system (Figure 3.1), RHST sponsoring agencies may end up using different networks of service providers to serve their trips. At the local level, this may result in three (or more) different providers serving what otherwise could be combined trips. If each sponsoring agency were to use a common network of service providers, or at least the same service provider locally to coordinate trips (Figure 3.2), there would be less duplication of service, and more opportunities to reduce unit cost further through economies of scale.

Figure 3.1: Unbundled Delivery System

Figure 3.2: Bundled Delivery System at the Local Level

All Trips
4 Jon E. Burkhardt, David Koffman and Gail Murray, TCRP Report No. 91 Economic Benefits of Coordinating Human Services Transportation and Transit Services (Washington DC: Transportation Research Board, 2003), Foreword. 5 The 2012 RHST Report compared statewide RHST performance in Georgia to Florida and North Carolina (two states that have bundled resources at a county level for many years) and performance in the Southwest Georgia Regional Commission (SWGRC) to the rest of the State of Georgia (SWGRC bundled resources at a regional level from 2009-2012 while the remainder of the state shows less coordination). Analyses in FL and NC showed greater efficiencies ranging from 30-50%, but also noted fixed-route utilization in those states are also potential drivers of efficiency. The SWGRC showed 17-22% greater cost efficiencies than the remainder of the state, see Figure 3.3 on page 5 for an updated analysis.
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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report

In the 2012 RHST Report, the business case for the resource bundling concept was evaluated by comparing the unit cost per trip in the Southwest Georgia Region Commission (SWGRC) area (where RPT, DHS and NET trips are combined on a common provider) to the rest of the state (which exhibits a lower extent of coordination; see Figure 6.1 on page 12). For the 2013 RHST Report, FY 2011 statistics have been added to last year's figure, which is presented below as Figure 3.3. Figure 3.3 shows that the unit costs per trip continue to be lower in the SWGRC.

Figure 3.3: Cost Per Trip Comparison: Southwest Georgia vs. the Rest of the State

Operating Cost per Passenger Trip

$20.00 $18.00 $16.00 $14.00 $12.00 $10.00
$8.00 $6.00 $4.00 $2.00 $0.00

$13.86 $13.84 $14.01

$17.92 $18.18 $17.74

Southwest Georgia Regional Commission (SWGRC)
2009 2010 2011

Georgia (excluding SWGRC)

This cost efficiency data, together with cost efficiency information gathered from Florida and North Carolina led to a recommendation to identify a preferred alternative to implement the resource bundling concept during the 2013 reporting year. In pursuit of this recommendation, the GDC and TCG evaluated several resource bundling implementation options. During this evaluation, partner agencies expressed a need to understand more clearly the impact resource bundling has on both service efficiency and level of service.
To this end, the GDC developed a methodology that would evaluate both of these factors and obtained preliminary feedback from partner agencies. A full version of the proposed methodology is provided in Appendix B; a brief summary of the methodology and next steps are described below.
GDOT's recent deployment of RouteMatch software on all RPT systems in the state offers an opportunity to assess the service efficiency and level of service impacts of coordination, especially since the resulting data is available in a central location. The methodology in Appendix B proposes two analyses, both of which compare the performance of RPT operators with differing levels of coordination. RPT operators providing "3-agency coordination" (these RPT operators provide trips for both DHS and DCH) would be compared to RPT operators that provide "2-agency

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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report
coordination" (these RPT operators provide trips for DHS or DCH) and finally to RPT operators providing service where agency coordination is not in place (only rural public transportation trips are provided). One analysis would use a modeling approach, while a second would focus only on empirical data. Key service metrics that are proposed include trips per hour (as a service efficiency metric) and on-time performance (to convey LOS). Upon review of the suggested methodologies, Analysis 1 may be less effective given its limited data set. However, Analysis 2 can be pursued upon TCG determination of a viable methodology. The primary concerns remaining are using a cursory definition of LOS (only on-time performance can be tracked in RouteMatch), conducting the analysis using such a new software system (some RPT operators are just beginning to report data and/or install the software as of August) and controlling for variables that could impact the service efficiencies being tested (e.g., more trips with a common destination in one comparison population will positively impact trips per service hour; this type of issue should be controlled for). An alternative path to resource bundling can be pursued in the event that a quantitative assessment cannot be conducted with a focus on the 23% of counties in which agency coordination is not in occurring (see Figure 6.1). Site visits can be conducted to understand barriers to coordination and subsequently, recommendations can be made to address them. Further, it has been recommended that RHST partners establish a goal of reducing the percentage of counties in which agency coordination is not in place. As a result, the GDC recommends the following next steps:
Pursue consensus on a methodology for Analysis 2 in Appendix B during the 2014 reporting year: o Develop a broader definition of LOS o Focus on methods to control for variables (e.g., trip disposition, distance, etc.) o Evaluate the need for a data review given that a new reporting module has been put in place
In lieu of, or in addition to conducting an amended version of Analysis 2, conduct site visits in counties where agency coordination is not in place
o Discuss with partner agencies whether reducing the 23% of counties where agency coordination is not occurring should be adopted as a common goal.
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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report
Chapter 4: Performance Measurement Results
A key component of the annual RHST report is to understand the effectiveness of the RHST network and the level of service provided. To do this, the GDC recommended establishing a performance management system in the 2012 RHST Report. The purpose of the RHST performance management system is to evaluate the RHST network effectively, establish trends in performance, and enhance the ability to make data-driven decisions regarding coordination options.
This chapter outlines the proposed system and the results based on data collection from the past three years. The system consists of two types of state-level performance measures: trip, cost and service efficiency measures; and level of service and coordination measures. Beyond the state-level measures shown here, the system also has the ability to develop performance measures by region (regional commission area). This level of disaggregate information will improve coordination-based, data-driven decision making by allowing the performance of different coordination models to be compared and evaluated.
Table 4.1 shows trip, cost and service efficiency measures that are proposed as part of the performance management system. New data for the 2013 RHST Report is provided for FY 11. As can be seen, measures related to vehicle miles, fixed-route utilization and trip purpose are not yet available as these were among the newly suggested measures in the 2012 RHST Report. Given the two year lag in reporting related to these measures (i.e., the 2013 RHST report provides FY 11 data), the earliest this data could be ready is by the 2015 RHST Report. Data collection efforts are underway in FY 13 and it appears likely this data will become available in 2015.
Table 4.1 shows that total trips have increased by more than 250,000 from FY 10 to FY 11, an increase of 3%. This increase is part of a broader increase in trips over the entire data period from 7,289,851 in FY 09 to 7,808,602 in FY 11, representing an increase of 7%. The majority of this increase comes from the Medicaid program which has seen a steady rise in eligible members from FY 10 through FY 12 that is due to the impacts of the economic downturn; this increase in eligible populations translates into an increase in the number of requested NET trips.
The cost-per-passenger-trip data show a positive trend from FY 10 to FY 11, decreasing from $17.63 to $17.29, or approximately 2%. One potential reason for this decrease is that fuel prices stabilized in FY 11. As additional data points such as vehicle miles and fixed-route utilization are collected and trends are established, it will become easier to determine the causes for this type of change.
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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report

Table 4.1: Recommended Trip, Cost and Service Efficiency Measures

Measures

Data Available for 2013 Report?

Current Year Data Challenges

Results

Trip and Cost/Efficiency Measures

FY 09

FY 10

FY 11

Total Trips

Yes

None

7,289,851 7,555,043 7,808,602

Cost per Passenger Trip (1)

Yes

None

$17.42

$17.63

$17.29

Cost per Vehicle Mile (2)

Trips per Vehicle Mile (2) Trip Purpose (2)

No

N/A - Not collected by all agencies, collection in progress for FY 13.

N/A

N/A

N/A

Fixed-route Utilization (2)

Source (Trips): GDOT NTD Database, DHS and DCH Staff Source (Cost per Trip): GDOT NTD Database, DHS and DCH Staff. Calculations by GDC.

(1) Operational Costs Only (2) Measures first suggested in 2012 RHST Report and expected to be ready for the 2015 RHST Report, data collection currently underway

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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report

Table 4.2 below displays the results for the recommended level of service (LOS) and level-of-coordination measures. New data is shown for FY 13. Unlike trip and cost-related performance measures, the measures below can be reported for the most recent fiscal year (FY 13). This is because LOS and level-of-coordination measures are based on the number and location of providers, which can be determined in real time, whereas trip and cost data require more substantial data collection and validation procedures. Thanks to the efforts of GDOT, DHS and DCH, current-year data (FY 13) has been provided for this report and is shown below. Given that these measures can now be reported for the current fiscal year, data for FY 11 and FY 12 will not be collected (a trend can be shown that utilizes the most recent available data, seeing trends in previous years is less beneficial and therefore not necessary).
The service coverage metric shows that from FY 10 to FY 13 the portion of eligible Georgians with access to GDOT's rural transportation program services increased, from 69% to 73%. This is a reflection of the addition of five new rural transit systems. Meanwhile, the percentage of populations eligible for DHS service with access to DHS transportation services has remained stable at 96%.
The level of coordination measure is new to the RHST Report. This measure calculates the percentage of counties where rural public transportation (RPT) is offered in which the RPT operator provides trips for at least one HST agency (DHS, DCH or both this adds together the "3-Agency Coordination" and "2-Agency Coordination" categories shown in Figure 1.2 on page 2). This type of coordination is also referred to as resource bundling. As of January 2013, RPT operators in 77% of the 112 counties where RPT is offered were also providing trips for at least one HST agency, indicating a high level of coordination in the state. As will be shown in Chapter 6, most of the RPT operators are providing trips for DHS; however, the amount of coordination between RPT operators and DCH is higher than estimated in previous RHST reports. This also means that 23% of the counties where RPT is offered have operators that do not provide HST trips, representing the potential for an additional opportunity to bundle RHST resources.

Table 4.2: Recommended Level of Service & Coordination Measures and Performance Results

Measures

Results

Level of Service and Coordination Measures

FY 10

FY 11 & 12 (1)

FY 13

Service Coverage (2)

GDOT: 69% DHS: 96%

GDOT: 73% DHS: 96%

New & Lost Service

GDOT: +11 (3) DHS: Stable

N/A (1)

GDOT: +5 DHS: Stable (4)

Level of RPT Coordination w/HST Agencies (5)

N/A

77%

Source: GDOT, DHS, DCH Staff, December 2011-March 2013, GDC Analysis (1) FY 11 and 12 data will not be reported on since new data reporting processes allow current fiscal year data to be reported
(2) Based on % of eligible population, DCH data is not reported - federal law requires 100% coverage (3) Based on number of additional counties providing/losing service from FY 09. DCH data not reported - federal law requires
100% coverage (4) Based on number of additional counties providing/losing service from FY 10. (5) RPT = Rural Public Transportation, coordination defined as an RPT operator providing trips for DHS, DCH or both

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Chapter 5: Analysis of RHST Programs

RHST Funding Overview
Total RHST operational costs in Georgia for FY 12 were $143.2 million (see Table 5.1). This represents a cost increase of approximately $7.1 million over FY 11, or about 5.2%. Most of this increase is due to how data has been collected historically and points to a need to ensure that the same type of data (e.g., apportioned amount vs. expended vs. contracted) is requested going forward. It should be noted that this does not include administrative costs at the state level; these are shown in Appendix C.

Figure 5.1 RHST Operational Costs for FY 12 (in millions)

Millions

$90 $83.2

$80 Total Operational Costs:

$70

$143.2 million

$60

$50
$40 $30.4
$30
$20

$29.6

Local State Federal

$10

$0

GDOT

DHS

DCH

As shown in Figure 5.2, federal spending accounts for 68% of RHST funding, while state funding contributes 19% of total program costs and 13% is provided by local funds. As in previous years, the majority of the $30 million in state dollars dedicated to RHST delivery is used to leverage federal funds. As shown in Figure 5.3, Medicaid (DCH) is the largest funder of RHST services, constituting 58% of all operational RHST expenditures; DHS and GDOT constitute 21% each.

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Figure 5.2: FY 12 Operational Funding by Level of Government

Figure 5.3: FY 12 Operational Funding by State Agency

13%
19% 68%

Federal State Local

21% 58%
21%

GDOT DHS DCH

Sources: GDOT, DHS & DCH staff, Spring 2013

Sources: GDOT, DHS & DCH staff, Spring 2013

GDOT capital funds (not included in the $143.2 million in operational costs above) in FY 12 were $6.2 million, up about 13% from spending in FY 11 (GDOT is the only RHST agency that directly invests in capital). This increase reflects a normal fluctuation in GDOT's need to purchase vehicles and invest in capital infrastructure. For a table providing a breakdown of operational, administrative and capital costs by program and agency, refer to Appendix C.

RHST Program Overlap
The RHST enabling legislation requires an assessment of potential overlap among the identified RHST funding programs. Previous reports have found that some overlap does occur. The most noticeable instance of overlap is at a provider level where multiple providers in some areas of the state serve state RHST agencies independently of one another. While multiple providers may be necessary where no single provider has the capacity to provide all trips, efforts in the Southwest Georgia Regional Commission area demonstrate that coordinated networks can be developed that have sufficient capacity to serve most, or all RHST agency trips. To better show where multiple independently operating networks occur, refer to Figure 6.1 on page 12, which shows the level of coordination in each county of the state where a rural public transportation provider is present. This map identifies areas where no agency coordination takes place; these are the areas of greatest provider overlap.
Resource bundling remains the primary recommendation to address these instances of multiple, independently operating networks. Chapter 6 will show that although multiple networks occur, much of the State shows at least some level of coordination. Refer to Chapter 13 for details on how resource bundling will be pursued.

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Chapter 6: The Current State of Coordination
This chapter provides an overview of the extent of coordination in Georgia as well as entities and efforts that are critical to the state's ongoing coordination efforts. Extent of RHST Coordination in Georgia The coordination of rural public transportation (RPT), DHS transportation and Medicaid NET occurs in Georgia through the use of common service providers who combine RHST trips sponsored by different funding programs (i.e., resource bundling). The extent to which this happens throughout the state is illustrated in Figure 6.1.
Figure 6.1: Coordination between Rural Public Transportation (RPT) and Human Services Transportation
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Figure 6.1 shows that, as of January 2013, rural public transportation (RPT) was provided in 112 of Georgia's 159 counties and that RPT service providers were also used to provide DHS or NET trips (2-agency coordination) in 59 (or 53%) of those 112 counties, while use of RPT service providers to also provide both DHS and NET trips (3-agency coordination) occurred in another 27 (or 24%) of those 112 counties. Overall, some level of coordination occurred in 86 (or 77%) of the 112 counties in which RPT services were provided.

Notably, in 91% of the 59 counties where 2-agency coordination exists, RPT operators are providing trips for DHS. This supports previous anecdotal report findings that DHS typically contracts with RPT providers and that the coordination of NET services with RPT providers is a significant coordination opportunity. Perhaps the most immediate opportunity is within the 26 counties (23% of all counties providing RPT) that currently provide no trips for HST programs (agency coordination not in place).

RHST Technical Coordinating Council
The GDOT RHST Coordination Plan Update recommended the establishment of the RHST Technical Coordinating Group (TCG). The TCG was formed by and is composed of Advisory Subcommittee agencies and was expanded to include additional key RHST representatives (see Table 6.1). Its mission has been to discuss and recommend policies that will foster coordination in RHST and to serve as a technical advisor for GDC's reporting efforts. The TCG has met regularly during the development of the 2013 RHST Report and has assisted in many ways including, evaluating resource bundling options, providing necessary data and providing initial feedback on draft recommendations. This group remains integral to the state's efforts to improve coordination and will continue to meet as necessary to provide direction on appropriate coordination options.

Table 6.1: Technical Coordinating Group (TCG) Membership

TCG Advisory Subcommittee Members GA Department of Human Services (DHS)
GA Department of Transportation (GDOT)
GA Department of Behavioral Health and Developmental Disabilities (DBHDD) GA Department of Education (DOE) GA Department of Labor (DOL)
GA Department of Community Affairs (DCA) Governor's Development Council (GDC)
GA Department of Community Health (DCH)

Expanded Membership Organizations GA Association of Regional Commissions (GARC) GA Association of Metropolitan Planning Organizations
(GAMPO)
GA Transit Association (GTA)
GA Chamber of Commerce GA Council on Aging
GA Department of Economic Development (GDEcD) Disabled Community Representative - DisAbility Link

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Mobility Management in Georgia
Mobility Management is a customer-centered approach to providing transit options (urban and rural) that recognizes the benefits of establishing partnerships between transit providers in order to more effectively meet the needs of transit customers. The 2010 GDOT RHST Coordination Plan Update included a recommendation to establish regional mobility managers who would be the focal point for planning and implementing mobility management efforts at the regional level. Regional mobility managers are currently in place at the Atlanta, Coastal, Middle Georgia, River Valley, and Three Rivers Regional Commissions (RCs). Discussions with the mobility managers currently funded through GDOT's 5316 / 5317 mobility management pilot efforts in the Middle Georgia, River Valley, and Three Rivers RCs revealed a variety of coordination activities underway since the program began in 2012. Two of the regions, River Valley and Three Rivers, received 2013 Excellence in Regional Transportation Awards from the National Association of Development Organizations (NADO) for their Regional Mobility Management Programs. A summary of key activities in each region is provided below:
The Middle Georgia Regional Commission (MGRC) formed a Regional Mobility Council consisting of officials from each county in the region through formal adoption by the MGRC board. The Mobility Council established a long-term vision of one coordinated RHST system for the 11-County Middle Georgia region and began steps towards achieving that vision. The mobility manager regularly met with member counties, providers, regional stakeholders, and the public to build champions and partnerships and worked with DHS on the potential procurement of a single transportation provider for services throughout the region. The River Valley Regional Commission (RVRC) mobility manager completed an extensive data collection effort to assess the existing conditions of the RHST system across the 16-county region, including the current level of RHST coordination and a provider inventory. An informal regional Advisory Committee to discuss coordination opportunities has also been established. The mobility manager has also assisted in the establishment of a new coordinated transit system, the Pataula Transit System. This system serves three counties and launched in July of 2012. The system is managed by the Lower Chattahoochee Transit Authority, with administrative services provided by RVRC. The Three Rivers Regional Commission (TRRC) took a purposefully informal approach to the formation of the Three Rivers Mobility Council and has focused mobility management activities on innovative outreach. Because a coordinated transportation system already existed in the region, the Mobility Council was intended to support innovation and creativity. Council Meetings have included visioning sessions about future opportunities for coordinated service provision in the region. Social media and the launch of a Facebook page has been a successful engagement approach to reach the RHST community. The Mobility Council reviews what's going on in the region, what's happening legislatively, implementation of the mobility management work plan prepared to support the 5316/5317 grant funding, and tracks successes as well as challenges to coordination.
The Atlanta Regional Commission (ARC) hired a Regional Mobility Manager who will be overseeing two projects: (1) an effort to establish a Regional Mobility Management Plan; and (2) a 1-Click project. These are described below:
Regional Mobility Management Plan ARC has retained a consultant to work with regional stakeholders to help move mobility management efforts forward in the region. The project, to begin in June 2013, will involve preparing a Regional Mobility Management Plan. The plan will identify how best to support mobility
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management and coordination programs among public transportation providers, human service agencies, and private and non-profit entities providing transportation in the Atlanta Region. This project will provide input to ARC on opportunities for improved transportation coordination and will develop a strategic implementation approach, while also identifying ARC's role. The implementation approach will include strategies related to financial/cost-benefit analysis, management, staffing, operations, agreements between agencies and implementation. This targeted mobility management information will be used to help guide the development of the 1-Click project (see below), help attract additional partners for the 1-Click project, and evaluate how the 1-Click project can serve to expand partnerships in other regional mobility management efforts.
1-Click Project - ARC is currently developing the software for the Regional Mobility Management One-Click System (1-Click) for the Atlanta region. Utilizing an FTA Veterans Transportation and Community Living Initiative Grant, ARC has retained a consultant, and has secured funding partners in the region, to help design a web-based repository of public transportation and HST resources that can be accessed through the internet, and that can link to or (potentially) offer trip planning resources. A possible second phase to the project would involve actual trip booking for partner agencies' HST customers in the region.
Veterans Transportation in the Atlanta Region
Since the development of the 2012 RHST Report, a new transportation program has been launched by the Atlanta VA Medical Center (VAMC). The VAMC plans to launch a new shuttle network in the spring of 2013 to provide veterans with direct transportation to and from scheduled medical appointments at the Atlanta VAMC as well as VA community clinics in a service area including Carrollton, Lawrenceville, East Point, and Stockbridge. Door-to-door service was also planned for those veterans living in rural areas. The shuttle system will supplement the existing Veterans' Transportation System that is currently outsourced by the Atlanta VAMC. The new program is funded by the VA Chief Business Office (CBO) for the first two years. The Atlanta VAMC purchased two new vehicles to supplement the use of existing VAMC facility vehicles. Six drivers were also hired to operate the vehicles as part of the program. If the program is successful, the VA intends to eliminate the existing VTS services and continue the operations of the shuttle program fully in-house, with the ultimate goal of cutting costs. Detailed cost data on the existing or planned program was not available at the time of publication of this report.
Georgia Transit Association's Mobility Management Subcommittee
The Georgia Transit Association (GTA), a non-profit organization dedicated to improving public transportation in the State, has formed a Mobility Management Subcommittee which plans to meet two or three times a year at standing transit-related events across the state to provide networking opportunities and a forum to share information on previous and current efforts, successes, and challenges. The subcommittee includes approximately twelve mobility management representatives from across the state and invites representatives from state RHST organizations to participate.
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Chapter 7: Shared Vehicle Purchase, Maintenance, Insurance and Fuel Programs
This section provides an overview of how RHST providers procure and lease vehicles as well as how they maintain, insure, and fuel these vehicles. Opportunities to increase efficiencies in these areas are then identified as well as recommendations that should be explored during the 2014 reporting year. A key takeaway is that while efficiency opportunities are likely, the variance and complexities in how providers maintain, insure and purchase vehicles means further evaluation is necessary to determine the feasibility and benefits of the recommendations.
Overview
To understand the opportunities to improve efficiencies, it is first necessary to outline existing vehicle purchase, maintenance and insurance programs and practices in the state. These practices differ primarily by the ownership of the vehicle, in particular whether the vehicle is state-owned or owned by a non-profit or private entity. The research conducted found common practices in each area, with certain exceptions as shown in Table 7.1.6 In general, eligibility for state programs involving vehicle purchasing or leasing are limited to public entities, while eligibility for state-contracted maintenance, insurance, and fuel purchase programs are available to operators of state-owned vehicles.7 An exception to this rule occurs with fuel purchase, where in addition to a state-sponsored bulk purchase option, private sector entities (e.g., Fuelman, Wright Express) also offer opportunities to purchase fuel cards that could result in savings for providers (private providers are eligible to participate).
In addition to new vehicle procurement practices, the purchase of "surplused" vehicles has also been reviewed.8 Surplused vehicles are GDOT 5311 rural public transportation vehicles that have reached their useful life of 5 years or 100,000 miles of service. Surplused vehicles are turned over to the Department of Administrative Services (DOAS) for processing and auction. Some RHST providers are interested in purchasing these surplused vehicles because many can still be used to provide service in a relatively cost-effective manner. DHS service providers in particular are interested in the surplused vehicles because DHS has not purchased new vehicles since 2007. Rather than purchase vehicles, DHS focuses on buying trips. This approach may have helped increase coordination, as in many areas of the State, DHS has contracted with GDOT's RPT operators to provide trips. However, as the DHS vehicle fleet ages and vehicles are retired, the need to find cost-effective vehicle options will increase, particularly given the research findings that privately held capital has minimal access to statewide contracts that contribute to cost efficiencies; it is conceivable that the vehicles that fill this void will be privately owned.
GDOT has established new surplus vehicle procedures that will allow GDOT providers and/or the counties a first right of refusal to obtain surplused 5311 vehicles before they are added it to the surplus vehicle list. This effort improves
6 Nine interviews were conducted in order to get a sample of current practices. Agencies interviewed included: GDOT, Department of Administrative Services (DOAS), DHS; as well as Three Rivers Regional Commission, Coastal Regional Commission, Atlanta Regional Commission, Lookout Mountain Community Service Board, and Southeastrans (Medicaid broker). 7 Research suggests that vehicles owned by non-profit agencies are not eligible for state contract programs. Partner feedback suggests that nonprofit agencies may have access. This issue will need to be addressed in the coming year. 8 GDOT has a 5-year or 100,000 mile (whichever comes first) vehicle replacement policy (Source: GDOT 2011-12 Administrative Guide for Section 5311). This policy helps contribute to lower operational costs by placing increasingly fuel efficient, well-maintained vehicles into the rural public transportation network. DCH and DHS have no surplus policy; instead maintenance and state-of-good-repair inspection requirements are utilized.
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the ability of RHST agencies to access surplus vehicles and will help to address the growing needs for capital, especially given the number of RPT systems that also provide trips for DHS. Another GDOT initiative that supports RHST coordination includes the development of a Surplus Vehicle Databank to provide a consolidated list of agencies requesting vehicles. This should assist in identifying additional RHST providers requesting vehicles.

Table 7.1: Vehicle Maintenance, Insurance, Procurement and Fuel Purchase Current Practices

Type of Vehicle

Vehicle Maintenance
Options

Vehicle Insurance Vehicle Procurements Fuel Purchase

State-Owned Vehicles

*DOAS state contract
Contract with a local maintenance shop
County in-house maintenance shop

*DOAS state fleet policy
County provides insurance
Coordinated system with independent fleet
policy9

*GDOT state
procurement contract10, including
coordinated systems

*DOAS state contract11
Coordinated system with independent fuel purchase program12

State-Leased Vehicles13

*DOAS state contract

*DOAS state fleet policy

*DOAS state leasing contract

*DOAS state contract

Privately-Owned Vehicles
(non-profit or for-profit)

*Contract with a local maintenance
shop (retail purchase)

*Privately insured (retail purchase)

County in-house maintenance shop

County provides insurance

Coordinated system group contract with local maintenance
shop

Coordinated system
with independent fleet policy14

*Retail purchase

*Retail purchase
Independent participation in a fuel purchase program15

*Asterisks indicate the most commonly found practice Practices noted in bold represent less cost-effective practices and hence the best opportunities for cost reduction

9 Example: Coastal Regional Commission 10 GDOT is the only RHST agency at this time purchasing vehicles 11 Wright Express (WEX) 12 Example: Coastal Regional Commission with Wright Express 13 State-leased vehicles are primarily utilized by Community Service Boards. Community Service Boards are quasi-governmental divisions of the Georgia Department of Behavioral Health & Developmental Disabilities. 14 Example: Three Rivers Regional Commission five-county coordinated system 15 Example: Southeastrans with Fuelman
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Conclusions
The research indicates that the use of government purchasing power, whether DOAS contracts or county-based services, offer the most cost-effective options in purchasing, maintaining and insuring vehicles. From this, privately owned vehicles purchasing at retail prices offer the greatest opportunity to increase efficiencies in all four areas. In terms of fuel purchases, both DOAS fuel contracts and private sector fuel cards are cost-effective options.
Opportunities & Recommendations
The review of vehicle purchase, maintenance, insurance and fuel practices and the identified best practices lead to the following opportunities and recommendations:
DOAS Surplused Vehicle Procedures
o Opportunity: Private non-profit and for-profit RHST service providers, and public DHS or DCH only RHST providers, have historically not been granted priority in the purchase of surplused vehicles, but could benefit from the opportunity to have a chance to bid on the surplused vehicles before opening the auction to other bidders. This is particularly important as public capital (e.g., DHS) is retired in the coming years, potentially leading to more private vehicles filling this capital void.
o Recommendation: Evaluate options to increase RHST provider access to surplus capital to respond to increasing capital costs and needs. It should be noted that GDOT's recent efforts to keep surplus vehicles with the RPT provider that surpluses it will help address this capital void. Further, GDOT's new Surplus Vehicle Databank should assist in identifying additional RHST providers requesting vehicles.
DOAS Vehicle Procurement/Leasing, Maintenance, and Insurance Programs for State-Titled Vehicles
o Opportunity: An opportunity exists to open up these programs to all RHST service providers. This opportunity has the potential to produce bulk purchasing cost savings. However, further study will be needed to explore whether an expansion of program eligibility should include only private non-profit RHST providers, considering the potential tax code limitations related to extending to private for-profits and since procedures and policies would likely need to be put in place to ensure that that the private forprofit providers are not using the vehicles for non-RHST purposes.
o Recommendation: Evaluate options to increase access to statewide vehicle purchase, maintenance and insurance contracts to lower capital and operating costs. 16
Fuel Card Programs
o Opportunity: Both DOAS' fuel program and independent (private sector) fuel programs (through WEX or Fuelman) offer sales and fuel tax savings, depending on the agencies exemption status. Some fuel programs also offer volume discounts. An opportunity exists to increase the number of RHST providers participating in fuel purchase programs. Though the bulk discounts and tax exemptions may not be the same
16 GDC with DOAS should discuss and evaluate feasibility by resource area; preliminary feedback indicates some areas like maintenance and insurance a likely to be more feasible.
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for all transit service providers, participation in a fuel purchase program could result in overall cost savings. o Recommendation: Inform service providers on the option to participate in fuel purchase programs for the purpose of reducing fuel costs.
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Chapter 8: Best Practices in Technology Utilization
This chapter identifies and describes the technologies that are used by RHST agencies in providing service (RouteMatch, TRIP$, LogistiCAD and NET InSight), the extent to which they are deployed and opportunities to integrate them to achieve greater efficiencies at the provider level. Multiple platforms are common throughout the country, and are necessary to accomplish goals that vary among federal program requirements and agency administration, such as determining eligibility and meeting federal reporting requirements. Each agency should be applauded for deploying cost-effective means to accomplish these goals. In recognition of the need for multiple platforms, this section focuses on integration opportunities among the three major platforms.
RHST Technology Overview
GDOT 5311 Rural Public Transportation (RPT) - GDOT began deploying RouteMatch scheduling software early in 2011 at all RPT providers in the state; as of August 2013, this installation process is 98% complete. RouteMatch software has the ability to record and track clients and trip eligibility for various programs, schedule and optimize vehicle routing, and can generate reports/invoices for billing to fulfill programmatic requirements. The scheduling algorithms imbedded in RouteMatch may afford an advantage to service providers by generating optimized schedules for service delivery, which may increase cost-effectiveness of all RHST services (since many RPT providers also provide DHS and NET services).
DHS Coordinated Transportation DHS's software program, TRIP$, is designed to determine client and trip eligibility, intake client transportation requests, and provide trip confirmation and invoicing. Trip requests are generated through the software and provided to service contractors who then schedule service delivery. Unlike RouteMatch, TRIP$ is not designed to provide scheduling functionality (e.g., route optimization). In this sense synchronization between TRIP$ and RouteMatch will require additional effort. TRIP$ is presently being piloted in Coweta and Troup counties (both counties are in DHS Region 4). DHS plans to deploy TRIP$ in all Region 4 counties after the pilots are complete and eventually deploy TRIP$ statewide, noting the time-frame for state-wide deployment is to be determined. The fact that TRIP$ is currently being piloted creates a unique coordination opportunity. Since 73% of GDOT RPT providers also provide DHS services, many service providers will soon have two software packages that create additional manual data entry that could be avoided if the platforms were integrated (see recommendations below). There have been numerous discussions between GDOT, RouteMatch, and DHS regarding TRIP$ integration. The parties have agreed to explore how best to coordinate TRIP$ and RouteMatch, once DHS has completed its pilot project.
DCH NET Services DCH's two NET brokers, LogistiCare and Southeastrans, use proprietary software to track clients, determine eligibility, book trips with service providers, and generate program reports. Much like TRIP$, neither broker software package includes a route scheduling component. GDOT is currently working with RouteMatch to integrate NET Broker information with the RouteMatch software, an effort that should yield provider level administrative efficiencies.
Extent of Technology Deployment
The extent to which this technology is deployed and supports RHST providers is presented in Table 8.1
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Table 8.1: RHST Technology Deployment

Services Supported
Percentage of RHST Trips Supported (May 2013) Percentage of Total RHST Trips Supported via RHST Technology (May 2013)
Client Records / Eligibility Verification Provider Records Trip Booking (Reservations) Manual Trip Assignments to Providers Automated Scheduling and Dispatching Trip Manifest Generation Trip Disposition Tracking MDT/AVL (digital dispatch + time/location stamping) Invoice Generation Statistical Reports Web-Based Access

RouteMatch (GDOT 5311 Rural Transit)
Supports GDOT 5311 rural transit providers. RouteMatch
has been deployed at all providers.
98% of 5311 trips 44% of DHS trips

TRIP$ (DHS Coordinated Transportation)
Supports DHS trip providers. In use in two pilot counties, Coweta and Troup (DHS Region 4). After pilot phase, will be
deployed in all of Region 4. No date set for expansion to all DHS Regions.
1% of DHS trips*

LogistiCAD (DCH Medicaid) Supports DCH Medicaid NET brokerages managed by LogistiCare in three (3) DCH NET Regions (East, Central
and SWGA).
62% of NET trips

80%** (98% GDOT trips, 100% NET trips; 44% of DHS trips)

Primary Functions

X

X

X

X

X

X

X

X

X

X

X

X

X

X (by vehicle/driver)

X (by contractor)

X

X

X

X

Optionally Available

Electronic Tablets

X

X

X

X

X

X

X

X

NET InSight / Mobile (DCH Medicaid)
Supports DCH Medicaid NET brokerages managed by
Southeastrans in two (2) DCH NET Regions
(Atlanta and North).
38% of NET trips
X X X X
X X
Electronic Tablets
X X

* TRIP$ serves 100% of DHS Coordinated system in Coweta and Troup. Calculation includes coordinated trips taken on these two systems taken from the NTD database. **Trip total from FY 11 calculation includes all GDOT and NET trips and 44% of DHS trips as provided by state agencies for FY 11.

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Opportunities & Recommendations to Integrate Technology Platforms GDOT is currently working with both the NET brokers and DHS to integrate RouteMatch with their software platforms. It has been suggested that integration take place first with the NET brokers since their software platforms are already in place. Since DHS's TRIP$ software is in the pilot phase, integrating RouteMatch with TRIP$ should wait until TRIP$ is fully deployed. To this end, the GDC will review progress to integrate RouteMatch with the NET broker platforms as well as the integration efforts with DHS's TRIP$ platform as it is deployed, and report back as part of the 2014 RHST Report.
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Chapter 9: Federal Funding Program Limitations
The GDC is required to identify limitations imposed by various federally funded programs and how the state can manage within them. In the 2012 RHST Report, the GDC expanded this purpose to review both federal and state barriers and found none that prevented coordination. Rather, barriers were found that complicate coordination and therefore reduce the extent to which RHST services are coordinated. Table 9.1 provides a summary of all limitations that if addressed, offer opportunities to improve the level of coordination. A more detailed explanation then follows.

Table 9.1: 2013 Federal and State Program Limitations

Level of Government

Limitation

Details

Research Results and Recommendations

Federal

Multitude of Federal Programs

80 plus federal programs can potentially fund RHST services. Many of these programs have unique reporting requirements, which overburden service providers who have multiple or coordinated
contracts

Pursue the integration of RHST technology platforms to reduce administrative burdens associated with
coordinating services.
Evaluate service efficiency and LOS impacts of resource bundling and/or conduct site visits in counties with no
agency coordination

Medicaid's Transportation Assurance and Long Distance Trips

The state must assure the provision of transportation services to eligible individuals. Some requested trips
must travel extensive distances.

Perception that long trips must be provided minimally inhibits coordination.
Educate RHST providers on options to limit the assignment of NET trips to those that conform to their capabilities, service
area and hours (increases level of RPT/NET coordination).

States

NET Performance Guarantees
NET Broker reimbursement
timeframes

DCH assesses liquidated damages if The perception that damages could be

NET brokers do not perform at

significant is believed to deter public

necessary levels. Brokers pass these transportation providers from contracting

on to providers. It is believed the with NET brokers. Educate urban and

potential to be assessed damages rural public transportation providers on

prevents some urban and rural

how damages are assessed and typical

public transportation providers from amounts to encourage the provision of

contracting with NET brokers.

NET trips.

The lag between providing service and getting paid requires RPT service providers "float" the
transportation costs, discouraging some RPT service providers from
contracting with NET brokers.

Some RPT service providers opt not to enter into NET contracts because of this perception. DCH mandates a 15-day turnaround. Educate public transportation
providers on this requirement and options to encourage prompter payments.

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Federal Limitations
The following federal limitations are not meant to be exhaustive; the limitations addressed below are those that have previously been identified by stakeholders as potentially having the greatest impact on coordination. Each year this list should be reviewed to determine whether additional limitations should be added.
Multitude of Federal Programs
The number of different programs that support RHST remains a challenge to coordination since transportation providers who coordinate RHST services are faced with administrative burdens including the tracking of clients and eligibility by program and recording trip data and billing to different RHST agencies. Software that streamlines these processes is a means to address this issue, and has been or is planned to be deployed by all RHST funding agencies. However, the deployment of multiple technology platforms results in the need for duplicative data entry. To offset this limitation, the automation of date entry and reporting through integration of technology platforms should be evaluated (see Chapter 8).
Medicaid's Transportation Assurance and Long Distance Trips
Once an individual is determined to be eligible for Medicaid, DCH must ensure that individual has access to medical services, including the provision of transportation in the event that client has no means of personal transportation. Problematic to many rural areas is the fact that sometimes medical services are unavailable within a community or the client requires specialized services only available at regional medical centers. This means that some NET clients must travel long distances despite efforts by DCH and the NET brokers to mitigate these impacts.
Long distance trips are particularly difficult to schedule and deliver as resources such as drivers and vehicles may be tied up for a full day while dedicated to these trips. As a result, stakeholders have identified NET trip distance as a reason why rural public transportation (RPT) operators do not provide NET services. However, interviews with RPT operators that provide NET trips indicated they are permitted to decline trips if they don't have the ability to provide them (e.g., no capacity, no vehicle available, etc) while operators that do not provide NET trips did not cite trip length as a reason for not running service for the NET brokers. From this, long distance NET trips are considered a minimal barrier to coordination. However, it is believed that some RPT providers are unaware they have an opportunity to negotiate trip selection with brokers. As such, GDOT and the NET brokers could lead an educational effort to better inform RPT providers of the parameters of the NET program which could lead to greater coordination between GDOT's rural public transportation program and DCH's NET program.
While long distance NET trips are not considered a barrier to coordination, they do contribute to higher RHST costs. Methods that could mitigate this impact are provided in Chapter 12 and include exploring mobile medical solutions to reduce trip distance.
State Limitations
NET Performance Guarantees
Contracts with NET brokers include performance guarantees that are designed to ensure an appropriate level of transportation service is provided for Medicaid customers, such as assuring that members are dropped off and
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picked up in a timely fashion.17 DCH has found that this assurance is needed given the consequences of delayed arrivals or pickups, which could negatively impact Medicaid members' health. These performance guarantees, and the resulting liquidated damages that stem from a failure to meet them, are then passed to the broker's providers. Stakeholders have indicated that the potential to be assessed liquidated damages might be a barrier to the provision of NET services by urban and rural public transportation (RPT) providers. In interviews with RHST providers, performance guarantees were rarely cited as a reason for not providing NET trips. However, discussions with the RHST Technical Coordinating Group (TCG) indicate that the perception that significant liquidated damages could be frequently levied are discouraging RPT providers from approaching brokers and therefore, from providing NET services. An educational effort to inform RPT providers of how damages get assessed and typical amounts would address this perception and could result in more RPT providers serving NET trips. NET Broker Reimbursements During the course of interviews some RPT providers indicated that lags in reimbursement was a factor in not entering into contracts with NET brokers. This was especially true for smaller and public/non-profit entities who are challenged to "float" the cost of providing service. DCH has indicated that brokers are required to pay service providers within fifteen (15) business days of receiving of an undisputed invoice.18 An education effort aimed at explaining DCH's requirement to RPT providers and availing them of options to encourage prompter payment is considered to best option to help resolve this issue.
17 Examples include requirements to arrive within 15 minutes of the scheduled pick-up time and within one hour of the notification for a return trip. Violations are $500 per incident in both cases. 18 Georgia Department of Community Health. Non-Emergency Transportation Broker Services Program Requirements, May 16, 2012, Chapter 100, Section 100.2.
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Chapter 10: HST Program Usage of Public Transportation Services
Human services transportation (HST) agencies (i.e., DHS and DCH) and public transportation systems interact when an HST agency purchases service (trips) on rural and fixed-route public transportation systems. However, the dynamics between purchases of service on urban systems are quite different from those on rural public transportation, and each is addressed separately below. To better evaluate this interaction, interviews were conducted with public transportation providers including a sampling of the state's rural transit providers and all urban (fixed-route) providers.
HST Interaction with Rural Public Transportation (RPT)
Rural public transportation (RPT) operators benefit from providing trips for HST agencies because they are able to earn additional revenues, which in many cases can be used as local matching funds for Federal Transit Administration (FTA) grants. From a local perspective, this means county governments can provide rural transportation at less cost to them (using federal 5311 revenues to offset costs associated with the public transportation trips). This in part explains why many RPT operators contract with human service agencies consistently throughout the state. From a state perspective this means that coordination offers the ability to further leverage federal resources and minimize costs to the Georgia taxpayer. As shown in Table 1.2 and discussed in Chapter 6, RPT operators provide DHS and/or NET trips in 86 (or 77%) of the 112 counties that have RPT service. This percentage does not specifically address how each HST program (DHS and NET) uses RPT operators (i.e. within the 77%, RPT operators may be providing trips for only one or both of the HST programs). When evaluating how each HST program uses RPT operators, it is found 29% of all RPT operators are providing NET trips while 73% are providing DHS trips.
Three observations come from this analysis. First, given that 77% of all RPT operators coordinate with one or more of the HST programs, it is clear that coordination offers benefits to both GDOT and HST programs. Second, the most significant coordination opportunity may be between RPT operators and the NET program, as 29% of RPT operators currently contract with NET brokers (note that Chapter 9 indicated several barriers that may first need to be addressed). Third, given that 73% of RPT operators provide trips for DHS, the ability to combine trips among these two programs seems considerable. From this, the most immediate opportunity to increase coordination opportunities may be within the 27% of RPT operators that do not provide trips for DHS.
HST Interaction with Urban Public Transportation Systems
Like RPT operators, some urban public transportation operators also work with HST agencies. While less prevalent than in the rural areas, several urban transit agencies currently sell tickets and passes directly to DHS offices (or their agents) and/or NET brokers. Urban transit agencies offer two types of service, fixed-route and Americans with Disabilities Act (ADA) complementary paratransit. Given the significant differences in the types of service and the impact HST agency usage has on each, they are addressed separately below.
Fixed-route Transit
Assigning HST trips to fixed-route transit is consistent with a coordinated and integrated HST network. Fixed-route transit is almost always the method of transportation available at the lowest cost to HST programs, and encouraging
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use of this network reduces program costs for HST agencies and increases revenues for transit providers. This practice is also consistent with federal guidance. For example, guidance issued by the Centers for Medicare and Medicaid Services states that that Medicaid should pay no more for fixed-route public transportation than the rate charged to the general public.19
ADA Complementary Paratransit
The interaction between ADA complementary paratransit and HST agencies is more complex than the use of fixedroute services. ADA paratransit service is only provided in response to a request for service (called "demand response") and is typically the most expensive of all public transportation services when considered on a per trip cost basis. Thus, assigning an HST client to the service will increase costs to the transit operator. The issue that arises is one that is common throughout the country: who pays how much of the costs of the trip when clients are dually eligible for ADA and Medicaid services?
Based on interviews with HST agencies and urban transit systems in Georgia, the use of ADA complementary paratransit services by HST agencies appears limited to the NET brokers.20 Approximately half of the state's ADA paratransit systems indicate they do not provide trips for the brokers, the remaining half either know for certain or think it is likely that the brokers purchase trips on their ADA systems. NET brokers purchase paratransit passes or tickets at the standard fare and distribute these passes or tickets to their dually-eligible clients who can use the ADA paratransit service to get to their covered medical appointment.
This creates a financial challenge for the ADA complementary paratransit operator that is in part a result of the various federal laws, one of which limits ADA fares to twice the rate of fixed-route fare. Given this limitation, paratransit fares typically cover between 4% and 15% of the cost of providing this service.21 Thus, when an NET broker directs dually-eligible clients to ADA paratransit services and pays the fare, transit agencies are subsidizing the broker's operation at significant costs to the transit agency.
As the 2012 RHST Report stated, DCH is aware of these concerns, and in recognition of them, requires that their NET brokers enter into negotiations with ADA paratransit operators prior to utilizing their services.22 NET brokers and transit operators have attempted to negotiate mutually beneficial rates for paratransit service, but to date, agreements have not yet been reached.
Given ADA paratransit operators `concerns of NET broker usage of their services, the GDC has evaluated the federal landscape to determine what approaches may be possible to create a mutually beneficial arrangement. These findings are below.
19 42 CFR 440.170(4)(ii)(B)(4)(iii). There is no known federal guidance specific to DHS programs. 20 All ADA paratransit providers indicated they provided no DHS trips. 21 NYC Transit, Paratransit Peer Review Report, CY 2010. Using MARTA as an example, the 2012 RHST Report showed that fares in FY 11 were $3.80 while the average trip costs were $36.62; the resulting fare recovery ratio is 10%. 22 Georgia Department of Community Health. Non-Emergency Transportation Broker Services Program Requirements, May 16, 2012, Chapter 100, Section 100.2.
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Federal Guidance Regarding NET Use of ADA Paratransit Services
The federal government, including both the Centers for Medicare and Medicaid Services (CMS) and the Federal Transit Administration (FTA) have issued guidance on the use of public transportation to support human service transportation programs. Medicaid, in the Deficit Reduction Act (DRA) of 2005, created new options for states with regards to providing NET services with brokerage models. The DRA is clear that Medicaid should pay no more for fixed-route public transportation than the rate charged to the general public and no more for public paratransit services than the rate charged to other state human services agencies for comparable services.23 This guidance, in effect, establishes the potential for transit agencies to negotiate rates for Medicaid clients using paratransit services as long as the rates are consistent with those paid by other agencies for similar service (e.g., DHS).
Rulemaking published by the FTA does not speak directly to how transit operators may, or should, provide HST services. However, the FTA's charter rule ( 604.7) stipulates that FTA recipients may provide "charter" service to a qualified human service organization serving persons with mobility limitations related to advanced age, disability or low income and if the organization receives funding directly or indirectly from a list of federal programs included in "Appendix A" of the Charter Rule. Medicaid is included in this list as are most of the major human and health service funding programs. This guidance supports public transportation operators entering into contractual agreements with human or health service organizations for the provision of transportations services, including Medicaid and DHS services.
Conclusions and Recommendations
HST interaction with Georgia's public transportation providers is a largely positive, symbiotic relationship that helps HST agencies provide trips at affordable rates and allows public transportation providers additional revenues. In terms of HST interaction with RPT operators, this is evidenced by the fact that 77% of RPT operators provide trips for HST agencies. Three observations that result from this level of interaction are:
The remaining 23% of RPT operators may have an incomplete understanding of coordination benefits (e.g. the ability to use HST agency funds as local match). The biggest opportunity to further coordinate appears to be between RPT operators and the NET program, as 71% of RPT operators do not provide NET (and that based on observations in Chapter 9 perceptions regarding the NET program may be limiting the existing level of coordination). Given that 73% of RPT operators provide trips for DHS, the ability to combine trips among these two programs seems considerable. The most immediate opportunity to increase coordination opportunities may be between DHS and the 27% of RPT operators that do not currently coordinate with DHS.
A recommendation that results from this is to better educate RPT operators on the benefits of coordination (in particular the ability to use HST agency revenues as match) and the key parameters of the NET program (e.g., how liquidated damages are assessed and the ability to negotiate the type of number of trips). It is believed this educational effort could increase the level of coordination between RPT operators and HST agencies.

23 42 CFR 440.170(4)(ii)(B)(4)(iii)

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This chapter also found an additional opportunity to improve the interaction between NET brokers and ADA paratransit operators. The research conducted shows that:
NET brokers utilize some ADA paratransit systems, other systems are uncertain whether they are providing NET trips. Where NET brokers utilize ADA paratransit systems, they pay the public fare, which results in these systems subsidizing NET trips. In response to this, DCH requires that brokers negotiate rates with ADA paratransit operators, a practice that encourages the establishment of a mutually beneficial arrangement between the NET broker and ADA paratransit operator, thus avoiding the subsidization issue. To date there are no known examples successfully negotiated, mutually beneficial trip rates in Georgia. Given that some ADA paratransit systems are uncertain about whether they are providing NET trips, a recommended first step toward improving this interaction is to educate ADA paratransit systems on both the state and federal regulations governing NET broker use of their systems. This educational effort should clarify to both transit operators and transportation brokers that transit operators are permitted by federal guidance to negotiate an "agency rate" with both DCH and DHS transportation brokers that reflects the actual cost of service. It should also specify that DCH and DHS transportation brokers are not obligated to contract with transit operators or accept this rate, but would clearly understand the payment terms for using ADA complementary paratransit service.
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Chapter 11: Cost Sharing Among Programs
Cost allocation is a process of identifying all costs attributed to a transportation program in order to:
Identify more accurate costs for each entity involved; Understand what cost benefits might result from coordination; and Assure that costs are allocated appropriately to participating agencies.
Cost allocation is critical in coordinated transportation environments. However, organizations that are involved in coordinated efforts, as providers and/or purchasers of service, often find it difficult to accurately identify the amount of money being spent on services. This can often lead to sub-optimally funded transportation programs and activities, as well as purchase-of-service rates that do not cover costs and/or result in unintended cross-subsidization, which for some agencies becomes an impediment to entering into or continuing to participate in a coordinated endeavor. Cost allocation models can address these issues by clearly showing what services cost and how much entities should pay to properly allocate costs.
The 2012 RHST Report recommended the adoption of a cost allocation model. The research in this year's report continues to support this recommendation. However, given that other recommendations present more effective opportunities to stretch limited resources, and the time, expertise and expenses necessary to establish a model in Georgia, the model remains a less immediate priority. A state mobility manager, if established, could be assigned to assist in fast-tracking its adoption. For a detailed assessment of cost allocation models and steps to implement one in Georgia, refer to Appendix E in the 2012 RHST Report.
During the public comment period it was suggested that the establishment of a cost allocation model become a more prominent recommendation. It was stated that there is a perception that some RHST funding agencies are subsidizing others. Further, a cost allocation model would help the key state agencies understand the cost synergies created by coordinating all RHST trips. The GDC recognizes the importance of cost sharing in a coordinated environment. Yet, prior to elevating this recommendation to higher status, it should first be discussed with the Technical Coordinating Group (TCG). If the TCG agrees that this change should be made, the TCG should move forward with a project scope to implement the recommendation.
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Chapter 12: Privatization Assessment & Other Methods to Reduce Costs
This RHST legislation requires the GDC to evaluate methods to reduce costs that go beyond those addressed in the previous chapters (e.g., shared vehicle maintenance, insurance and purchase). At a minimum, greater use of the private sector must be evaluated. This section addresses the current state of privatization and how expanding the use of private sector entities might present cost savings opportunities. Following this is a description of mobile medical services, an additional opportunity that may reduce costs.

Privatization Assessment

As shown in Table 12.1, a significant portion of Georgia's HST network consists of private entities. The percentages in Table 12.1 are based on provider data provided in early 2013 by GDOT, DHS and DCH. For example, the GDOT data shows that 40% of all rural public transportation (RPT) providers are private entities.

Table 12.1: RHST Privatization in Georgia

Big 3 RHST Agencies
GDOT DHS Transportation
DCH NET

Percentage of Providers that are Private Entities 40% 40% 96%

Percentage of Providers that are Public Entities 60% 60% 4%

Source: GDOT, DHS, DCH Staff, December 2012-March 2013

As was the case in the 2012 RHST Report, this year's findings show that Georgia's RHST network is mostly privatized; this is principally due to the size of the DCH NET program which is larger than both GDOT and DHS combined and is almost entirely operated by private operators. Given that public sector entities also provide service, additional privatization opportunities may exist. However, stakeholder input indicates that in some counties, publicly operated rural public transportation operators are the only option; there is no private or non-profit sector entity available. Additionally, it is not clear to what degree greater use of the private sector could reduce costs. Because of these factors, the GDC suggests that future annual reports focus less on whether greater use of privatization could be an effective and cost-efficient method of delivering RHST services and more on what increases the cost-effectiveness of the RHST network.

Other Methods to Reduce Costs Mobile Medical Services Assessment
Mobile Medical Units are vehicles staffed with medical personnel and appropriate medical equipment, and have been used in other states by some segments of the publicly-funded health care network (including Medicaid and the Veterans Administration) to bring needed medical services to rural areas, where transportation resources are sparse. Experience suggests that mobile units have been successful at providing primary medical care, such as preventative care and mental health screenings, dental health care screenings, routine primary care services, and influenza and pneumonia vaccinations. Using mobile medical units to provide more complicated services has not proven to be as effective in part because complex medical services mean the mobile units must transport more and increasingly

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complicated equipment.24 Materials and equipment drive up costs associated with power supplies and temperature control, and in many cases, costs outweigh benefits.
It has been suggested that mobile medical units may result in a less costly approach compared to transporting Medicaid recipients who require frequent (daily) medical attention and must travel long-distances to get to the medical facilities providing specific medical services.
The use of mobile medical services may have some benefit in Georgia given the state's size and rural character. However, further research and analysis is required to ascertain first whether or not there are groupings of frequent, long-distance NET trips that require the same general type of treatment; and second, whether the operational costs of providing a mobile medical unit are lower than the cost of transporting these individuals long-distance to methadone clinics or other medical facilities that provide specific medical services.
Given that the literature suggests that decisions associated with starting mobile medical units are typically designed as strategies to improve overall medical care, rather than focusing on transportation aspects of care, further evaluation of mobile medical services in the RHST context is not recommended at this time.

24 Interview with Naomi Clemmons, Senior Public Health Consultant, JSI, Boston, MA.

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Chapter 13: Recommendations
The preceding chapters have introduced a number of findings and recommendations. In this chapter, these findings and recommendations are grouped into key areas representing the major themes that arose throughout the 2013 reporting year. Each grouping starts with the key finding and the details that led to it, and provides a key recommendation to be pursued. Under each key recommendation are additional details and next steps that are necessary to move the recommendation forward. Following these summaries, the key recommendations are prioritized using cost-effectiveness, level of service and feasibility impacts as ranking factors.
Findings, Recommendations & Next Steps:
Key Finding: Access to efficiencies via statewide contracts for vehicle purchase, maintenance, fuel and insurance is limited:
Many RHST trips are provided by private non-profit and for-profit providers. Some of the vehicles operated by these private providers are publicly-owned, others are privately-owned. This is an indication that public funding availability and requirements may limit the number of publically owned vehicles or that public capital alone is not enough to satisfy all RHST trips. The Georgia Department of Administrative Services (DOAS) has developed statewide contracts for vehicle purchase, maintenance, fuel and insurance; each is designed to reduce costs through bulk purchase opportunities. However, the vehicle purchase contract is only available to public entities, and the other contracts are only available for publicly-owned vehicles (regardless of who operates them). An opportunity exists to lower the costs of RHST services for state purchasing agencies by extending DOAS purchase, maintenance, fuel and insurance contracts to privately-owned vehicles (whether private non-profit or private for-profit) that provide RHST trips. Additionally, opportunities may exist to further utilize existing DOAS contracts where private providers using public vehicles (via an agreement with public grantees) are currently unaware of such contracts (this is best approached through an educational effort). Key Recommendation: Evaluate Options to Increase Access to Statewide Vehicle Purchasing, Maintenance, Fuel and Insurance Contracts to Lower Capital and Operating Costs Explore the benefits and challenges of expanding the DOAS contracts for vehicle purchase, maintenance, fuel and insurance to private, non-profit and for-profit RHST providers. Evaluate the extent to which private providers operating publicly-owned vehicles are or are not taking advantage of these programs, and whether their participation would result in costs savings. If the opportunity for cost savings exists, consider integrating this educational effort with public transportation educational efforts listed below. Next Steps: Convene the TCG together with DOAS to confirm findings. Explore the challenges associated with expanding DOAS contracts to private non-profit and for-profit providers together with DOAS and the TCG.
o Determine the benefits of expanding DOAS contracts by surveying RHST providers concerning their use of DOAS contracts (e.g., are private providers operating publicly owned vehicles taking advantage
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of DOAS maintenance contracts) and/or assessing the cost savings that could result by expanding these contracts to private providers. o The GDC should initiate and facilitate the discussions and conduct necessary research. Progress should be reported by the GDC during the 2014 reporting year.
Key Finding: The need for cost-effective capital is increasing: The need for additional, cost-effective vehicles is increasing in the RHST network, particularly as DHS has discontinued the purchase of vehicles. As the DHS fleet ages and vehicles are retired, costs increase given both a diminished state of repair and the need to replace the vehicle at retail costs. DOAS/GDOT auction-off (surplus) rural public transportation vehicles that have met their useful life; RHST providers have indicated these vehicles can continue to be cost-effective for additional RHST trips. GDOT is taking steps to streamline surplus procedures and increase RHST provider access to these vehicles. This opportunity as well as other methods should continue to be explored.
Key Recommendation: Evaluate Options to Increase RHST Provider Access to Surplus Capital to Respond to Increasing Capital Costs and Needs
Evaluate options to extend a first right of refusal to bid on such vehicles to RHST providers after discussing recent policy changes with GDOT. Next Steps: Engage GDOT on their ongoing efforts to increase RHST provider access to surplus vehicles and on details regarding the newly established Surplus Vehicle Databank. The GDC should develop a fact base identifying the need for additional capital in the RHST field in order to determine the value of extending RHST providers a preference in obtaining surplus vehicles. As necessary, discuss additional options to prioritize RHST provider access to vehicles with DOAS and the TCG. The GDC should initiate and facilitate the discussions and conduct necessary research to ensure a meaningful evaluation takes place. Progress should be reported by the GDC during the 2014 reporting year.
Key Finding: State agencies are expanding the application of technology to meet their individual program requirements:
GDOT, DHS and DCH's NET brokers each have unique software systems that are necessary to accomplishing agency goals, which is a cost-effective means to accomplish these goals. At present, manual data entry between the different platforms is necessary, resulting in additional labor costs for service providers who provide trips for more than one RHST program. Automating this information exchange will reduce administrative costs by minimizing or eliminating the need for such manual data entry. GDOT and NET brokers are already in the beginning stages of automation. Integrating DHS's TRIP$ program with GDOT's RouteMatch software will become a significant opportunity given that 73% of GDOT's rural public transportation (RPT) operators contract with DHS to provide trips. TRIP$ is not yet deployed, complicating efforts to integrate the platform with RouteMatch. Key Recommendation: Integrate GDOT technology with NET and DHS platforms to reduce administrative costs; pursue NET integration first and DHS integration after their platform is implemented Synch data importing and exporting protocols between RouteMatch and TRIP$
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Develop data transfer protocols that allow for the exporting of client and trip request data from TRIP$ into RouteMatch, and then exporting service delivery data from RouteMatch back to TRIP$ (after the trip has been served) for trip tracking and reporting purposes. Next Steps: Monitor efforts to integrate RouteMatch and NET broker platforms. Monitor the deployment of the TRIP$ software platform, report on efforts to integrate these platforms as TRIP$ achieves full deployment. The GDC should report progress during the 2014 reporting year.
Key Finding: Partners have requested additional data analysis regarding the service efficiency and level of service (LOS) impacts of resource bundling:
During the 2013 reporting year, RHST agencies reviewed and evaluated options to implement the resource bundling concept. RHST agency feedback indicated that the potential service efficiencies and LOS impacts of resource bundling need further evaluation and expressed a need to better understand the operational aspects of further applying the concept. A more robust fact base is necessary prior to moving the resource bundling concept forward.
Key Recommendation: Evaluate the Efficiency and Level of Service Impacts of Resource Bundling Evaluate the service efficiency and LOS impacts of resource bundling, and/or conduct site visits in areas without agency coordination to determine barriers to coordination at the provider level
Next Steps: Pursue consensus on a methodology for Analysis 2 in Appendix B during the 2014 reporting year: o Develop a broader definition of LOS o Focus on methods to control for variables (e.g., trip disposition, distance, etc.) o Evaluate the need for a data review given that a new reporting module has been put in place In lieu of, or in addition to conducting an amended version of Analysis 2, conduct site visits in counties where agency coordination is not in place to learn more about coordination challenges and possible opportunities.
Key Finding: Incomplete HST program understanding on behalf of public transportation operators may be reducing opportunities for coordination:
Some urban and rural public transportation providers are not aware of the benefits of HST participation, are unknowledgeable about the differences among DHS transportation programs and NET, and/or are unclear about how they can participate in HST programs, in particular the NET program (e.g., rate negotiation, specific trip characteristics, trip choice, federal and state guidance, etc.). No known educational effort clarifying these HST program participation parameters has been conducted to date. Some private non-profit service providers operating publicly-owned vehicles are not aware that they can access DOAS contracts/programs related to vehicle purchase, maintenance, insurance and fuel. Key Recommendation: Increase Public Transportation Provider Knowledge Regarding HST Participation
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An educational effort focused on all types of public transportation providers should be developed and delivered with a goal of increasing RPT participation in HST programs and increasing knowledge of options to decrease capital and operating costs through bulk purchasing. Consideration should be given to splitting the RPT and urban provider education efforts, as each type of provider has unique coordination issues. The program should focus on:
o The benefits providing HST agency trips can provide, with a particular focus on the ability to buy down local match dollars and/or better leverage federal dollars.
o Key parameters of the NET program, including the ability to negotiate trips, reimbursement requirements, how liquidated damages are assessed and options to negotiate rates above the public fare.
o Additional options to lower costs through statewide and/or county-based vehicle purchase, maintenance, insurance and fuel programs.
Next Steps: The GDC should develop a high-level summary of a potential outreach effort and discuss the value and feasibility with TCG members, as their approval of any outreach effort is necessary to its success. If considered valuable by all parties, outreach roles, specific topics, timeline and venue/approach (e.g., meetings or issuance of policy guidance) would then be discussed.
Recommendation Prioritization
The prioritization scheme follows a similar approach as the 2012 RHST Report, that is, each recommendation was subjected to a qualitative assessment as illustrated in Table 13.1. The assessment includes the following evaluation criteria:
Feasibility: The effort and level of coordination required between agencies to implement the recommendation. Cost of Implementation: The total cost associated with implementing the recommendation. Impact on Cost-Effectiveness: The overall impact on cost efficiencies. Impact on Level of Service: The overall impact on level of service.
Each criterion was categorized into one of three categories:
Most desirable Moderately desirable Least desirable For example, an ideal recommendation would require little coordination, be implemented easily and quickly, would have significant impacts on cost efficiency and would have a positive effect on level of service (service quality).
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Evaluation Criteria
Feasibility
Cost of Implementation Impact on CostEffectiveness Impact on Level of Service

Table 13.1: Evaluation Criteria Assumptions

Most Desirable
Little Required Coordination/Effort

Moderately Desirable More Required
Coordination/Effort

Lower Associated Costs

Higher Associated Costs

High Impact

Moderate Impact

High Impact

Neutral Impact

Least Desirable Most Required Coordination/Effort Highest Associated Costs
Low Impact
Negative Impact

Table 13.2 on the following page applies the above criteria to each of the recommendations outlined earlier in this chapter. The greatest number of hollow circles indicates the best performing recommendations.

While Table 13.2 qualifies the recommendation within each category, it does not allow aggregate scores to be developed. Table 13.3 addresses this shortcoming by ranking each recommendation by a numeric score, according to the following scale:

Most desirable

3

Moderately desirable

2

Least desirable

1

In addition, given the legislative emphasis to improve cost-effectiveness while maintaining or improving level of service, these categories have been weighted twice as heavily as all others. Table 13.3 applies these weightings resulting in the final ranking of the recommendations. The highest scoring recommendations in Table 13.3 should be the first priorities to focus on in the 2014 reporting year.

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Table 13.2: Recommendation Evaluation Matrix (1 of 2)

Recommendation
Evaluate Options to Increase Access to Statewide Vehicle Purchasing, Maintenance and Insurance Contracts Evaluate Options to Increase RHST Provider Access to Surplus Capital Integrate GDOT and DHS Technology Platforms Evaluate Efficiency and LOS Impacts of Resource Bundling Increase Public Transportation Provider Knowledge Regarding HST Participation

Feasibility of Implementation

Cost of Implementation

Impact on Cost
Effectiveness

Impact on Level of Service (LOS)









































LEGEND:


Highly Desirable


Moderately Desirable


Least Desirable

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Table 13.3: Recommendation Evaluation Matrix (2 of 2)

Recommendation

Feasibility of Implementation

Evaluate Efficiency and LOS Impacts of Resource Bundling

3

Evaluate Options to Increase Access to Statewide Vehicle Purchasing, Maintenance and Insurance Contracts

2

Evaluate Options to Increase RHST Provider Access to Surplus

2

Capital

Integrate GDOT and DHS Technology Platforms

2

Increase Public Transportation Provider Knowledge Regarding HST Participation

2

Cost of Implementation
3 3
3 3 2

Impact on Cost Effectiveness X2

Impact on Level of Service (LOS) X2

Total Score

6

4

16

4

4

13

4

4

13

2

4

11

2

2

8

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2013 RHST Report - Appendices
Appendix A: RHST Committee Enabling Legislation
Chapter 12 of Title 32 32-12-1. The General Assembly finds that there exist a number of programs designed to provide rural and human services transportation and that frequently these services are provided over large geographic areas through various funding sources which are frequently targeted to narrowly defined client bases. The sheer number of such programs lends itself to a need for coordination among the programs and agencies which implement them so as to best assist economies in purchasing equipment and operating these many programs, to better serve the taxpayers of the state in ensuring the most cost effective delivery of these services, and to best serve the clients utilizing the transportation services provided through these programs. 32-12-2. There is created the Georgia Coordinating Committee for Rural and Human Services Transportation of the Governor's Development Council. 32-12-3. The Georgia Coordinating Committee for Rural and Human Services Transportation and its advisory subcommittees shall meet not less often than quarterly. Administrative expenses of the committee shall be borne by the Governor's Development Council. The members of the committee shall receive no extra compensation or reimbursement of expenses from the state for their services as members of the committee. 32-12-4. The Georgia Coordinating Committee for Rural and Human Services Transportation shall establish the State Advisory Subcommittee for Rural and Human Services Transportation which shall consist of the State School Superintendent and the commissioners of the Department of Transportation, Department of Human Services, Department of Behavioral Health and Developmental Disabilities, Department of Community Health, Department of Labor, the Governor's Development Council, and the Department of Community Affairs or their respective designees. The commissioner of transportation or his or her designee shall serve as chairperson of the State Advisory Subcommittee for Rural and Human Services Transportation. The Georgia Coordinating Committee for Rural and Human Services Transportation may also establish such additional advisory subcommittees as it deems appropriate to fulfill its mission which shall consist of a representative of each metropolitan planning organization and representatives from each regional commission in this state and may include other local government representatives; private and public sector transportation providers, both for profit and nonprofit; voluntary transportation programs representatives; public transit system representatives, both rural and urban; and representatives of the clients served by the various programs administered by the agencies represented on the State Advisory Subcommittee for Rural and Human Services Transportation. Members of advisory committees shall be responsible for their own expenses and shall receive no compensation or reimbursement of expenses from the Georgia Coordinating Committee for Rural and Human Services Transportation, the State Advisory Subcommittee for Rural and Human Services Transportation, or the state for their services as members of an advisory committee. 32-12-5. The Georgia Coordinating Committee for Rural and Human Services Transportation shall examine the manner in which transportation services are provided by the participating agencies represented on the committee. Such examination shall include but not be limited to:
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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report - Appendices
(1) An analysis of all programs administered by participating agencies, including capital and operating costs, and overlapping or duplication of services among such programs, with emphasis on how to overcome such overlapping or duplication; (2) The means by which transportation services are coordinated among state, local, and federal funding source programs; (3) The means by which both capital and operating costs for transportation could be combined or shared among agencies, including at a minimum shared purchase of vehicles and maintenance of such vehicles; (4) An analysis of those areas which might appropriately be consolidated to lower the costs of program delivery without sacrificing program quality to clients, including shared use of vehicles for client trips regardless of the funding source which pays for their trips; (5) An analysis of state of the art efforts to coordinate rural and human services transportation elsewhere in the nation, including at a minimum route scheduling so as to avoid duplicative trips in a given locality; (6) A review of any limitations which may be imposed by various federally funded programs and how the state can manage within those limitations as it reviews possible sharing opportunities; (7) An analysis of how agency programs interact with and impact state, local, or regional transportation services performed on behalf of the general public through state, local, or regional transit systems; (8) An evaluation of potential cost sharing opportunities available for clients served by committee agencies so as to maximize service delivery efficiencies and to obtain the maximum benefit on their behalf with the limited amount of funds available; and (9) An analysis of possible methods to reduce costs, including, but not limited to, greater use of privatization. 32-12-6. No later than July 1 of each year, the Governor's Development Council shall submit the preliminary report of the Georgia Coordinating Committee for Rural and Human Services Transportation to the members of the State Advisory Subcommittee for Rural and Human Services Transportation. Comments and recommendations may be submitted to the Governor's Development Council for a period of 30 days. No later than September 1 of each year, the Governor's Development Council shall submit a final report to the Governor's Office of Planning and Budget for review and consideration. The report shall address each of the specific duties enumerated in Code Section 32-12-5 and such other subject areas within its purview as the Governor's Development Council shall deem appropriate. Each report shall focus on existing conditions in coordination of rural and human services transportation within the state and shall make specific recommendations for means to improve such current practices. Such recommendations shall address at a minimum both their cost implications and impact on client service. No later than January 15 of each year, the Governor's Office of Planning and Budget shall submit the final report of the Governor's Development Council and any affiliated budget recommendations to the presiding officers of the General Assembly, with copies of said report sent to the chairpersons of the transportation committees, the appropriations committees, and the health and human services committees of each chamber of the General Assembly."
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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report - Appendices

Appendix B: Resource Bundling Modeling Exercise

Purpose
This appendix proposes a technical analysis that assesses both the service efficiency impact of coordinating rural public transportation (GDOT) trips with human service agency (DBHDD, DCH and DHS) trips, and the resulting level of service (LOS) impacts. This coordination approach is more frequently referred to as resource bundling.
These analyses are necessary to meet the request of RHST partner agencies who have asked for an evaluation of the potential service efficiencies that result from bundling RHST resources. This document provides a background on available data and methodologies for both of the recommended analyses.

Background
Previous coordination reports showed that RHST provision differs significantly throughout the state, from stand alone rural public transportation providers to providers that serve all RHST agency trips. Overall, there are seven types of service providers as described and shown in the table below:

1. Service providers who provide rural public transportation service only 2. Service providers who provide both rural public transportation service and DHS transportation service 3. Service providers who provide both rural public transportation service and Medicaid NET service 4. Service providers who provide rural public transportation service, DHS service, and Medicaid NET service 5. Service providers who provide DHS transportation only 6. Service providers who provide DHS transportation service and Medicaid NET service 7. Service providers who provide Medicaid NET only
Table B.1: Types of RHST Providers in Georgia

Service Provider Type

5311-Funded Rural Public Transportation

DHS Transportation

Medicaid NET

Type 1

X

Type 2

X

X

Type 3

X

X

Type 4

X

X

X

Type 5

X

Type 6

X

X

Type 7

X

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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report - Appendices
Starting in 2011 GDOT retained RouteMatch to install its software on all rural public transportation systems in the state; these systems fall under the first four types above. Over the past several months, rural public transportation systems have been collecting transportation performance data for all trips they provide (i.e., if a rural public transportation provider also provides human service agency trips, human service agency trip data is collected as well). The trip data that has been collected can be used to assess service efficiency (e.g., trips per hour) and select LOS measures (travel time and/or on-time performance).
The GDC consultant team, together with RouteMatch representatives, have developed two separate analyses. In each analysis, RouteMatch would retain sole access to the raw data and would provide summary information to the GDC consultant team and TCG member agencies.
Under Analysis 1, RouteMatch would utilize one week's worth of empirical data for a sampling of systems providing all RHST agency trips. Baseline performance will be developed for this "bundled" scenario. RouteMatch would then take out HST agency (DHS and DCH) trips and recalculate the same performance measures, yielding performance results for a lesser bundled, and unbundled system. This will necessitate using RouteMatch's trip optimization software to create the adjusted "run structures". Under the second analysis, only empirical data will be used, and the performance of systems that provide only rural public transportation will be compared against those that bundle trips for some or all RHST agencies. Further details are below.
Analysis 1 Methodology
The first step of this analysis is to identify those rural public transportation providers who are also providing DHS transportation service and Medicaid NET (thus, Type 4 from the above chart). RouteMatch staff identified 11 such service providers. These will be categorized into three, representing small (under 100 trips/day), medium (100-250 trips/day), and large (over 250 trips/day) systems.
The second step is to collect the same five weekdays of data for each system. The third step is to document the following "baseline" performance statistics, for each of the three Type 4 systems:
Trips per revenue vehicle hour -- as a common metric of service efficiency.
On-time performance -- as a common metric of LOS. On-time performance is measured in RouteMatch as the percentage of times that a customer was picked up and dropped-off within the locally-specified pick-up and drop-off window. This will be measured for each of the three groups of customers (i.e., rural public transportation, DHS, and Medicaid NET). 25
On-board travel time performance -- as another common metric of LOS. This will be measured as the ratio of actual travel time to the RouteMatch-calculated direct travel time. This will be measured for each group of customers.
The fourth step is to strip out the Medicaid trips (thereby "creating" a Type 2 provider). After the Medicaid trips are removed, RouteMatch analysts will perform a fifth step in which they will optimize the new "run structure"
25 DBHDD customers can be considered a fourth group, but are grouped under DHS here since DHS provides transportation services for DBHDD via MOU and since RouteMatch has no DBHDD-specific data (only DHS).
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GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report - Appendices

(containing only rural public transportation and DHS trips). Once this step is completed, all three metrics above will be documented for each service provider for their set of days.
The sixth step is to further strip out DHS trips (thereby creating a Type 1 provider) and undertake the same methodology as above, documenting the resulting productivity and service quality metrics for each day for each system.
The final step will be to compare the productivity and service quality metrics of each of the three systems for the week's worth of data.

Analysis 2 Methodology
This analysis compares service efficiency and LOS data from all rural public transportation providers where RouteMatch has been installed (65 installations). It utilizes six months of real data, thus no modeling (such as that which is undertaken in Analysis 1) is required.
The first step is to take all of the service providers that currently have RouteMatch and divide them up into Type 1, 2, 3 and 4, as defined in the table above. This is shown in the table below.

Table B.2: Types of Rural Public Transportation Providers in Georgia

Agencies Trips
Vehicles

Type 1: 5311 Only

Type 2: 5311 &
DHS

Type 3: 5311 &
DCH

Type 4: 5311, DHS
& DCH

18

35

1

11

615 5403

90

2073

50

299

6

1722

Source: RouteMatch Analysis, Spring 2013

Totals
65 8181 2077

The next step is to compare the service efficiency (trips per revenue hour) and LOS performance (on-time performance) for Types 1, 2 and 4. Type 3 will not be evaluated given the small sample size. Note also that only ontime performance will be used as a service quality metric since there will be no modeling as part of the analysis. The analysis must rely on tracked service quality metrics, and the only service quality metric that is currently tracked for all data is on-time performance.

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Appendix C: FY 12 Detailed RHST Program Costs

GOVERNOR'S DEVELOPMENT COUNCIL Coordinating Rural and Human Services Transportation in Georgia
2013 RHST Report - Appendices

Table C.1: FY12 Detailed RHST Program Costs

Agency Funding Program

Operations

Federal

State

Local

DCH Medicaid NET Totals $58,229,278 $24,955,405

FTA 5311

$12,498,508

$12,498,508

GDOT

FTA 5316 FTA 5317

$2,399,963 $299,400

$2,399,963 $299,400

GDOT Totals

$15,197,871

$15,197,871

Dept of Behavioral

Health &

Developmental Disabilities - Social

$7,408,222

$0

$2,636,567

Security Block

Grants (SSBG)

Temporary

Assistance for

$5,656,076

$0

$0

Needy Families

FTA 5310

$2,646,724

$0

$0

DHS Revenue Contracts (County and DOT)

$3,304,213 $1,963,823

$0

SSBG (Div of Aging) $2,784,717 $133,117

$0

Title IIIB (Div of Aging)
GA Vocational Rehab Agency
Aging State (includes CBS)

$1,848,529 $273,913

$764,669

$0

$0

$0

$52,299 $0
$133,176

DHS Totals

$24,413,150 $2,370,853 $2,822,042

GDC FTA 5307 Totals

Total $83,184,683 $24,997,016 $4,799,926
$598,800 $30,395,742
$10,044,789
$5,656,076 $2,646,724 $5,268,036 $2,917,834 $2,174,741 $764,669 $133,176 $29,606,045

State Administration

Capital

State $152,979
$509,043
$509,043

Federal
$3,744,221 $1,077,627 $103,992 $4,925,840

State

Local

N/A $468,028 $468,028 $134,703 $134,703

$12,999 $12,999

$615,730 $615,730

$1,737,061 N/A
$1,737,061 $110,836

Totals

Total

Federal

State

Local

Total

$4,680,277 $1,347,034

$58,229,278 $25,108,384 $16,242,729 $468,028 $12,966,536 $3,477,590 $134,703 $2,534,666

$83,337,662 $29,677,293 $6,146,960

$129,990 $403,392 $12,999 $312,399

$728,790

$6,157,301 $20,123,711 $1,124,773 $15,813,601 $37,062,086

N/A

$24,413,150 $4,107,914 $2,822,042

$88,669

$22,167

$31,343,106 $110,836

Total $97,840,299 $27,326,258 $18,019,913 $143,186,470

$2,509,919 $4,925,840 $615,730 $615,730 $6,157,301 $102,854,808 $30,363,238 $18,635,643 $151,853,690

Source: GDOT, DHS, DCH Staff, Spring 2013

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