Rethinking I/DD Transportation 

Services During the COVID - 19 Era 

Administration for Community Living

September 30, 2020 

3:00 – 4:30 PM EST
Poll

2
Opening Remarks

Lance Robertson

Administrator of the 

Administration for 

Community Living 

Assistant Secretary for 

Aging

3
Agenda

• Transportation Background 

• Impact of COVID 

• Funding 

• Self - Directed Services 

• Speaker Spotlights 

• Future of Transportation 

• ACL’s Transportation Program 

• Q&A

4
Transportation Background

Transportation 

is a social 

determinant of 

health

Transportation 

is a critical 

link to 

employment, 

health, and 

community

5

Lack of access 

to 

transportation 

results in 

isolation and 

poor health 

outcomes
Impact of COVID

COVID-19 has 

exacerbated 

existing issues 

within the 

realm of 

transportation

Significant 

impact to 

public 

transportation

Dramatic 

reduction in 

transportation 

services 

available

6
Common Funding Sources

Federal Transit 

Administration

Sections 5307, 

5310, 5311, and 

5316

Medicaid

Medical and 

Non-Medical 

Transportation

CARES Act

State plans

7
Self-Direction

The map on the following slide shows states with 

1915(c) waivers offering self - directed non - medical 

transportation as a stand - alone service for 

individuals with I/DD in 2019

8
Understanding the Pre - COVID Medicaid Funded 

Self-Directed Transportation Landscape

Source: Applied Self - Direction National 

Inventory of Self-Direction Programs, 2019

9
Understanding the Pre - COVID Self - Directed 

Transportation Landscape

• In many states, participants can purchase transportation 

as part of an individual - directed goods and services 

benefit in which participants can use waiver dollars to 

purchase items and miscellaneous services that help 

them manage their disability and improve their community 

integration 

– In these cases, transportation would not be included 

in the waiver as a stand - alone service 

– T ransportation can also be provided as part of 

personal care and other self-directed waiver services

10
Understanding the Pre - COVID Medicaid Funded 

Self-Directed Transportation Landscape

Source: Applied Self - Direction National 

Inventory of Self-Direction Programs, 2019

11
Virginia Department of Medical 

Assistance Services (DMAS)

Fee For Service and Managed Care Organizations NEMT 

Programs

Bill Zieser, Manager Transportation Services Unit

12
Agenda

• DMAS NEMT Programs 

• FFS and MCO NEMT Programs 

• COVID - 19 Pandemic & NEMT Transportation 

• DMAS had to Relax or Recreate NEMT Requirements 

• COVID - 19 Updates for Transportation Providers 

• Other COVID - 19 Operational Information 

• DATA and Software 

• TIMS System NEMT Software Requirements 

• DMAS Access to all FFS NEMT Program Information 

• Leverage Transportation Network Companies 

• FFS Payment and Contract Management

13
DMAS NEMT Programs

• DMAS Serves 1.5 Million Medicaid Members 

– Includes 462,675 Medicaid Expansion Members 

• ID/D Waiver NEMT Services 

– FFS NEMT transports to their waivered services 

§ Community Living (CL) waiver - 11,347 Members 

§ Building Independence (BI) Waiver - 309 Members 

§ Family and Individual Support (FIS) - 2,377 Members 

– MCO NEMT Programs transport ID/D Members to their acute care 

• DMAS has Seven NEMT Programs 

– FFS NEMT Program serves an Average Population of 97,311 

– Six Managed Care Organizations (MCO) 

§ Each MCO has their own NEMT Program 

§ Includes MCO two contacts – CCC Plus and Medallion 4.0 

§ Includes CCC Plus Waiver Transports (EDCD & Tech Waivers)

14
DMAS FFS and MCO NEMT Programs

The chart below illustrates who are the successful partners of DMAS FFS & MCO NEMT 

Programs and the types of transportation providers and services it takes to make all 

DMAS NEMT Programs a success 

15
COVID - 19 Pandemic and NEMT 

Transportation

• Partnering of all Seven NEMT Programs to Redesign of Virginia’s NEMT Program taking into consideration CDC 

Guidelines and Governor’s Northam’s Executive Orders 

• Effects of COVID - 19 on NEMT programs 

– Prior COVID 19 all NEMT Programs were on track to complete 7 million trips 

– ID/D Trip Totals in 2nd quarter were only 13% compare to 1st quarter of 2020 

– Total NEMT Program trip totals – March 24, 2020 to Sept 4, 2020 are 64.53% of normal total trips

• Weekly COVID - 19 Conference Calls with all Seven NEMT Program Representatives 

• Agreed to COVID - 19 Transport Criteria, Policies and Procedures 

– DMAS, MCOs, and Transportation Brokers working together 

• New recommended vehicle seating recommendations for all vehicle types 

• Shared Information 

– Changes in CDC guidelines and Governor Northam’s Executive Orders 

– Create email list of all 77 NEMT Representatives 

– Shared Best Practices from all NEMT Programs 

– Shared Best Practices of Agency and Facility COVID 19 Opening Criteria in ABM 

– Published list of Agencies, Facilities and Supported Employment Sites that service ID/D Members (as of 

September 22, 2020) 

§ Closed Facilities - 317 

§ Open Facilities – 50 

§ Facilities that opened then closed -11

16
DMAS had to Relax or Recreate NEMT 

Requirements

• Member Signatures 

– Members gave DOB to driver who wrote it on manifest instead of 

signing manifests (prevented driver/member exposure) 

• Medical offices closed office waiting rooms therefore modified driver 

requirements so drivers had to wait 

• Virtual vehicle inspections 

• Virtual driver training 

• Virtual Advisory Board and Provider Meetings 

• Modified Member IVR Reservation call scrip to ask COVID 19 

questions (i.e. press 1 if you have COVID19, etc...) 

• Modified Provider Assistance Line - IVR to route COVID - 19 related 

calls to designated routers for special assistance and guidance

17
COVID - 19 Updates for Transportation 

Providers 

• Transportation Providers (TP) are required to ensure all 

drivers and attendants wear a mask or face covering 

• Conducting driver COVID 19 symptom checks prior to 

allowing them to transport each day 

• TPs should be transporting Members individually if 

possible and/or distancing in the vehicles 

• Vehicles sanitized after each trip and the end of the day

18
Other COVID-19 Operational Information

• Weekly Operations Meeting with LogistiCare to discuss COVID 19 

Transports and updates on overall operations for the week 

– COVID 19 Transports 

– Staff Updates 

– Successes 

– DMAS, ID/D, MedEx , Lyft Trends 

– Unfilled Trips 

– Top 5 Providers who had complaints 

– Unassigned standing orders 

– Other updates as requested

• The sign above is in the process of being added to the door of each 

FFS NEMT Vehicle 

19
DMAS Transportation COVID 19 

Message to All

• “We all Thank You for adapting your procedures 

to meet the new ever changing conditions and 

needs of our Members.”

20
Data and Software

• Contracting Requirements 

– Ensure NEMT software, encounter, provider, driver, vehicle 

requirements are the same across all FFS and MCO NEMT contract 

requirements 

• NEMT Encounter Data 

– Encounter data requirements are the same for FFS and MCO contracts. 

– Includes Emergency Air and Emergency and Non Emergency Ground 

Ambulance and all NEMT Services 

– Able to collect trip data for each Member 

§ On time performance – scheduled & actual drop off times 

§ Facility locations 

§ Number of trip legs and trip type to include all data (i.e. name of provider, 

number of miles, amount paid, transportation HCPCS Codes)

21
VA Transportation Information Management 

System (TIMS) NEMT Software Requirements

• Optimized Automated Scheduling 

– Include automated provider manifest download, billing & GPS tracking 

– Automated suggested trip assignment based on quality, price, and distance 

– Able to access hospital discharge software to streamline hospital discharges 

• Member Information Management 

• Transportation Network Management & Support 

• Reporting – including ad hoc reports when requested 

• Import, Export, Collect Data and Files 

– Submit encounter data 

– Stores data for accurate reporting of support efficiencies in monitoring contract 

– Imports eligibility file(s) 

• Provide HIPAA compliant web based electronic portal for Members and Facilities to 

access (i.e. Transportation.DMAS.Virginia.gov) 

• Member Apps – make reservations, cancel trips, able track vehicle location by GPS

22
DMAS Access to all FFS NEMT Program 

Information

• DMAS FFS NEMT Program Information – LogistiCare’s Tableau 

– Inquiries by Date Range, Region, Level of Service, Provider Name, by Member ID, Treatment Type, Life 

Sustaining Trips, Long Distance, Facility Trip information, Complaints, Info by Member, Transport 

Information by Program (i.e. All FFS Trips, ID/D, Medicaid Expansion) – Gross and Net Trip Totals

23
Leverage Transportation Network 

Companies (TNCs) 

• Added 462,675 Medicaid Expansion Members and they all receive the 

transportation benefit 

• DMAS and LogistiCare Conducted a Lyft Pilot 

– Fourteen Month Pilot 

§ Completed 37,981 total trips for 2,275 Unduplicated Members 

§ following very strict exceptions and guidelines of the total we had 602 ID/D Members taking 16,772 

trips 

– Designed Rider Expectations List 

– Command Center monitored all Lyft Trips 24/7 

– Extensive broker employee call center and scheduling training 

• DMAS Approved TNCs into Two Types 

– Each TNC Type had Member Exceptions List 

§ Lyft, Uber, UZURV, and Veyo’s Independent Driver Program 

• TNC Success 

– Prior to COVID 19 TNC weekly trips averaged 9,444 

– Currently TNC complete 3,585 trips per week or 37.9%

24
FFS Payment and Contract Management

• FFS NEMT Contract Payment 

– Per Member Per Month (PMPM) 

– PMPM is made up of Twelve Rate 

Cells 

§ Each rate cell cost includes 

o Administration Cost – RFP bid 

Service Cost – Agency provided 

•

o 

DMAS Transportation Management 

Services Unit 

– Office Staff 

§ Monitors FFS Contract 

§ Intake of all FFS and MCO NEMT 

Communications including Complaints 

§ Assist other Units with NEMT questions, 

concerns and contract language 

§ Member of DMAS Encounter Team – 

SME Transportation Encounters 

– Field Monitoring – Supervisor and five 

Field Monitors

FFS NEMT Contractual Service Level 

Agreements

• Unfulfilled trips had graduated penalties 

• Hospital Discharges <95% on time and over the 3 

hour window 

• Late Incident and Accident reports totaled 

• Vehicles not inspected within every 6 month 

requirement 

• Reports were delivered late to DMAS 

less than 5% Abandonment Rate 

Wait time 

Blocked calls 

• Data submitted on time according to Data Quality 

Score Card 

• Complaints more than .85% graduated penalties 

• Provider Prompt Pay 

• Key Staff Positions filled less than 90 days 

• Same day Non - Emergency Urgent 

• Recurring Appointments scheduled 

• Encounters Data Quality Score Card

• Drivers found not trained 

• Call Center statistics 

•

•

•

25
Contact for Questions

• Presenter: Bill Zieser 

• Email: Bill.Zieser@DMAS.Virginia.gov 

• DMAS websites: 

– http://DMAS.Virginia.gov

– http://transportation.dmas.virginia.gov

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Freedom Road Transportation

Karen Boice

Executive Director

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How the Core Program Works

• Interested person calls in to find out more about program 

and clarify any information 

• Eligibility of Applicant is determined through a series of 

questions on Applications : 

q Residency (Oakland, Macomb, Wayne, and Washtenaw 

counties) 

q Income ($22k or lower) 

q Seniors (60 or older) 

q Disabled (Varies)

• Application is taken over the phone and proper 

paperwork is sent for further verification

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Key Components of the Program

• Riders find their own driver 

• We provide funds to pay drivers up to 200 miles per 

month at .55 cents per mile 

– Mileage reimbursement is not considered income & does not 

interfere with Social Security or other Benefits 

• Approved Riders must arrange travel with their volunteer 

drivers 

• Volunteer drivers must file a form stating who 

• they are and who they are driving for 

• Riders travel with drivers as mutually agreed

29
Additional Key Components of the Program

• Mileage reimbursement forms are submitted at month’s 

end by a certain day (for FRT it is on or before the 5th of 

the following month). 

• Detailed data is entered for each reimbursement form. 

Software calculates mileage for each trip. 

• Mileage checks are issued and mailed to the proper 

payee.

30
Current Data: Demographics

Disabled

55% Other

9%

Senior

37%

FRT Current 2020 Data – 113 Riders

31
Designed Around User-Friendly Qualities

• Personal vehicles are used 

• A no - cost service to riders 

• It is available 24 hours a day, 7 days a week 

• No advance scheduling is required 

• Travel is possible between cities without transfer or 

inconvenience 

• A volunteer driver makes each trip with their rider, 

assisting them as necessary and required . 

• Riders receive mileage reimbursement, which they pay to 

their drivers which is not considered income.

32
Innovative Model Creates 5 Progressive 

Assumptions

• When riders recruit their own drivers, they feel empowered. 

• When riders have something to offer family, friends and 

neighbors, they feel more comfortable asking for trips. 

• When drivers are reimbursed for their travel, drivers will be 

more likely to provide rides over an extended period. 

• When family, friends and neighbors use their own automobiles, 

the need to purchase and maintain vehicles by the 

program is eliminated. 

• When passengers and drivers can schedule their own rides, 

staffing and infrastructure are significantly reduced.

33
How Can The Model Be Adapted?

FRT can be implemented in rural as well as urban and suburban 

communities – Whatever the organizing approach, FRT is

designed as a dynamic and flexible model that can be adapted

within any community.

The FRT Model

New Service Add-On Within

Human Service Agency

Add-On Within

Transportation Service

Stand-Alone Service

Interfaith Group

Provider Organization

Hospital

Area Agency on Aging Public Transit Agency

Para-transit Agency

Taxi Voucher Service

Existing Vol. Program

Senior Trans. Program

34

Partner Adaptability
Future of the Road

• Develop a Statewide Model – further expand across the 

state. 

• Phone Apps – web and smartphone use for services 

• Grant/Progressive Funding - successful/perpetual 

• Current Expansion plan includes Van services for 

partners to expand outreach. 

• NEMT Transportation Provider for Medicaid 

• Immediate enrollment, no waiting!

35
What Our Riders Say

“Thank you for the warm birthday wishes. May I also

add, it is I who thanks you for your help with my 

transportation needs. It has helped me maintain 

something very important to me - my dignity.” ~ Susan 

“I really appreciate all your help, it would have cost me

over $150 for taxi service this month. Thanks for helping

me.” ~Charlotte

36
Contact

Freedom Road Transportation Authority 

Karen Boice 

boicefrt@gmail.com 

248.232.1259 

www.freedomROADtransportation.org

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Delaware Division of Developmental 

Disabilities Services

Jennifer Garcias

Director of Day Services and Transition
Mission

Valuing persons with intellectual and developmental 

disabilities, honoring abilities, respecting choice, achieving 

possibilities..... working together to support healthy, safe 

and fulfilling lives.

39
Pathways to Employment (PTE) 1915(i)

State Plan Amendment (SPA) 

1915( i ) Home and Community - Based Services State Plan 

Option 

• Eligibility : 

– Serves ages 14 - 25 years old 

– Goal of employment 

– Qualifying State Plan Medicaid 

– Live in a setting meeting HCBS rule 

– Qualifying Disability

40
Services

§ Employment Navigation Case Management** 

§ Benefits Counseling 

§ Non - Medical Transportation** 

§ Orientation, Mobility, and Assistive Technology 

§ Career Exploration and Assessment 

§ Small Group Supported Employment 

§ Individualized Supported Employment 

§ Personal Care (including option for self - direction) 

§ *Note: 1915( i ) runs concurrently with the State’s approved 1115 

waiver 

§ **1915(b)(4) waiver-limiting providers for this service

41
Non-Medical Transportation

• 1915(b )(4) Waiver 

– Limits the providers for Employment Navigation and 

Transportation Services 

• State maintains administrative oversight of service 

• Medicaid supervises performance 

• Employment Navigator coordinates service 

• Service is authorized by the individuals Employment Plan

42
During the Pandemic

• Business as usual 

• Virtual meetings - monthly contact, IEP meetings, and 

service coordination meetings 

• Verbal Consents 

• Collaborative meetings with DOE, DVR, DVI, and local 

education agencies 

• Town Halls 

• Provider Fairs 

• Virtual Services

43
Contact

Jennifer Garcias, MPA 

Woodbrook Professional Center 

1056 South Governor’s Avenue 

Suite 101 

Dover, DE 19904 

Phone: (302) 744 - 9712 

Email: Jennifer.L.Garcias@Delaware.gov

There is no wrong door!

44
Rise/Lyft Transportation Overview

Dan Meyers, Director of Vocational Services

Natalie Zacharias, Director of Day and Employment Services
Overview of Rise

• A private, nonprofit organization providing employment, life 

enrichment and housing services 

• Serves 3,500 people annually across 40+ programs 

• Transports over 900 people per day with a fleet of 150 vehicles 

• Over 30 locations across Minnesota and Western Wisconsin 

• Provides services to: 

– People with intellectual and developmental disabilities 

– People with mental illness 

– Ex - offenders 

– Immigrants , refugees, and people living in poverty 

– People who are Deaf, DeafBlind , or Hard of Hearing 

– People with brain injuries

46
Community Supported Employment

• Employment Consultants (EC’s) support people with 

finding and maintaining competitive employment 

• EC’s help people plan transportation to/from their 

independent jobs 

• Rise partnered with others to offer a new mode of 

transportation

47
A little more about Lyft

• Lyft is a ride share transportation company 

– Safety is important! 

– Background Checks - Lyft has the strictest DMV and Background 

check in the business; Lyft has an ever present background check 

running on their drivers, if something pops up in their record they are 

offboarded until an investigation is done 

– Rating System - Drivers are required to stay within a 4.7 and 5.0 rating 

to stay on the Lyft platform. Passengers have the ability to rate the 

driver at the end of every ride (1 - 5 starts, with 5 stars being a good ride) 

– Safe Vehicles - Drivers are responsible to stay within the car 

requirements set by the city and the driver requirements set by Lyft 

– Each Lyft rider is covered by $1 million in insurance from the 

moment the rider gets into the car to the moment they exit the car

48
Eligibility

• Person must be Medicaid waiver funded 

• County leadership approval 

• The cost of the ride must be less than the 

negotiated rate (for Rise it is $17 per one way). 

• Person must have access to a cellphone to receive 

a text message that their ride has arrived 

• Team support for the person to use the service 

independently

49
How Does The Program Work?

• Rise Employment Consultants (ECs) connect with the team if the person is 

eligible 

• ECs introduce Lyft to the team: 

– Discuss and review the Lyft User agreement with the team (Sections 

include eligibility, participation requirements, risks to consider and a 

signature page) 

– Provide training on how to use Lyft. Practice rides as needed with 

person/guardian/parent 

– Funding - Submit for the new transportation rate - Example = $17 per 

way to be added to the waiver service authorization 

– Identify the Rider’s “Plan B” – (Wallet sized back up plan for when Lyft 

is not available) Identify before the first anticipated ride what is the Plan 

B, when rides from Lyft are not an option.

50
Plan B Card

51
How it works on the Rise back - end 

• Rise ECs log into 

Lyft Concierge to 

review the Rise 

cost 

• From there you 

can plan/dispatch a 

ride for the person 

• You can also track 

the status of the 

ride

52
Success

• We are currently supporting 27 people using Lyft for transportation 

• Riders report: 

– Wait time reduced from 60 mins to 5 mins 

– On demand available if last minute changes 

– Increase independence and self esteem 

– Gives people feeling of normalcy getting to/from work 

• Lyft transportation has been available during the pandemic – we 

helped people learn to follow Lyft safety plans while riding 

• Rollout success depends on county partners willingness to try 

something new and regular meetings to discuss working / not 

working between Rise, Lyft, and County reps

53
Issues and Barriers

• Not everyone eligible due to funding or cost of 

ride 

• Rural Minnesota has limited drivers available 

• Families scared or unfamiliar with the new 

service 

• Missed ride fees ($5 - $10) We are able to 

dispute with Lyft 

• Technology for people to have own cellphone

54
Lessons Learned

• Schedule back up plans 

• Profit margin may allow for some exceptions for 

the occasional ride over the negotiated rate 

• It is very important to maintain good 

communication with partners to discuss what’s 

working/not working 

55
Start your own project

Rise Contacts 

Dan Meyers 

Director of Vocational Evaluation and 

Transitional Services 

dmeyers@rise.org

Or 

Natalie Zacharias 

Director of Day and Employment 

Services 

Nzacharias@rise.org

Lyft Contact 

Briana Thayer 

Team Lead 

bsorochak@lyft.com

56
Question

57
Future of Transportation

Autonomous Cars

Addressing rural disparities

Increase in 

virtual supports

58
ACL/FTA Partnership

• Coordinating Council on Access and Mobility: 

https://www.transit.dot.gov/coordinating-councilaccess-and-mobility

• Strategic Framework for Action: State Opportunities 

to Integrate Services and Improve Outcomes for 

Older Adults and People with Disabilities 

https://acl.gov/news-andevents/announcements/seeking-input-strategicframework-action

• Technical Assistance Resource Centers

59
FTA/ACL Transportation Resource Centers

Free Technical Assistance (TA) Centers

Technical assistance centers provide a range of services that support the provision and 

coordination of transportation services and promote the mobility of Americans.

National Aging and Disability Transportation Center

mission is to promote the availability and accessibility 

of transportation options for older adults, people with 

disabilities, and caregivers . 

National Center for Mobility Management

mission is to promote customer - centered mobility 

strategies that advance good health, economic vitality, 

self - sufficiency, and community. 

National Rural Transit Assistance Program

mission is to address the training and technical 

assistance needs of rural and tribal transit operators 

across the nation, and support state RTAP programs.

60
FTA/ACL Transportation Resource Centers

National Center for Applied Technology

mission is to translate emerging transportation technologies 

for states and localities across the United States . 

Shared-Use Mobility Center

mission is to achieve equitable, affordable, and 

environmentally sound mobility across the US through the 

efficient sharing of transportation assets . 

Transit Planning 4 All resource center issues demonstration 

grants to communities of older adults, people with disabilities 

and transportation providers to engage in inclusive planning 

and develop technical assistance resources to replicate 

successful strategies . 

Inclusive Design Challenge

61
FTA/ACL Transportation Resource Centers

ADA Participation Action Research Consortium (PARC)

publishes maps that assist policy makers, community 

leaders, transportation developers and state leaders in 

understanding transportation needs and opportunities for 

improvement . 

AT3 is a one - stop connection to information about assistive 

technology (AT). Every state has an AT program. The 

state AT program demonstrates AT, provides training on AT, 

and makes short term loans of AT so people can try the AT 

prior to making a purchase. There is AT available to assist 

people with transportation. The AT3 site lists every state AT 

program. 

Paralysis Resource Center (PRC) provides information for 

traveling with your wheelchair and makes grants to 

communities to increase access to transportation and 

technology.

62
Inclusive 

Community Transportation Program

• Develops Inclusive Transportation Planning Resources

• Inclusive Mobility on Demand Transportation Demonstration 

Program 

o Northern Arizona Intergovernmental Public Transportation 

Authority (NAIPTA) 

o Atlanta Regional Commission (ARC) 

o Seattle Department of Transportation (SDOT)

• Resources and information available at: 

https://transitplanning4all.org/

63
Q & A

64
Closing Remarks

Office of the National Coordinator 

Arun Natarajan 

Senior Policy Analyst 

Arun.Natarajan@hhs.gov

Administration on Disabilities 

aod@acl.hhs.gov

65