Models to Improve Transportation for Veterans, Patients and People with Disabilities

Community Transportation Association of America
CTAA's National Resource Center for Human Service Transportation Coordination released NRC Report: Transportation for America's Veterans and Their Families, which discusses improving transportation for our nation's veterans through partnerships and coordination. Examples of the work of regional ambassadors are given. The NRC also maintains a webpage "bookshelf" with veterans transportation resources.

Life-Saving Transportation

CTAA also distributed the Dialysis Report, which discusses the dire, complicated transportation demands that dialysis patients present.

The crux of the transportation challenge is that the majority of dialysis patients are covered by Medicare, which — unlike Medicaid — does not offer non-emergency transportation as a benefit. Three out of four dialysis patients in the U.S., are Medicare primary, meaning that Medicare sets the reimbursement rate and pays 80 percent of that amount ...

Indeed, in background discussions with community and public transit officials around the country for this article, a common refrain was the difficult position in which many transit operators find themselves — how to continuously add new dialysis patients to the transit schedule with no means of payment.

The situation places transportation providers between the proverbial rock and a hard place. CTAA is advocating for a funding mechanism within Medicare and for increased kidney organ donation. "Transplants can add decades to people’s lives and significantly forestall the need for dialysis, but only when the needed organs are available."

Solutions Possible to Realize Decades-Old Commitments

Association of Programs for Rural Independent Living
APRIL's Executive Director, Billy Altom, testified before the Senate Health, Education, Labor and Pensions Committee about the need for affordable, accessible and available rural transportation. Forty years after the Urban Mass Transportation Act and 20 years after the passing of the ADA, Altom argues, "minimal or nonexistent transit services in rural areas still create serious barriers to employment, accessible health care, and full participation in society for people with disabilities."

Altom sees some solutions that are working - mobility management and voucher programs. Altom praised the Easter Seals Project ACTION Mobility Management Independent Living Coaches program and he cited as an example the Center for Independent Living for Western Wisconsin Regional Mobility Management/New Freedom Program, which provided 12,000 rides last year and coordinates in seven counties with public and private transportation providers. More than 140 volunteer drivers provide the rides and the program is expanding into an 18-county area. Already weekly rides are being supplied to 130 veterans.

Partnership for Mobility Management member Denise Larson is the mobility manager for the program. She also serves on the Partnership's advisory committee.

Another Type of Coordination

American Public Human Services Association
Bridging the Divide: Leveraging New Opportunities to Integrate Health and Human Services is APHSA's new report about the value added of coordinating and aligning health and human services for clients beyond eligibility and enrollment for a "customer‐focused, one‐stop shop, 'service home'." Such coordination makes sense, according to the report, because:

Many of the same people who qualify for Medicaid, CHIP or some level of premium subsidy identified through the Exchanges also qualify for one or more human service assistance programs.

The positive impact of coordinated care and integrated case management on improving the overall health and well‐being of individuals and populations— strengthening families, achieving employment and independence, improving the well‐being of children, youth, people with disabilities, seniors and other vulnerable populations—is well documented. Better outcomes mean healthier, safer, stabilized individuals and families with a better chance of sustainable independence from government services and long‐term personal success.

The report contains case studies of what several states are doing and the impending impact of the new healthcare law.

Events

National Association of Development Organizations
NADO posts that Apr. 12, Governing is hosting a free webinar, Smart, Sustainable, Livable Communities: Plans, Projects and Key Market Drivers. The webinar will explore the “green government” market and opportunities in building sustainable communities.

National Association of Counties
2011 Rail Conference - DuPage County, Ill., on Apr. 27–29, 2011. The conference will focus on the impact of freight and passenger rail on citizens, businesses, and county, city and state governments.

Members of NACo’s Rural Action Caucus (RAC) are currently in Washington, DC, for the Annual RAC Legislative Fly-in. They will meet with more than 60 members of Congress to advance priority issues for rural counties. RAC members will meet with officials from U.S. Environmental Protection Agency, Federal Emergency Management Agency, U.S. Department of Transportation, U.S. Forest Service
and the U.S. Department of Health and Human Services. RAC’s leadership will meet with Secretary of Agriculture Tom Vilsack.

Nearly two-thirds of the nation's 3,068 counties are designated as rural, with a combined population of 60 million. One of RAC's 2011 priorities is transportation reauthorization.

Webinar - Using County Health Indicators to Inform Local Policy Decisions - May 5, 2011 at 2 p.m. EDT. Speakers will discuss how counties can utilize community health and quality of life indicator information to help inform policy decisions and more effectively target local public health resources.

NACo Annual Conference - Multnomah County (Portland), Ore., on July 15–19, 2011. Aron Ralston, mountain climber and inspiration for the Film 127 Hours, will be a featured speaker.

Association of Programs for Rural Independent Living
APRIL Annual Conference - Anchorage, on October 15-17, 2011.

News Roundup: Coordination, Transportation Legislation and Technology

National Conference of State Legislatures (NCSL)
NCSL's Transportation Coordination Newsletter is a quarterly compendium of coordination developments, particularly at the state level. This issue also includes news about a volunteer driver law and resources.

NCSL's magazine has an article, Boomers on Board, which provides an overview of the demographics of the emerging boom in need and likely growth in mobility management, coordination, safety for older drivers, and land use and transportation coordination.

News

Federal Transit Administration (FTA)
FTA has a new webpage with information about each of its grant programs. Both the names and numbers of each program are supplied, with links to each program.

American Public Human Services Association (APHSA)
APHSA is closely covering the activity in Congress relating to proposals for budget cuts and human services, including transit programs.

Association for Commuter Transportation (ACT)
Act is supporting the COMMUTE Less Act (HR 260), which would actively encourage employer involvement in transit and transportation planning processes as well as "engage employers in providing commuting alternatives to employees, including carpooling, vanpooling, use of transit, and teleworking." It would also fund a national organization to house a technical assistance center, an information clearinghouse and an "information and educational program with respect to the employer investment in transportation and commuter benefit program."

Association of Programs for Rural Independent Living (APRIL)
APRIL is now offering its mentors virtual peer visits, along with the equipment to make them possible, as an alternative to in-person mentoring visits. CILs retain the choice of an in-person visit. The website has more details about the CIL mentoring program.

In a Google search to find out more about Rep. John Mica's upcoming listening tour about transportation reauthorization, there were a few transit blog posts and coverage from the Wall Street Journal. In an excellent article, Fight Looms over Transportation, the paper lays out the different positions within the Republican Party and the Administration, the shrinking value of gas tax revenue, and what is at stake for all types of infrastructure and transportation. Positions of associations, states and other stakeholders are not discussed.

Listening tour dates are available from at http://dc.streetsblog.org/2011/01/28/ti-committee-announces-field-hearing-schedule/.


Transit Wire Highlights

The Transit Wire, a transit and technology blog, links to news of what GPS means for the Lehigh and Northanpton Authority, a Pennsyvania bus system, and its customers in terms of real-time bus information and using the information about passenger loads to improve service.

Your local bus stop could soon transform from the place with exhausted faces to the place people visit whether or not they are getting on a bus. The Transit Wire led me to this neat photo-laden article about a new generation of bus stops, places with interactive media, Internet and GPS access, solar energy-produced heat and power, opportunities to leave messages, and avant garde design.

Resources: Accessibility and Health Reform

The Association of Programs for Rural Independent Living (APRIL) has posted an outpatient accessibility form and guidebook, the Outpatient Health Care Usability Profile V4, for health care facilities. The form is a self-assessment that quickly generates a picture of accessibility for any type of building and could be used beyond the health care field. It covers accessibility to bathrooms, elevators, hallways, ramps to the building entrance, among others. However, the guidebook only discusses federal requirements; state and local regulations may be more stringent. Transportation to the facility - an assessment of whether transit, taxi service or other services are available - is not mentioned, but could be added.

For information about ADA paratransit eligibility, the National Transit Institute has a course on this topic and Easter Seals Project ACTION has an upcoming series of distance learning classes about ADA paratransit.

Health Care Reform

The Children’s Health Fund has posted a link to the video of the Kaiser Family Foundation's event last week, What Does the Election Mean for Health Reform and Other Health Issues?

For information on what states must accomplish and are doing to fulfill the mandates of the new health care law, the National Governors' Association (NGA) has created a website, the Health Reform Implementation Resource Center, a product of the State Consortium on Health Care Reform Implementation (State Consortium), which provides information and technical assistance to states about requirements, offers options and best practices and synthesizes feedback to federal agencies on issues that affect state implementation. The website has resources on aspects of the health reform law that are likely to have the biggest effect on states – the Medicaid expansion, the establishment of health insurance exchanges, insurance regulations, and delivery system initiatives, along with important governance, coordination and timing issues for states are available from NGA and on each of the Consortium members' websites.

The four consortium organizations are: National Governors Association (NGA), including the NGA Center for Best Practices, National Association of Insurance Commissioners (NAIC), National Association of State Medicaid Directors (NASMD), and National Academy for State Health Policy (NASHP).

Health care guidance for individuals is available from AARP. It's health reform fact sheets offer information about a wide range of changes and implications for consumers, particularly older adults.

Rural Transit Gets Attention

The Association of Programs for Rural Independent Living (APRIL), along with YouthBuild USA, Good News Mountaineer Garage (a car ownership program for low-income residents of West Virginia), Redwood Coast Rural Action (a regional network of rural leaders based in northern California), and Sustainable Northwest (a Western U.S. community-oriented, conservation-based non-profit group), is a member of the National Rural Assembly Rural Transportation Policy Group. The group released a statement declaring, "Highway-building alone is not enough to address the economic and mobility needs of small-town and rural America."

The group's position on transportation reauthorization legislation calls for the federal government to be a catalyst to "modernize, strengthen and integrate the transportation systems that connect rural people and places to each other and urban commercial centers, while protecting the landscapes, habitat and livelihoods of rural communities." The National Rural Assembly is also asking for investments in broadband technology.

Billy Altom, executive director of APRIL, stated that "rural residents, especially those with disabilities, need and deserve affordable and accessible transportation. This includes public transit, regional, and inter-modal systems that are in compliance with Americans with Disabilities Act."

Stories of Rural Livability

The Transportation for America blog series on rural livability is now complete, with 12 examples of livability initiatives across the spectrum of small towns, reservations and small cities. A few of the examples are from the archives of technical assistance projects of the Community Transportation Association of America (CTAA). Some are examples of EPA smart growth projects.

The series shows some examples of transit's role in creating livable communities. Others showcase places that have embarked on downtown and pedestrian-friendly projects. The full series is available at http://t4america.org/tag/livability-case-studies/.

One State Goes Totally Smart Growth

The newsletter of the American Association of State Highway and Transportation Officials (AASHTO), announced that New York State recently passed a smart growth bill that is intended to do away with unnecessary sprawl. Enacted as an environmental conservation measure, the law sets forth nine smart growth criteria, including protection of rural agricultural land and improvement of public transportation choices to move beyond automobile dependency.

Though there are no exceptions to the law listed, it only applies to state agencies. It requires state infrastructure agencies to create smart growth advisory committees and mandates state committees to "solicit input from and consult with various representatives of affected communities and organizations within those communities, and shall give consideration to the local and environmental interests affected by the activities of the agency or projects planned, approved or financed through such agency."

I'm a New Yorker; I'm skeptical, watching and waiting to see how this broad legislative action plays out in the real world. There are no enforcement teeth or specific mandates.

Livability and Legislative Efforts for Rural Areas

Billy Altom, Executive Director of the Association of Programs for Rural Independent Living (APRIL) and Robin Phillips of the American Bus Association participated in Transportation for America’s Congressional lobby day for its rural and small town partners.

The issue for the participants is access, whether to jobs, grocery stores, or medical care. “Many felt their towns, tribes or counties were ready to move on innovative projects that improve access and quality of life, if only federal policy would give them a little nudge. Far from asking Washington to tell them what to do, they were asking for resources to make change for themselves possible.” At a panel to discuss these issues, Altom talked about the transportation challenges facing older Americans and people with disabilities.

He called on audience members to no longer see those with unique transportation needs – whether due to reliance on a wheelchair, inability to afford a car or age-related limitations– as an “us versus them” situation. Getting transportation right is not just about changing public policy, Altom said, but “changing public perception.”

The Lobbying Day effort is supportive of the continuing statements of Secretary of Transportation Ray LaHood. On May 6, 2010, Secretary of Transportation Ray LaHood testified before the Senate appropriations subcommittee about livable communities. He specifically addressed rural areas in terms of pedestrian friendliness, transportation options, and the threat to farmland of suburban sprawl. The Secretary gave the example of Bath, Maine.

Bath is a small town in southwest Maine whose historic downtown area is a model of a livable community. The town provides two trolley loops to transport residents and tourists through downtown, reducing the need for on-street parking. Bath’s street design encourages citizens to get out of their cars, which in turn supports local merchants through increased foot traffic.

The Secretary for the Department of Housing and Urban Development (HUD) also spoke and stated that HUD is “looking at creating a separate, special funding category for small towns and rural places." The testimony can be found at http://appropriations.senate.gov/ht-transportation.cfm?method=hearings.view&id=ff4c98a0-58a1-4182-a9a2-5b718da15266.