Forum/Town Hall: O'Mara Hosts Albany Roundtable on 'Major Change' Underway in Rural Transportation

1 ROUNDTABLE DISCUSSION HELD BY

THE NEW YORK STATE SENATE 2 STANDING COMMITTEE ON TRANSPORTATION 3 ------------------------------------------------------ 4 FORUM/TOWN HALL: 5 O'MARA HOSTS ALBANY ROUNDTABLE ON

'MAJOR CHANGE' UNDERWAY IN RURAL TRANSPORTATION 6

------------------------------------------------------ 7 8 Senate Capitol Building

172 State Street, Room 124 9 Albany, NY 10 May 6, 2013

11:30 a.m. to 1:00 p.m. 11 12

PRESIDING:13

Senator Thomas F. O'Mara 14 Chair 15 16 SENATE MEMBERS PRESENT: 17 Senator Elizabeth Little 18 Senator David Valesky 19

ASSEMBLY MEMBERS PRESENT:20

Assemblyman William A. Barclay 21

Assemblyman Gary D. Finch 22

Assemblyman Joseph M. Giglio 23

Assemblywoman Barbara Lifton 24 25 1 ROUNDTABLE PARTICIPANTS: 2 James Arey

Director 3 Elmira-Chemung Transportation Council 4 Terry Inkawhich

Director, and Treasurer 5 Birnie Bus Service/Tours, Inc. 6 Michael DeRaddo

Director, Transportation Department 7 Ontario County, New York 8 Jeanette Frank

Executive Director 9 The ARC of Schuyler County 10 James Gorman

Regional Director 11 First Transit, Inc. 12 Shelley Gray

Ontario County Department of Finance Departments 13 Representing Ontario County Social Services Dept. 14 Christine Kraemer

Director 15 Schoharie County Public Transportation 16 Sarah Meredith

General Manager 17 Ontario County, New York 18 Janelle Reome

Director 19 Franklin County Department of Social Services 20 Amber Simmons

Schuyler County Mobility Manager 21 Working at the ARC of Schuyler 22 Karen Sullivan

Director 23 Otsego County Planning & Solid Waste Department 24 Psalm Wyckoff

Planner 25 Otsego County Planning & Solid Waste Department 1 SENATOR O'MARA: All right, good morning. 2 I'm Senator Tom O'Mara. 3 Sorry I'm late. I'm a little out of breath, 4 I just ran over here. I had a long trip this 5 morning. 6 But, I welcome you all here to Albany. 7 Thanks for coming to participate in this roundtable 8 on this, I think, issue of concern to many of us on 9 our transportation systems, particularly in our 10 counties, and where these regulations on 11 non-emergency Medicaid transportation come down. 12 We had invited the Department of Health to be 13 here today; however, they declined to come. 14 They say they've been in discussions with 15 some of the providers, but I'm not sure who. 16 If anybody here has been in discussions with 17 them, I'd be interested in hearing your input on 18 where they're thinking about going with this. 19 But without, you know, further taking up your 20 time, we'll get right to it here, and open up the 21 discussion. 22 I welcome my colleagues here. 23 We've got Senator Valesky, 24 Assemblywoman Lifton, Assemblyman Giglio, 25 Assemblyman Finch, and Assemblyman Barclay there. 1 Do you guys have seats? 2 UNKNOWN MALE SPEAKER: We do, but we have to 3 go to another meeting. 4 SENATOR O'MARA: All right, well, thanks for 5 being here. 6 Let's -- Dave, do you have any opening 7 remarks? 8 SENATOR VALESKY: Just to, I appreciate you 9 taking the leadership in setting up this roundtable. 10 I know it's been an important issue, that's 11 being led by the Health Department, so it's 12 disappointing that the Health Department is not 13 here, but, we, as legislators, are very anxious to 14 be as helpful as possible as the process moves 15 forward. 16 So, we also have Senator Little joining us as 17 well. 18 SENATOR O'MARA: Sorry, Senator Little is 19 joining us as well. 20 SENATOR LITTLE: You're sorry I'm here? 21 SENATOR O'MARA: No, I'm sorry I overlooked 22 you, Betty. 23 SENATOR LITTLE: That's okay. 24 SENATOR O'MARA: I'm glad you're here. 25 SENATOR VALESKY: So we look welcome forward 1 to hearing your comments and suggestion and ideas of 2 how we can helpful. 3 Thank you. 4 SENATOR O'MARA: Barbara. 5 ASSEMBLYWOMAN LIFTON: Oh, thank you, 6 Senator. 7 No, I'll just say, thank you for convening 8 people to -- I'm really just here to listen and 9 learn. I'm sort of new. 10 I've been wondering how things are being 11 implemented; what the changes are going to mean for 12 local people. 13 So, I just welcome the discussion and honest 14 feedback from folks in the trenches. 15 Thank you, Senator, for convening this 16 roundtable. 17 SENATOR O'MARA: Senator Little. 18 SENATOR LITTLE: Yeah, thank you very much. 19 I happened to stop at my Glens Falls office 20 this morning, and one of the issues that's been 21 presented this week was, a woman in a rural area, 22 Grandville, New York, having to take her 4-year-old 23 son for medical treatment to Albany Med. 24 It was costing $160 for a taxi to take her 25 back and forth. And, she was told she needed to 1 take a bus, and transportation here and there and 2 the other thing, would take her several hours to get 3 to Albany in that rate. 4 So, I do think that it's an issue of 5 importance, and there certainly is a better way to 6 do things, and that's what we're looking for. 7 So thank you for having this. 8 SENATOR O'MARA: Joe? 9 ASSEMBLYMAN GIGLIO: Same thing; I'm here to 10 listen. 11 Most of my district, actually, is in 12 Western New York. 13 I just moved into Steuben County, so I'm new 14 to this. 15 Medicaid is something we've worked on very 16 hard. We've worked to try to save money at it. 17 You guys know it's the biggest cost-driver 18 for all the counties in the state of New York. 19 So -- and transportation is one of the places 20 we found in other parts of the state were rampant 21 with fraud. 22 So, a lot of those things we need to find out 23 is: 24 What's the best way to do it? 25 How to make sure people in rural districts 1 like ours are able to get to the services they need 2 at a cost that doesn't bankrupt the counties. 3 So, thank you. 4 SENATOR O'MARA: Why don't we just go around 5 and everybody just introduce yourselves, and where 6 you're from, and your interest here. 7 We'll start with you, Jim. 8 JIM AREY: My name is Jim Arey. I'm 9 representing Chemung County. I'm director of the 10 Elmira-Chemung Transportation Council. 11 I provide transit oversight for 12 Chemung County. 13 KAREN SULLIVAN: I'm Karen Sullivan. I'm the 14 director of the Otsego County Planning and Solid 15 Waste Department, which doesn't have the word 16 "transportation" in it, but we oversee the 17 transportation system for the county, which we 18 contract out. 19 PSALM WYCKOFF: My name is Psalm Wyckoff. I 20 also work in the Otsego County Planning Office, with 21 Karen. 22 Also working with our transportation 23 providers, which we have several. We have very a 24 coordinated system that makes it kind of unique. 25 AMBER SIMMONS: I'm Amber Simmons, 1 Schuyler County Mobility Manager, working at the 2 ARC of Schuyler. I help coordinate transportation 3 within the county. 4 JEANETTE FRANK: Jeanette Frank, executive 5 director with the ARC of Schuyler, and I think we're 6 an example of one of those unusual partnerships that 7 has occurred to coordinate transportation. 8 We are the county public-transit operator. 9 TERRY INKAWHICH: Terry Inkawhich, 10 Birnie Bus. 11 We provide transit services under contract 12 with Otsego County, Lewis County, Herkimer County, 13 and we do fee-for-service work in Herkimer and 14 Oneida County. 15 SHELLY GRAY: Shelley Gray. I'm with 16 Ontario County, Department of Finance Departments. 17 And I'm here, really, listening in, 18 representing the Social Services Department in 19 Ontario County. 20 SARAH MEREDITH: I'm Sarah Meredith. I'm the 21 general manager for Ontario County. [Inaudible]. 22 MIKE DeRADDO: I'm Mike DeRaddo. I'm the 23 transportation director for Ontario County, and will 24 receive a contract for a public transit; plus, also, 25 in Medicaid and Social Services and [inaudible.] 1 JANELLE REOME: I'm Janelle Reome. I run 2 Franklin County Department of Social Services. 3 I'm the director of financial assistance, 4 which I also oversee the transportation piece. 5 JIM GORMAN: I'm Jim Gorman, regional 6 director for First Transit. 7 We operate public transportation and 8 non-emergency Medicaid transportation in several 9 New York counties. 10 SENATOR O'MARA: Thank you all for being here 11 this morning. 12 Again, I apologize for being late. 13 The -- it's important that you come and -- to 14 spend the time here. 15 Many of you have traveled a great distance to 16 be here, and we truly appreciate that. 17 With these proposed regulations, it's been 18 difficult for us to get any real information on 19 what's going on, or what the direction of the 20 Department of Health really is going to be here, and 21 what that impact may have on your transportation 22 systems at the county level, as many of the 23 counties' transportation systems I think are 24 intertwined with the various types of transportation 25 being offered. 1 And, I think it's important that that's 2 coordinated as best that we can in our counties, to 3 have the most efficient and cost-effective 4 transportation system, and provide this needed 5 transportation that we have. 6 So, you know, I'm interested in hearing from 7 all of you on how you're doing things now; and, in 8 particular, if anybody has been in contact with the 9 Department of Health in their process of going 10 through these regulations, on how that process has 11 gone for you so far. 12 So if there's anyone that would like to kick 13 it off and just -- we're going to have a dialogue 14 here. 15 KAREN SULLIVAN: I am going to speak up 16 first, if that's all right. 17 SENATOR O'MARA: Yes. 18 KAREN SULLIVAN: We have been contacted by 19 the State Department of Health, and they did come 20 down to Otsego County at our request. 21 We worked closely with Christine from 22 Schoharie County, and they're already under the 23 centralized answering system. 24 So we're -- we have concerns with our system 25 as it runs now, and, the State did come down and 1 explain to us that, at first, we thought it was an 2 optional thing. 3 Otsego County, we've had a coordinated system 4 with DSS. Our contract is an EMT, as well as our 5 public service. 6 And the incentive for our provider is to put 7 as many Medicaid trips on our public system as 8 possible to reduce those taxi fees and costs. 9 We have worked closely with them, to help to 10 coordinate trips out of our county, to Albany, to 11 Binghamton, so that we're providing service as a 12 group trip. 13 Instead of a -- one, you know, individual 14 going three times a day, we may go two times a week, 15 and try -- and encourage these people to schedule 16 their appointments accordingly. 17 So, when the State came down, we were only 18 made aware that, all of a sudden, Otsego County is 19 going be mandated to be part of this system, about a 20 year ago, and we began to have concerns with that 21 because our DSS is an underwriter for our system, so 22 they contribute part of the cost, as well as our 23 Stow and our 5311 operating systems. 24 So the county is run efficiently, utilizing 25 DSS's Medicaid trips as part of our system, as long 1 as we can put them on our public system. 2 So, the general sense of the meeting was 3 that, first of all, we don't have a choice; 4 Second of all, that they will come down and 5 talk with us before the contract -- the RFP is 6 issued and the contract is negotiated, to make sure 7 that the answering service is well aware of our 8 rural transportation system. 9 And, in the transportation world, you will 10 find everybody does things a little differently. 11 Our provider is through a contract, but we 12 have shared services with ARC; we have three routes 13 that are ARC contracted as well, just for the 14 county. 15 So we do things a little different than 16 Schoharie and Ontario, so, everybody's a little 17 different. 18 Our concerns with the centralized answering 19 system is, first of all: What is the incentive for 20 that answering system to make this the most 21 cost-efficient route? 22 When our current contract gets a phone call 23 from Medicaid, they're going to look at our public 24 system and see: How can we coordinate this into a 25 public system and get them to -- Point A to B 1 utilizing a bus? 2 Will they have that incentive before them? 3 I think, basically, their incentive, and 4 correct my if I'm wrong, Christine, is, basically, 5 to get the person from A to B regardless of the 6 cost. 7 So what we have heard through Christine, and 8 other counties, is that, when the customer hears 9 that they can get a door-to-door service, they'll 10 schedule their appointments accordingly so they 11 don't have to take the public service because, with 12 public service, you have waiting, and you have to be 13 flexible and you have to be patient, more with a 14 public system than they do with a taxi service, so 15 that, they are now learning that, if they make an 16 appointment for a Friday afternoon at 3:00, they may 17 not be able to -- they know they can't get on a 18 public system, so they get a door-to-door service. 19 My concern, as a taxpayer, is, I'm not sure 20 this is going save money. 21 Our incentive is to keep the cost down 22 because our contractor has a contract with us, and 23 it's his incentive to put these people on as many 24 public systems as they can to save the cost of a 25 private transport. 1 So we are in the process now of the RFP. 2 Someone just mentioned Madison County has 3 been notified that they have a week -- a month 4 before the system will be implemented. 5 We feel very distant from the 6 Department of Health as to what's going to happen. 7 We feel that they will have very limited time 8 to understand what our needs are, to understand the 9 system completely, to understand how we work with 10 DSS, how we work with ARC, and to understand that we 11 try to coordinate our Medicaid onto our public 12 system as much as possible. 13 I'm really concerned that I don't know how 14 the cost is going to be; where the cost savings is 15 going to be reflected. 16 So we're in transition. We're preparing for 17 that. That's why we're here today. 18 We're only -- thanks to Mike DeRaddo, we 19 weren't aware of this meeting, so, Mike shot us an 20 e-mail Friday, and we made it a point to be here 21 because we are concerned. 22 So, I feel like it is something that we have 23 been -- it's been placed before us, we have to 24 accept it, and we have to move forward, but, I 25 really feel that the -- there's going be some 1 growing pains with that, in regards to losing the 2 personal contact that we now have with our 3 customers. 4 SENATOR O'MARA: Has the Department of Health 5 indicated anything to you with regards to the cost 6 savings, and, is that part of the discussions 7 they've had with you at all? 8 KAREN SULLIVAN: No. 9 SENATOR O'MARA: All right. 10 That's very concerning because, obviously, 11 this is a mandate service that you must provide, 12 and, if this is going result in increased costs, 13 that's a concern for all of us, with the 14 efficiencies we need to get in this very expensive 15 system. 16 KAREN SULLIVAN: The other concern I have is 17 that, I asked the question to Tim Perry-Coons [sic] 18 who is paying the MAS's servicing to Schoharie and 19 Delaware. 20 I asked him, "Who is paying MAS?" 21 "Well, the State is paying it." 22 Ultimately, I have a feeling that burden's 23 going to come back to the counties that are 24 utilizing the system. 25 So, you've added another layer of -- onto the 1 process. 2 Someone else is paying it now, but I think, 3 ultimately, it might come down to the county having 4 to take that responsibility on, and pay for an 5 answering service that we didn't really need. We 6 were functioning without it. 7 SENATOR VALESKY: What was the time 8 [inaudible]. 9 KAREN SULLIVAN: We're supposed to be early 10 spring. They're supposed to be implementing 11 Otsego County early spring, but we haven't heard or 12 talked to them since December. 13 SENATOR O'MARA: Since December? 14 SENATOR VALESKY: December? Hmm. 15 TERRY INKAWHICH: Senator, Bernie Bus 16 operates the system in Otsego County, a portion of 17 the system. We've been lucky enough to do that for 18 ten years. 19 And as I understand, the system really 20 started when the DSS took a look at how much it was 21 currently paying for transportation under their 22 model, which was taxi service, and they put out an 23 RFP to consolidate that transportation. 24 And it was -- it needed to be 5 percent less 25 costs in order for a waiver to be issued in the 1 county, which is how this system really started in 2 Otsego. 3 Otsego County put out that RFP. 4 The transportation for that service didn't 5 meet the "5 percent less" stipulation, and the 6 county system kind of was spawned out of that 7 change. 8 And ever since that time, the county has 9 solicited other transportation providers, ARC, 10 employers in the county. They have tourism that's 11 kind of wrapped around the transit service. 12 So it's a very mature system, where they took 13 that first leg of the stool, which was DSS, and 14 then, over a period of time, they actually added 15 other agencies and services to the elderly to it. 16 So it's a very mature system. 17 And I would think, based on the origins of 18 the system, it met that "cost-effective" threshold 19 when it was started. 20 We have had a meeting in Madison County, with 21 the Department of Health, who is prepared to take 22 over Madison County, whose system isn't as mature as 23 Otsego's. The first part of June is when that call 24 center is supposed to be in place. 25 SENATOR O'MARA: That's for...? 1 AMBER SIMMONS: For Madison County. 2 SENATOR O'MARA: Okay. 3 TERRY INKAWHICH: Madison County has a 4 transit system that is integrated in with the 5 Medicaid transportation. 6 Not like -- Karen said, every system is a 7 little different, so the integration takes place a 8 little differently, but, that's scheduled to be 9 transitioned first. 10 SENATOR O'MARA: So they've then gone through 11 the RFP process in Madison County? 12 Or, how are they getting to the point where 13 they're going start this June 1st? 14 TERRY INKAWHICH: It didn't sound to me as if 15 they had gone through the entire awarding process of 16 the RFP, but they -- it sounded as if they were 17 going to be ready to go by June 1st. 18 SENATOR O'MARA: How do you currently handle 19 the calls for this non-emergency Medicaid 20 transportation? 21 KAREN SULLIVAN: Our provider answers, takes 22 those calls. 23 So, we have a dispatch located in 24 Richfield Springs. Medicaid call comes in, they get 25 clearance through eMedNY, and then she coordinates 1 the trip. 2 JIM AREY: It's the same in Chemung County, 3 in that, First Transit, who's contracted to 4 Chemung County to provide the service, also runs the 5 brokerage, which is where the clients call to get 6 their services coordinated. 7 And I think, as other folks have mentioned 8 here, non-emergency Medicaid, in some cases it was 9 is the first leg of the stool, in some cases it was 10 the last leg of the stool. 11 But, coordinating transit service is very 12 important to making it work; otherwise, you've got 13 individual silos built, each one funding something 14 where you have a bus with one person on it. 15 And the counties, we've been working very 16 hard to double-up, and the rural areas get double 17 and triple the passengers on it, to make it 18 economically viable. 19 To talk about going back to a system that 20 does -- you know, a provider providing one trip for 21 one person, I don't see how that can be 22 cost-effective. 23 In Chemung County, we already have the 24 brokerage set up. 25 There's the central system to call in, where 1 people are advised of what their transportation 2 alternatives are. 3 And the brokerage is set up, so the private 4 operator looks for the least cost but the most 5 effective service. 6 That's already there. 7 To think that someone in a distant location 8 knows our transit routes well enough to know that 9 somebody could be provided with this service on an 10 existing fixed route, I doubt that they could do 11 that. 12 Maybe it's a walk of, you know, a block, or 13 half a block, to get to where the fixed route comes 14 in. 15 Are they going to know that in some distant 16 location? 17 I just don't see it. 18 I mean, there are 23,000 passenger trips for 19 non-emergency Medicaid in Chemung County that were 20 provided by the fixed-route service; the existing 21 fixed-route service. 22 That's got to be a cost savings. 23 So I would encourage the Department of 24 Health, they've made some signs, and some talk, 25 about not hurting the existing services. 1 Well, this is a case where we're basically 2 providing what they're saying is needed. 3 Why would we replace that with something 4 distant? 5 It doesn't make sense to me. 6 ASSEMBLYMAN GIGLIO: Have they done any 7 review of what you're doing currently, or are they 8 just throwing this in your lap? 9 JIM AREY: They know what we do, and they 10 know how we do it. 11 I mean, we've changed over the years, as 12 they've requested us, to a fee-for-service, so the 13 individual billing is done for each individual. 14 The one time we had a consolidated contract. 15 Now we do the billing for each individual, 16 and the County pays for the brokerage separately, 17 which is what they asked us to do. 18 So they're aware of what we do. 19 I'm not aware that they have said, This is 20 something we'll keep in place. 21 ASSEMBLYMAN GIGLIO: Have your costs gone up 22 at any point? I mean, skyrocketed? 23 Anything different than the normal curve? 24 JIM AREY: No. 25 No. 1 We've worked within what we had in terms of 2 costs, as best we can. 3 It's a little difficult, frankly, in past 4 year, to keep track of it, since we don't have some 5 of that billing anymore, because it's -- once it's 6 farmed out to a taxi, we don't see that billing 7 coming in. 8 So that's one of the difficulties, in terms 9 of us managing. 10 But in terms of trying to control those 11 costs, we still have the up-front, to say: It comes 12 in, this person can be handled on a fixed-route 13 service. It goes from where they are to the 14 health-care provider, or to the hospital. 15 That trip is there, you know. 16 And the next thing we're going to look at is 17 our own demand response for service. 18 We just spent $100,000 getting dispatch 19 software -- using the federal government's money to 20 get dispatch software, so that we could get 21 coordinate those trips, and try and get, you know, 22 the second and third person on the trip. 23 So, I don't know what they're going to do 24 that we're not already doing on a local basis, where 25 that software will tell us: A to B, and this one 1 over here is C. We can make the trip in a 2 reasonable time frame and take two people. 3 I guess I'm saying, very clearly, we have a 4 system that works. We've invested the time and the 5 money to make sure it works. 6 Give us the opportunity, that you don't come 7 in and replace with it something that's far distant, 8 and at the very least, would take a multitude of 9 time to get back to where we are right now. 10 SENATOR O'MARA: Has there been any 11 indication in your discussions with the 12 Department of Health on making sure that what 13 they're going to do is going to result in lower 14 costs, or, they're going to make the effort to put 15 these passengers on your fixed-route transportation? 16 JIM AREY: Frankly, no. 17 ASSEMBLYWOMAN LIFTON: Was there any -- if I 18 could ask: Was there any consultation with any 19 County or county health department about the needs, 20 or what concerns people had, at the local level 21 during the MRT process, that anyone's aware of? 22 MIKE DeRADDO: Not to me. 23 I'm Ontario County; Mike DeRaddo. 24 We're also a self-coordinated county. 25 We have a one-stop, one number, for all 1 riders, regardless of funding source, that calls in. 2 It goes into our provider, which is MV. 3 And if it's a Medicaid provider, then they'll 4 transfer that over to my county offices, and I have 5 a call center who does the pre-authorization piece, 6 that represents the government and the State, in 7 making sure that these are actually verified 8 validity, Medicaid-authorized, approved trips. 9 Put it in our routing software, and then our 10 contract provider schedules and bundles all of the 11 rides. 12 It's a symbiotic relationship with our social 13 services, ROFA. 14 We also have senior-citizen homes that call 15 in and coordinate, and the VA. 16 It's all one number. 17 And all they know is, they're being 18 transferred to pre-authorization. They don't know 19 where that's going, and it goes back. 20 So [unintelligible] maximize load, gain 21 efficiencies, reduce costs. 22 Then, the symbiotic relationship, you take it 23 out and you make a silo effect, clearly, you're 24 raising costs. 25 DOH came to us. We had a meeting in October. 1 Mr. Tim Perry-Coon and Ms. Heidi Seney, 2 very nice, said all of the right things. 3 Bottom line, at the end, quote, "Once the 4 regional manager is selected, then specific routes 5 will be determined on trips." 6 Our biggest concern: 7 Two weeks ago, I was here in Albany at 8 another workshop, and I was talking to a gentleman 9 from Ulster County. And, they have already 10 transitioned, and I did not get into the specifics. 11 They had a significant decrease in Medicaid 12 trips per day. They went from about 900 to 13 40 Medicaid trips. 14 Now, that's what this gentleman told me. 15 Bottom line is: 16 If Ontario County, we average about, 180, 17 181 Medicaid trips on our demand. We have 18 countywide demand response, 15 fixed routes. 19 Seven of them are cabs, plus, we also have a 20 contract with our ARC. We partner with ARC, and we 21 utilize eight those fixed routes to reach into the 22 netherlands of the county, plus countywide demand 23 response. 24 If we experience a significant decrease in 25 the amount of a trips, amount of riders, clearly, 1 there will be a significant loss in services. 2 First thing to go would be countywide demand 3 response. 4 SENATOR O'MARA: Countywide...? Excuse me? 5 MIKE DeRADDO: Countywide demand response; 6 Dial-A-Ride. 7 SENATOR O'MARA: Okay. 8 MIKE DeRADDO: Which, that's where we bundle 9 our general public and we maximize load. 10 We've actually done flex routes, as opposed 11 to onsies, twosies. 12 Obviously, we try to maximize to save costs. 13 First thing to go would be the demand 14 response countywide, and we'll look at the fixed 15 routes. 16 And, I envision us seeing a reduction in the 17 fixed routes. We may be down significantly with 18 those. 19 We cannot, in Ontario County, sustain that 20 kind of loss in the amount of trips. 21 Right now, we're on a cost-sharing method. 22 I contract through our social services, and 23 the cost-sharing method, so the amount of riders 24 that are Medicaid is cost-shared and analyzed out 25 through our contract. 1 And that's how we do it. 2 So, I mean, it's a huge concern. 3 First thing, just like Ms. Sullivan said, 4 when they came on October 1st, first words out of my 5 mouth, and it still holds true, "Ontario County does 6 not volunteer in this program." 7 We were told this is a volunteer program. 8 And it's great a tool for those counties in 9 those systems that (a) don't have it, or require it. 10 But for a mature self-coordinated county, 11 such as Ontario County, man, we're doing that 12 already. 13 We're vendoring out, we're outsourcing, when 14 we can't do it. We're already outsourcing and 15 vendoring to other transportation providers. 16 We don't -- you know, success, my 17 understanding, downstate is, they shift a lot of 18 their trips, basically, to the cabs; taxi companies. 19 So, yeah, that's a success. Great. 20 Yeah, they might meet their -- DOH might meet 21 their financial-reduction-goal target, and I'm for 22 that, as a taxpayer. 23 But to arbitrarily shift them all to private 24 taxi companies, and I -- I ask you to ask the 25 Department of Health, go beyond the taxi companies. 1 After they say we've met our downstate goal, 2 anything upstate is more money, cash in the hand, 3 which is great, which is at our cost, ask them, 4 "Okay, great. If it's such a success," ask them 5 about the private transportation companies, the 6 other transportation companies and vendors that out 7 there that have a significant decrease in 8 [inaudible] trips. 9 Go beyond. 10 Just shifting them to private taxi companies 11 in the rural community, we don't have all that. 12 SENATOR O'MARA: Right. 13 MIKE DeRADDO: We do have some. 14 We also -- you know, we try to maximize, and 15 go from our demand response, to -- and put them on 16 the fixed route as much as we can. 17 And -- that's just it. 18 They're saying all the right things; 19 And, of course, their goal is cost reduction; 20 And, of course, they're going to maintain our 21 cost share; 22 And, of course, they're going to -- you know, 23 they're going to work with us. 24 Devil is in the details, [inaudible]. 25 And, I have been in e-mail contact with 1 Ms. Heidi Seney from DOH, and she has been sending 2 out emails, as far as the status of: 3 We want to know: 4 Okay, who got the contract, who won the bid? 5 So, who do we need to -- and when can we get 6 on the schedule for the -- just for the sake of 7 argument, I'll call it "MAS?" 8 They're a vendor that's predominately medical 9 answering services. 10 We'll say: Okay, if they get the bid, MAS, 11 okay, when can we get into the timeline of them 12 coming down and working out the details? 13 And how is this going to save us money? 14 How is it going to be cost-effective? 15 None of that has -- obviously, they've 16 been -- per the e-mails, it's been on hold, until 17 they get the official authorizations released, 18 whatever. 19 That's the truth as I know it. 20 JIM AREY: I think the other thing, looking 21 at it, is that, the assumption that we can switch 22 all of these trips to taxis isn't realistic in many 23 upstate areas. 24 Totem Taxi is our only taxi provider in 25 Chemung County. 1 How are they going to handle 2 20,000 additional passenger trips in a year? 3 They don't have that capacity. 4 You know, I'm sure they would like to think 5 that they could handle that many, but they don't 6 that capacity. 7 I'm not sure that there are that many 8 slightly used vehicles that they could purchase. 9 And, frankly, how safe would it be, if we're 10 only looking at the cost, that -- understand, we're 11 looking at all sorts of federal and state 12 regulations that we comply with to make sure that 13 these people are safe in that trip. 14 You don't have that oversight on the taxi 15 system. 16 I'm not saying, therefore, don't do it. 17 I'm saying, understand, with the limited 18 number of taxi operators that we have upstate, they 19 can't assume a huge growth in ridership without 20 experiencing tremendous growing pains, at the very 21 best, you know. 22 And, we've done a lot of work to have 23 coordinated systems; to put together those 24 patchworks of ARCs, of Office for the Agings, of 25 other groups coming together, to make sure their 1 riders are in a -- given trips in a coordinated 2 fashion. 3 Are we to abandon that and build a silo again 4 that's only for non-emergency Medicaid? 5 I think the other thing is, I would like 6 Schuyler to talk about the potential service they 7 have, that would go from Schuyler County to 8 Chemung County, that serve both residents, that, 9 frankly, we look at and say, It can't happen under 10 this new approach. 11 JEANETTE FRANK: Yes, thank you. 12 I agree, this is definitely a step backwards 13 rather than a step forward. 14 We were the non-emergency medical 15 transportation provider for Schuyler County for 16 probably 20 years, but it had to be handled as a 17 separate contract. 18 We could not allow other people to ride that 19 same bus because of regulations. 20 And, it was through the coordinated 21 transportation planning committees and plans that 22 ended up evolving 2007, 2008, that it said: 23 Agencies had to come to the table with 24 public-transit providers and look at, How could we 25 share those rides? 1 How could we put somebody else on that bus 2 that had somebody that had a Medicaid card? 3 And, it was through that that this concept of 4 cost-sharing was allowed by the Department of 5 Health, and that was a major breakthrough. 6 So, it meant that it actually reduced 7 Medicaid's cost, because now that run that was 8 specifically taking people with Medicaid to the 9 doctor, could be opened up to the public, and 10 Department of Transportation could share in that 11 cost, and, now you had a public system where a 12 public system did not exist before. 13 Schuyler County did not have public 14 transportation until 2010, when this cost-sharing 15 formula became available, to allow the sharing of 16 those rides. 17 And as Jim said, that has also grown, where, 18 now, some of the ARCs' transportation systems are 19 opened up to public; again, reducing costs, because 20 you're already running that route, bringing in 21 additional income through Department of 22 Transportation, and, providing a public service 23 where a public service did not exist before. 24 The run that -- we were ready to expand our 25 service area, Schuyler County is a very small little 1 rural county. Many people have to go out of county 2 for doctors' appointments for specialists. 3 And we have a Medicaid run that we currently 4 provide to Chemung County, that we were ready to 5 cost-share and make that a public run. We had all 6 the approvals to do that. 7 At this point, we do not feel we can make 8 that expansion happen, because we believe that the 9 non-emergency medical transportation that would 10 underline the costs of that is in jeopardy; that 11 that could end up being farmed out to a taxi 12 service, or someone who is not interested in public 13 transit. 14 So, we have put that plan on hold. 15 That would also not only expand to doctors' 16 offices and expand medical transportation access for 17 people in Schuyler County to Chemung County, but it 18 would also, by being a public run, provide 19 opportunities for people who wanted to do shopping, 20 for people who wanted to find employment. 21 So it really is, by pulling that Medicaid 22 transportation away from these coordinated systems, 23 it really -- honestly, it could put the 24 public-transit system out of business, and, all of a 25 sudden, we are back to where we were in 2007. 1 And it also flies in the face of what's 2 called "Olmstead." 3 There is a plan that is supposed to be 4 presented to the Governor in May, I believe, that 5 talks about, How do state agencies coordinate? 6 And this just seems to just -- and 7 transportation is such an integral part of 8 coordination. 9 If we're going to have people live in most 10 integrated settings, which are low-cost options, 11 they still need to be able to get to doctors' 12 offices, to shopping, to work, to social 13 opportunities. 14 So, it just seems like it was a good idea at 15 the time, but I think its time has already come, and 16 it doesn't really fit with some of the other 17 planning that I believe the State is -- and the 18 Governor, needs to be doing. 19 SENATOR O'MARA: Has the Department of Health 20 indicated to any of you that the -- that your 21 public-transportation system that you have in place 22 now would be the first choice for this call center 23 to go to, to arrange the ride? 24 Or -- 25 MIKE DeRADDO: Like I said, [unintelligible] 1 saying all the right things, I was told that. 2 PSALM WYCKOFF: I remember, back in December, 3 Tim Perry-Coons [sic] came to Otsego County, and he 4 talked about this. 5 And we asked, specifically, if our 6 public-transportation system could be the first ride 7 of choice. 8 And they said, they could probably do that 9 for the first couple of months during the transition 10 period, and that was as far as they could commit. 11 SENATOR O'MARA: Did they indicate what they 12 were going to transition into? 13 PSALM WYCKOFF: They did not. 14 SENATOR O'MARA: We've got, I think, two 15 transit companies here, Birnie and First Transit? 16 What is -- you already spoke a bit, Terry, 17 about yours. 18 But, Jim, in the areas that First Transit 19 serves, what involvement, if any, has your company 20 had with the Department of Health on this issue? 21 JIM GORMAN: I have met with commissioners -- 22 social service commissioners from Cortland, from 23 Chenango, and Yates County, and they have all the 24 problems that you've heard here this morning. 25 And in addition, they don't have providers to 1 provide the services. 2 If the public transit isn't in the counties, 3 Terry mentioned the waiver and the 5 percent 4 reduction, Cortland and Chenango, for example, 5 needed transportation, so that they could have a 6 vehicle for providing non-emergency Medicaid 7 transportation. 8 So, in that -- in their case, that was the 9 first stool -- first leg of the stool. 10 Then, as transportation became available, 11 agencies started to take advantage of -- 12 Broome Developmental is a customer of public-transit 13 service, ARCs became. 14 So, it became a mature, vibrant system in the 15 community, where people use it for employment, they 16 use it for social activities. Medicaid consumers 17 are using it on a regular basis and getting all the 18 service they need. 19 In a place where social service was getting 20 calls previously, there were no providers. 21 There were taxi companies that were ambulette 22 providers. They had nothing. 23 And, actually, Yates County is still in that 24 position now. They're -- they have no people to 25 provide the transportation that they need. 1 So, having public transportation in the 2 community provided a service, first of all, to the 3 mandated medical services that were needed. 4 But, then, all the opportunities for agencies 5 to coordinate their transportation with the public 6 provider, get State assistance, and operate 7 effectively and efficiently by sharing the rides. 8 I echo everybody's sentiments here this 9 morning: It's an effective, efficient way. 10 FTA and the national DOT has encouraged for 11 years, all of us, and Jim can certainly speak to 12 this issue, to coordinate. 13 I was in a meeting in Washington, D.C., with 14 the DOT, where someone announced that they're 15 funding 60 or more different agencies that provide 16 transportation. 17 "Why aren't these people working together?" 18 Well, that was ten years ago. Everybody, 19 from that point, started working together. 20 Many of the federal initiatives were to 21 coordinate transportation. 22 5310 even requires you to coordinate your 23 agency's activities in order to receive funding for 24 vehicles. 25 So, every effort has been to put 1 transportation into a coordinated effort within 2 counties. 3 And this initiative is to pull a significant 4 piece out of that coordinated effort. 5 There's no incentive, there's no initiative, 6 for the call center to look at any other agency. 7 The ARC of Schuyler, that doesn't matter to 8 them. 9 They need to get this person from Point A to 10 Point B, and they need to get that call off their 11 phone, because they're -- if you've read the RFP, 12 that's an important part. 13 They have to answer the calls in a certain 14 amount of time. They'll be audited on how quickly 15 the people are passed through the system and out the 16 door. 17 They need to get them from Point A to Point B 18 irregardless of any other agency, any other 19 coordinated system. 20 There's no incentive or interest on their 21 part to be a part of that, or help in that area. 22 SENATOR O'MARA: How many counties does 23 First Transit serve? 24 JIM GORMAN: We're providing Clinton County, 25 Chenango County, Cortland County, Chemung County, 1 Allegheny County, Cattaraugus. 2 SENATOR O'MARA: Birnie, how many? 3 Birnie Bus Company, Terry. Excuse me. 4 TERRY INKAWHICH: Yes, Terry. 5 Lewis County, Herkimer, Otsego, Oneida, 6 Madison. 7 SENATOR LITTLE: You all seem to be saying 8 what my -- one of my counties said, which is: If it 9 ain't broken, you know, we shouldn't be fixing it. 10 Right? 11 JIM GORMAN: Exactly. 12 If the -- you know, to come and look at 13 what's being done. 14 And the personal touch is probably what 15 everyone in this room feels most of all, you usually 16 know these people by name. 17 And, you know, something changes -- the 18 mobility manager sets up a trip, and something 19 changes -- the person isn't feeling well and they 20 need something different -- the change could be made 21 on the fly. 22 But now you have another level of bureaucracy 23 that's going to -- the trip will end up not being 24 taken. 25 Mike, you mentioned the county where the 1 trips went from 900 to 40. 2 That's because there's -- there just isn't -- 3 the trips aren't being met. 4 They're mandated services, but if there's no 5 one to provide them, it's just not going to happen. 6 ASSEMBLYWOMAN LIFTON: And that means people 7 aren't getting Medicaid services? 8 Is that what I heard you say, they're not 9 going to doctors? 10 Is that the implication of what you said? 11 MIKE DeRADDO: They shifted. 12 From my understanding, talking to the 13 director of Ulster County, they shifted them all to 14 private taxi companies. 15 SENATOR LITTLE: All to private tax 16 companies, which has got to be a lot more expensive; 17 right? 18 SENATOR O'MARA: Absolutely. 19 SENATOR LITTLE: It's got to be a lot more 20 expensive. 21 SARAH MEREDITH: And it's a huge safety 22 issue. 23 I mean, we're regulated by the Department of 24 Transportation, we're regulated by [unintelligible]. 25 You know, there's no one; who's going to 1 regulate these taxi companies that are going to come 2 in and hire people at 9 bucks an hour to drive 3 people around? 4 Who's going to regulate them? 5 It's certainly not going to be DOT. 6 They're -- they're up to their eyeballs as it is. 7 MIKE DeRADDO: That's another thing. 8 We can talk about coordination. And I know, 9 certainly, we can talk about the [unintelligible]. 10 But where's DOT? 11 Because, throughout this whole process, 12 [unintelligible] on the part of DOT, they're in the 13 same level of darkness as we are. 14 [Inaudible.] 15 And, I mean, it's -- it's this -- my 16 impression is, this system is being fabricated on 17 the fly [unintelligible]. 18 That's my impression. 19 [Unintelligible.] 20 AMBER SIMMONS: Senator, if I may? 21 SENATOR O'MARA: Yes. 22 AMBER SIMMONS: Representing the mobility 23 manager from Schuyler County, talking about, we've 24 all spoken about service coordination, and the 25 importance of it, and all of this cost savings that 1 they're trying to generate from this, part of 2 mobility management is to coordinate rides. 3 That's our purpose; to try and break down 4 barriers, bring people together, to have the right 5 people at the table at the right time, so that we 6 can coordinate our existing systems. 7 We have people that called mobility 8 management office, asking, how do they get to 9 Chemung County? 10 Schuyler County, again, being rural, you have 11 to travel out of county for many specialty services. 12 As it stands now, we can help assist them to 13 get their ride on a particular day so that they can 14 get to where they need to go; 15 Or, we try and find a volunteer driver; 16 Or, we look at another system, if they need a 17 higher level of care, where do we send them from 18 there? 19 We had people that were relying on service 20 coordinators using very specialized, more expensive 21 modes of transportation, to provide them for their 22 needs, to their medical appointments, to take them 23 shopping. 24 They need to learn how to do a number of 25 everyday -- everyday tasks and needs. 1 Because of this coordinated process that 2 we've developed in Schuyler County, these people 3 call, they are now using our transit system, because 4 of people who were willing to teach them how to use 5 a transit system. 6 And, not only are they able to get to their 7 medical appointment, but they're taking themselves 8 shopping. 9 They're now integrated into the community, 10 which is the goal, I think, of a lot of the other 11 initiatives that are going on. 12 And, they are able to get to medical 13 appointments. They're able to take themselves 14 shopping. 15 If they have a question, they call a local 16 person who is able to answer their questions, and 17 understand what their actual need is, knowing, that 18 when they say, "I'm standing on the corner next to 19 the Valero, I don't know how to get to this next 20 step," there's somebody there that understands that 21 and can help them. 22 So, now, they're not going have to be reliant 23 on a more expensive provider, but they can just have 24 somebody give them that little bit of assistance, so 25 that they can remain independent, and be able to use 1 the public system which was a direct result of all 2 the coordinations. 3 SENATOR O'MARA: What is -- 4 Yes, go ahead. 5 SENATOR LITTLE: No, I'm just going to say, 6 that, in the district I represent, which is 7 six counties, the city of Glens Falls, the city of 8 Plattsburgh, has a little bit of public 9 transportation, and it's taken a lot of time and 10 energy to get any public transportation among 11 Franklin County and Essex County, and get it 12 coordinated, so people could get from Essex County 13 up to Plattsburgh, or up to Malone, in that area. 14 And I think that, you know, the idea of 15 sending people to taxi service is ridiculous because 16 that is so expensive. 17 It's also isolated, and you're missing the 18 opportunity, like you just said, Amber, that these 19 people learn how to take public transportation. 20 I mean, I think, you know, we have a whole 21 generation, maybe two generations now, that don't 22 want to take public transportation. 23 And now with the cost of gas, and the 24 situations that they're in, it's necessary. 25 But, to eliminate that and direct them 1 towards a taxi, which, certainly, from Grandville, 2 New York, to Albany, New York, $160, or maybe it was 3 $180, even, round trip, was ridiculous; and, yet, 4 just telling this person that this is the way it's 5 going to go. 6 And I think that, Warren, Washington County, 7 must already be in some kind of a system, because 8 they're not considered in this northern. 9 I don't know if the Capitol District is in it 10 now. 11 Huh? 12 Essex? 13 UNKNOWN MALE SPEAKER: Essex. 14 SENATOR LITTLE: Yeah, well, they're -- 15 UNKNOWN MALE SPEAKER: And they were in the 16 Hudson Valley co-op. 17 SENATOR LITTLE: They're a long ways from the 18 Hudson Valley. 19 UNKNOWN MALE SPEAKER: Oh! 20 SENATOR LITTLE: Right. 21 So, I mean, it just shows you, you're not 22 having a local person that knows where the issues 23 are. Knows how far, you know, this little town is 24 from the other little town that you're trying to get 25 to. Or how far it is from the doctor's or the 1 medical center that you're trying to get to. 2 So, I just don't see how this works in really 3 rural areas, and there's so many side effects that 4 are going to be negative. 5 You know, the person might get to their 6 appointment, but they're missing a lot of other 7 things that they would have had as a benefit of 8 using public transportation and having a local 9 person coordinating it. 10 And the coordination, the other thing is, the 11 little bit of public transportation that we have is 12 not going to survive if the Medicaid transports 13 aren't using it. 14 JEANETTE FRANK: We also haven't talked about 15 the growing elderly population in the upstate area 16 who, more and more, are going to need means of 17 transportation. 18 And I know, again, a story that Amber had 19 told me early on, was, it was an older person who 20 kept missing her Medicaid transportation 21 appointments. 22 And -- so part of what Amber, as the mobility 23 manager, was able to do, is she made a home visit, 24 and found out that the reason was, because she was 25 having difficulty with her stairs and needed a ramp 1 to get in and out of her house. 2 And once that was able to be corrected, she 3 was able to use the Dial-A-Ride public-transit 4 system. 5 Again, so there is a human piece to this. 6 And much of what we've accomplished has been, 7 one person at a time, through travel training, 8 through finding out what these barriers are to 9 people using public transit. 10 I know there's a lot of discussion about: 11 When does somebody need to hang up their keys 12 to their car and use public transit, and how do you 13 transition people to that? 14 I see this as a growing need, not a need 15 that's going to get less. 16 TERRY INKAWHICH: Just to piggy-back on some 17 of what's being said, Birnie Bus does operate in 18 contiguous counties. 19 We did attempt to create a call center that 20 would handle those contiguous counties, but we 21 abandoned the approach, because each county had 22 their own unique set of agencies that were 23 participating, taxicab operators that -- so you 24 really needed -- in order to effectively operate the 25 system in the county, you needed to have a presence 1 in that county. You needed to understand where the 2 places were, and how to assist people to get where 3 they need to go. 4 So, we attempted a call center, and it didn't 5 work, for that reason. 6 SENATOR O'MARA: Can some or a few of you 7 speak to the differential in cost between a taxi 8 ride in your area and what the cost is on a -- on a 9 flex of the public-transportation system? 10 KAREN SULLIVAN: I can just -- we have a 11 Route 28 corridor between Oneonta and Cooperstown, 12 and our DSS services are located in what we call the 13 "Meadows Complex," which, OPT (Oneonta Public 14 Transport Services), a round-trip ticket is 450, by 15 bus. And, a taxi ride is, I'm going to guess, 16 around $26. 17 And I'm being -- I'm being conservative on 18 that. 19 So we do a lot of DSS transports, Medicaid 20 transports, from Oneonta to Cooperstown on our 21 public-transportation system. 22 And I just -- I wanted to add something, 23 because Christine from -- Kraemer, from 24 Schoharie County, they're under the MAS answering 25 service, and not everything is negative. 1 I think she has some good -- some positive 2 things to say about it. 3 I think that the couple of interesting 4 points, when we first started these conversations, 5 was that DOT wasn't brought into the picture. 6 DOT, we work very closely with. They are 7 our -- you know, they're our guidelines. We have to 8 abide by the rules and regulations. 9 And, DOH wasn't talking to DOT. 10 And now they're talking to DOT, and DOT is 11 part of these meetings. 12 It's critical, because our system depends on 13 our ridership. If we lose our ridership, we lose 14 our system. 15 So, simply put, that's, you know, what I felt 16 was lacking from the very beginning. 17 And that's improving. 18 But, also, with some of the conversations 19 that we've had with Christine, is that, I think 20 there may be an opportunity for this to work if the 21 Department of Health understands that the personal 22 touch, knowing the people, knowing the area, knowing 23 the connections that we have with other 24 transportation systems, if they just, basically, 25 take a phone call, and they call whoever it is 1 that's supposed to coordinate these trips in the 2 county, and says, "Okay, we've got a rider, they 3 need a trip," and let that contractor coordinate 4 that trip, and not try to coordinate it themselves, 5 and all they do is transport that phone call, that 6 could work. 7 If they try to coordinate it, and they're 8 going to take it upon themselves to figure out the 9 best routes, I really don't see how it's going to 10 save money. 11 They're not going to -- they're just going to 12 get them from Point A to Point B, and not be worried 13 about whether they can get them on a public system 14 and make the cost -- and reduce the costs. 15 And Christine may want to add to that, but, 16 you know, we're just -- we're asking DOH to take 17 that into consideration when they implement in 18 Otsego County, is to please call our contractor and 19 let them coordinate the route. 20 SENATOR O'MARA: And did they give you any 21 indication -- 22 CHRISTINE KRAEMER: You lose the personal 23 touch with the clients. 24 They do not understand your system, and they 25 never will. 1 We've been working with this system since 2 March of 2012. They still do not understand how the 3 system works. 4 Basically, we rely on them just to give us 5 our transportation orders, and that's it. We take 6 over from there; we decide how we're getting them 7 there. 8 If MAS were back, we do have clients that 9 were public-transportation riders, but then they 10 found out they can get a private taxi. 11 So now we can't get them back into the 12 public-transportation system, once the private taxi 13 has been offered to them. 14 But if -- if -- it would work if they would 15 just leave the call takers, the eligibility 16 requirements, and then let the transportation system 17 handle their clients [unintelligible]. 18 ASSEMBLYWOMAN LIFTON: But isn't that 19 duplicative? 20 We already have a call -- we already have -- 21 KAREN SULLIVAN: We're already doing it, so 22 even that's duplicative. 23 ASSEMBLYWOMAN LIFTON: [Unintelligible] might 24 not do harm, but at least it's not duplicative. 25 CHRISTINE KRAEMER: [Unintelligible] 1 decrease. 2 KAREN SULLIVAN: Right, but that's going save 3 money. 4 TERRY INKAWHICH: Are you saying that the 5 ridership on transit has gone down in the new 6 system? 7 CHRISTINE KRAEMER: On our public -- on our 8 public-transportation system, it has gone slightly. 9 Not because -- unlike some of the other 10 counties here, we provide both sedans and bus 11 transportation. 12 We do not have -- we only have one other 13 Medicaid provider in our county. 14 So, everything does come to us. There is no 15 other providers that the transportation orders can 16 go to. 17 Our local taxis do not want to be Medicaid 18 providers. 19 TERRY INKAWHICH: In the meeting I had with 20 the Department of Health, they said that there -- 21 they saw an increase in the transit ridership in the 22 new model. 23 Doesn't sound like that's happening. 24 CHRISTINE KRAEMER: No, we've had -- it first 25 started -- actually, it really first started back 1 when Fidelis provided the transportation, with the 2 Medicaid insurance. 3 That's when it first started, because Fidelis 4 put everyone in a taxi. 5 Then, when Fidelis no longer was providing 6 the transportation as part of their insurance, we 7 couldn't get people back into public transportation. 8 So, you know, we do our best. 9 Most of the time, you know, like I said, we 10 do know our clients. If we talk to them, show 11 them -- you know, tell them what we have available 12 for them. 13 You know, our Albany runs, I mean, yeah, it's 14 a long day. 15 And if you had the backing, you know, the 16 public can go for the day, but, MAS will be, like, 17 Well, that's too long for them to be, so let's put 18 them in a taxi. 19 TERRY INKAWHICH: When you had mentioned 20 comparing costs, a little tricky to compare the 21 costs in the current models of some of these 22 counties, and the new model. 23 We're a broker, so there's trips that we'll 24 try to place with taxi operators, and the taxi 25 operators will refuse them, because the way they're 1 reimbursed is, so much per laid mile, so much per 2 trip. 3 So, if they have a person that needs to go a 4 mile to an appointment, they generate very little 5 revenue on that trip. 6 They may have ten miles to get to a trip that 7 they'll only be able to bill a mile for, so they'll 8 turn that down. 9 And under the current models, with transit 10 there, it's kind of the catch-all. 11 But, it's not a function of -- we're tasked 12 to do things efficiently on the aggregate, not look 13 at things on a trip-by-trip basis and be able to 14 turn trips away that aren't sufficiently 15 revenue-generating. 16 SENATOR O'MARA: Anyone else have anything 17 they would like to add, that hasn't spoken? 18 Amber, I want to thank you for this column 19 that you wrote. It kind of put this more on my 20 radar screen, this issue that we're dealing with, 21 and, bringing it to our attention. 22 So, I thank you for that. 23 That's about all I have. 24 Any issues anybody else would like to bring 25 up? 1 AMBER SIMMONS: Could I ask a question to the 2 general group with this? 3 SENATOR O'MARA: Yes. 4 AMBER SIMMONS: As we look forward, since 5 this seems to be a done deal, as far as, it is 6 happening, whether we like it or not, has anyone 7 heard, definitively, how they plan to connect the 8 dots? 9 You know, as we travel rurally between our 10 systems and we look to go from point to point, on a 11 local level, you know, the person who's answering 12 the phone, taking that initial call, does not know 13 how our system connects to your system, that 14 connects to the next system. 15 How, you know, to connect the dots and be 16 efficient, to say, the goal being cost-savings? 17 In order to do that, we can, on a local 18 level. 19 We've started those conversations with 20 Chemung County and Steuben County. 21 And the way we're speaking now, we have the 22 potential to be able to connect someone in 23 Schuyler County to Chemung County, not to chase each 24 other's buses around, but to connect to their 25 existing systems, so that they can get to 1 St. Joe's Hospital that's in Elmira, from little 2 tiny village Burdette in Schuyler County, that, you 3 know, the question being: How would that person in 4 the call center know how to connect those dots? 5 And that would be something, if anybody has 6 heard anything definitively on how to connect those 7 dots, that's -- 8 MIKE DeRADDO: I think that's a good point. 9 Because, Ontario County, we have actually 10 coordinated our schedules with Seneca County to our 11 east. 12 We have a bus stop that's coordinated between 13 both Seneca County and Ontario County, to our east. 14 And we also coordinate with Monroe County to 15 our northwest, for the trips that need go to 16 Strong Memorial Hospital. 17 So, in theory, [unintelligible] 18 Seneca County, utilizing public-transit system, 19 right through our county, get on RTS, 20 [unintelligible]. Plus, we also run a shuttle. 21 That's a great point. 22 It's -- making this system go, and then, 23 after the fact, you're looking at: Okay, now we're 24 going to do the analysis on, okay, how can we make 25 this work for you? 1 And that's a good point, because we are 2 connected with bus stops, [unintelligible] schedule, 3 intercounty transportation on the public system, 4 fixed routes. 5 And that's a good point. 6 ASSEMBLYWOMAN LIFTON: Can I just ask one 7 other question? A comment occurs to me. 8 SENATOR O'MARA: You can ask as many as you 9 want, Barbara. 10 ASSEMBLYWOMAN LIFTON: I hate to -- Tom was 11 gracious to invite me, and I appreciate it. 12 Have any of you written, put your concerns in 13 writing, to the Department of Health? 14 Are people writing letters, officially, 15 weighing in with your concerns? 16 Or are they just sort of been informal 17 discussions at this point? 18 JIM AREY: Discussions. 19 KAREN SULLIVAN: Discussions. 20 JIM AREY: And, again, I think what Michael 21 was saying, we hear some of the right words, so it's 22 difficult to write a letter and say, Do you really 23 know what this means? 24 ASSEMBLYWOMAN LIFTON: Right, right. 25 JIM AREY: I mean, you're not going to say 1 that to a government agency, "Do you really 2 understand?" That, you know, this is how it works, 3 and this is how it sort of has to work, to have that 4 coordination go on. 5 That's a difficult letter to write without 6 appearing to say: I know everything, you don't know 7 anything, let me tell you. 8 ASSEMBLYMAN GIGLIO: [Unintelligible] Tom's 9 letter saying, that, you know, one size doesn't fit 10 all. 11 When you look at the whole Medicaid program 12 throughout the state, what they're targeting in the 13 five boroughs would work quite well; what they 14 target the counties like ours, won't. 15 But I have a question. 16 You brought up safety issues and DOT. 17 Have those been addressed separately, or at 18 all, in any of these conversations? 19 And, has anybody discussed where liability 20 begins and ends for the county, for the State, for 21 the people providing the transportation? 22 Has that come up at all? 23 JIM AREY: Safety has not been discussed as 24 an issue, to my knowledge. 25 I would look to anybody else. 1 I -- 2 MIKE DeRADDO: As I said, we mentioned it 3 during their visit, as far as regulation and 4 oversight of taxi cabs, as opposed to public transit 5 [inaudible]. 6 Now, as far as addressing the DOH, other than 7 that, from our concern [unintelligible], that 8 meaning, what the county supervisors have done, I'm 9 unaware. 10 I just know, they're not very happy 11 [unintelligible]. 12 SENATOR LITTLE: Yeah, it would be 13 interesting to see, to get some kind of a report 14 from the existing answering services, or their 15 existing programs, because a lot of those are in a 16 combination of rural and urban counties, and they're 17 not really seeing what it's doing in the rural 18 county. 19 And the other thing I'd be interested in, is: 20 What kind of training does this answering-service 21 group get, as far as what's existing in the areas 22 that they're now answering the calls for? 23 There ought to be some big coordination, and 24 lists, and meetings ahead of time, before anything 25 takes place. 1 And maybe that's something we can ask for, or 2 ask what they're doing. 3 JANELLE REOME: In Franklin County, we've had 4 a lot of contact with the Department of Health, 5 [unintelligible]. We have a completely different 6 situation than anyone who's talked about here. 7 We don have taxi service, we don't use a lot 8 of public transit. We have volunteer drivers. 9 But we've had numerous phone conversations 10 with the Department of Health. They always have the 11 right answers, like everybody here has said. 12 Our understanding, on the DSS level, is they 13 will, once a contract company has been determined, 14 because they haven't been yet, they will be in 15 contact with us. They will come to our county, and 16 have several meetings with our drivers. 17 So, they'd like us present, so they're going 18 to keep us in the first part of it, just to make the 19 drivers comfortable. And then, after the first few, 20 we will be done. 21 We're not sure what to think of it. We've 22 heard bad, we've heard good. 23 They've always had the right answers. 24 We've asked for a copy of the contract once 25 it is decided who is going to get it. 1 And [unintelligible] referred to an RFP on 2 the DOH website, which I read, and it is along the 3 same lines of what we do, but, there's more to it 4 than just that RFP. 5 So, I guess we're just kind of going in and 6 taking each step as it comes, because it's not a 7 choice. 8 And we're going to go on July 1st. 9 But we don't -- we don't have the same losses 10 that a lot of other counties are going through 11 because it doesn't touch along our public transit, 12 overall. 13 I have one staff member and one backup staff 14 who coordinates all of the vouchers and the -- talks 15 to all the recipients. 16 We're more worried about the recipient issue 17 than we are about how the transportation is going to 18 work. 19 SENATOR O'MARA: Has there been any 20 complaints raised or issues by the Department of 21 Health to those of you that are integrating your 22 public-transportation systems for this non-emergency 23 transportation, as far as the timeliness of that 24 coordination, for having to wait for the bus, or the 25 inconvenience of it, as opposed to cost savings? 1 JIM AREY: That's usually been managed by the 2 local department of social services. They're the 3 ones who get the complaints. 4 It's not that the Department of Health gets 5 them. 6 It's, in Chemung County, it's the 7 Chemung County Department of Social Services. 8 And, certainly, I've been involved in those 9 meetings where we've had some of those discussions. 10 And I'm not here to say what we have is a 11 perfect arrangement and we're always on time for 12 everybody. 13 You carry enough people, you're gonna have 14 some issues, but we always have the ability to 15 address them, to -- to -- you know, I provide 16 oversight for the county, so we have discussions 17 with First Transit about specific issues, and 18 perhaps specific individuals, and how their services 19 are being handled. 20 JIM GORMAN: I think I can speak to that. 21 There has not been a major issue with 22 complaints. 23 JIM AREY: I would echo that, it's not a 24 major issue. 25 JIM GORMAN: [Unintelligible] driven. It's 1 not driven by issues of complaints or timeliness. 2 I work with the DSS Commissioner. If there's 3 issues, I hear about them immediately, and we deal 4 with them. 5 If there is an issue, it's usually, you know, 6 a person here or there, that we need to fix a 7 problem. 8 But one thing that Karen brought up, is the 9 DOT and the Department of Health not working 10 together anymore. 11 I was on the ground floor of several 12 coordinated systems that are up and running, and 13 mature today, and working very effectively and 14 efficiently. 15 DOT and the Department of Health actually 16 provided the formula for cost sharing for these 17 coordinated public-transportation systems, and now 18 they will not talk to one another. 19 That -- my questions, when we met with 20 Tim Perry-Coon and Heidi and the DSS commissioners, 21 is: Where is DOT in this? 22 And, they're just not talking. 23 If the two of them could get together and try 24 to work out, if there needs be a cost savings 25 between them, what they -- they've completely 1 separated and gone in different directions, and 2 they're not talking to one another at all, as far as 3 this. 4 That could be one of the most important 5 things that come out of the meeting, if they put 6 their heads together and figure it out, how to 7 continue to coordinate transportation, and, if need 8 be, save whatever dollars that could be saved there. 9 UNKNOWN FEMALE SPEAKER: Yeah, I would echo 10 that. I mean, it's -- that is what caused 11 coordinated transportation to occur, was 12 Department of Health and Department of 13 Transportation talking to each other, and presenting 14 us with models. 15 And, you're right, they're not doing that 16 now. 17 JIM GORMAN: They encouraged you right into 18 this, and now pulled right out. 19 SENATOR O'MARA: Well, yeah, it seems 20 contradictory to me, to set up this type of a system 21 in counties where it's, virtually, already in place. 22 If there isn't this complaint issue of, not 23 timely service or not individualized enough, but, 24 we're not hearing that. 25 And I haven't heard that myself. 1 So, obviously, the counties have a great deal 2 at stake in the cost, overall, of the system. 3 So, you know, I think it's, from my 4 perspective, important to keep that as coordinated 5 as we can. 6 And, you know, I will be working with the 7 Department of Health in following up on this, and 8 seeing that we can make that a priority in their 9 efforts here. 10 So, if there's anything that anybody would 11 like to add, or to add later, you can submit to my 12 office, e-mail or mail, any way you wish, to help us 13 understand what's going on, as it happens. 14 And if that -- and, you know, we'll work on 15 it as soon as we can, to try to make sure that 16 there's a priority given. 17 I think it's important to the existing 18 systems, because of the -- I think the potential 19 negative consequences here in shifting too much 20 ridership away from the public-transit lines that 21 are in place now is something that we need to foster 22 for the benefit of the Committee as a whole. 23 PETE: I'll leave my card at the door. 24 SENATOR O'MARA: Pete's my chief of staff, 25 so -- 1 PETE: You can follow up with me. 2 Thank you all for coming. 3 SENATOR O'MARA: Any closing comments from 4 anybody? 5 UNKNOWN MALE SPEAKER: Thank you for having 6 us. 7 (All participants say "Thank you.") 8 SENATOR O'MARA: Thanks. 9 Thank you, Amber, for highlighting it more 10 on -- to get my attention to it, and, coming here 11 and participating today. 12 And all of you that made the long trip here 13 to Albany, which we do every week, so we're kind of 14 numb to it, so, it doesn't seem quite as far for us. 15 We do it every week. 16 Some of you probably had quite a trek, so I 17 appreciate you coming. 18 Senator, Assembly Members, any final comments 19 that you would like to make? 20 ASSEMBLYWOMAN LIFTON: I just want to say, 21 thanks, everyone, for coming. It really helps. 22 UNKNOWN FEMALE SPEAKER: We can see what's 23 really happening. 24 ASSEMBLYWOMAN LIFTON: It's very helpful. 25 SENATOR O'MARA: Yeah. 1 SENATOR LITTLE: Very good. 2 Thank you. 3 SENATOR O'MARA: Thank you very much. 4 5 (Whereupon, at approximately 12:40 p.m., 6 the roundtable discussion held before the New York 7 State Senate Standing Committee on Transportation 8 concluded, and adjourned.) 9 10 ---oOo--- 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25