Appendix A (Part 4)
UNIVERSITY OF TEXAS MEDICAL BRANCH
PROGRAM: Discussion of ESD Systems
MEETING DATE: May 31, 2000
The University of Texas Medical Branch at Galveston is a major academic health science center dedicated to health science education, patient care, research, and community service. It has been in operation in Galveston for over a century.
2. Current Delivery System:
UTMB is a teaching hospital, with a contingency of over 2500 students, and over 13,000 faculty and staff. Its biomedical research component is well known.
3. Identify Current or Planned EBT/ESD Initiatives:UTMB currently operates two ESD systems: a card for campus security, and one for employee identification. These systems are implemented at basic levels, but enhancements are being discussed. The facility is planning a card identification system that will allow sign-on to all systems at the level authorized for each employee. All business actions will be attributable to a specific individual, including entries on patient records, department purchases, etc.
A procurement system is being purchased which uses e-commerce technology to buy from trading partners authorized to spend up to a given dollar amount with an electronic signature.
Computer based training (CBT) will also be used with this system. Each user must complete automated training of 15-20 minutes, which is acknowledged electronically. The system will not allow user access until the CBT is completed.
Staff would like to move toward storage of information on a database on the Internet or virtual private network which would be accessible anywhere. Doctors could access the entire medical record and link to related files and systems. There are many other technical possibilities for use of ESD in the health field that would aid clinicians and that would improve health management problems for both administrators and consumers.
4. Issues to consider related to an ESD System:Much of what UTMB develops will depend on how Texas deals with the Healthcare Information Portability and Accountability Act (HIPAA).
TEXAS DEPARTMENT OF PUBLIC SAFETY
PROGRAM: Driver Licenses
MEETING DATE: June 26, 2000
1. Current Delivery System:Texas has approximately 14 million drivers and 17 million vehicles. Implementation of a new Texas driver license began about five years ago. Current estimates indicate roughly 78 percent of Texas drivers have been issued the new license. Licenses are renewed every six years, so it takes at least that long for any changes to be completed throughout the population. The new card contains:
- Photo (stored on the Department's mainframe computer digitally);
- Printed Demographic Data;
- Bar Code (used only by DPS in-house for processing); and
- Magnetic Stripe.
The mag stripe, by statute, only contains the information that is printed on the front of the driver license/identification certificate. H.B. 571 prohibits imbedding or encoding any information not actually printed on the face of the driver license/identification certificate. This law also prohibits anyone from using the mag stripe for any use other than law enforcement or governmental purposes.
A fingerprint is taken when a driver license is issued, duplicated, or renewed at a DPS office and is stored on the mainframe in a digital format. The fingerprint is not stored on the card. Driver license fingerprints are used for identification in exceptional situations only (missing persons, John Doe deaths, criminal records search, etc.). Crime Records Bureau maintains the database.
Some convenience store vendors were using a special magnetic stripe card reader (which they provide themselves) to quickly flash a red or green light indicating whether a citizen is or is not over age 21 (related to age-controlled sales, i.e., tobacco and alcohol products). Some retail vendors formerly also used a reader that connected to check writing verification systems. H.B. 571 no longer allows a non-law enforcement or non-governmental use of the magnetic stripe.
DPS has received a legislative mandate to reduce waiting lines for driver license renewals. Two solutions in process of being implemented are:
- Interactive Voice Recognition (IVR) - part of an automated system for driver license renewals through telephone access (similar to unemployment insurance claims), and
- Internet transactions.
A third solution, currently in place, is a change in the mail-in renewal criteria that allows for more applicants to take advantage of this service.
DPS is also using an electronic system ID card for all employees to gain building access.
2. Identify Current or Planned EBT/ESD Initiatives:Certain criminal information (such as sex offender locations) is currently available via the internet. Other ideas have been considered for use of the new system, and may be implemented in the future. At present, the cost of automating the various databases is prohibitive for some of these applications:
- Citizens using the driver license/identification certificate to access driving records and accident reports. e.g., at kiosks - put in driver license, pay fee, get report; and
- Verification of required automobile insurance coverage.
Some planned uses of the new driver licenses have been prohibited by H.B. 571, such as:
- Retailers verifying driver licenses in check writing;
- Use by car rental companies to access driving histories and driver license validity; and
- Access to hand gun licensing information.
Issues to consider related to an EBT/ESD System:
- DPS sees a person only every 6 years. (If renewed by an alternative method it may be 12 years.) Citizens frequently delay making changes to demographic data on their driver's license until renewal time. Such information can change dramatically in that period of time.
- DPS cannot support any system that slows down their processing of driver license applicants.
- DPS cannot support any other agency issuing a modified driver license - e.g., some other agency adding a chip to a driver license for certain clients and issuing a new license to the client.
- Additional problems with using embedded chip technology for driver license/identification certificate production are that
- it is too easy to change the encoded information;
- it is extremely difficult, if not impossible, to keep this information current;
- the cost of production is high;
- crooks can and will catch up with the technology (counterfeit documents are being produced that look amazingly authentic); and, most importantly,
- in states that have attempted to use this technology, public acceptance of this technology was very negative.
TEXAS DEPARTMENT OF TRANSPORTATION
PROGRAM: Public Transportation Services
MEETING DATE: June 26, 2000
1. Services:The Public Transportation Division of the Texas Department of Transportation coordinates and monitors public transportation in the state. There are 72 public transportation systems in Texas.
2. Current Delivery System:Transit services are delivered by:
- Metropolitan Transit Authorities - in populations over 200,000 (there are seven total);
- Urbanized Transit Providers - in populations of 50,000+ (there are 24 total);
- Rural Transit Providers - in populations less than 50,000 (there are 41 total); and
- Elderly/Disabled Service Providers (there are over 300).
These public transportation providers carry over 241 million passengers a year, providing an impressive array of transportation options for many Texans. Rural or specialized services are available in all but four of the state's 254 counties. All urbanized areas over 200,000 have a transit system in place. Only six cities with populations between 50,000 and 200,000 population do not have a municipal transit service. Each TxDOT District has a public transportation coordinator who monitors local public transportation activities.
The number of transit riders in Texas has increased over the last several years. Light rail systems are being developed rapidly.
The public transit system is already delivering transportation services related to medical and workforce programs. In these cases, the program representative typically issues a token or transit pass to clients. Billing is pre-authorized by the program agency, and is documented via email or faxed passenger manifest.
There are usually multiple programs/agencies in any geographic area. A good deal of interest has been shown in consolidating funds and services on a regional basis in order to serve more people. Programs could combine services and spread costs on an allocation plan across funding agencies. TxDOT might be able to provide funding for the general population group that would not fall into other agencies' eligibility categories, so the program would serve the total rider population of a region.
Texas also has an Office of Community Transportation Services (OCTS), a part of the Health and Human Services Commission. They work collaboratively with state and federal agencies, local communities, and other stakeholders to remove transportation as a barrier to participation in health and human service programs. There is a close working relationship between OCTS and TxDOT's Public Transportation Division.
3. Identify Current or Planned EBT/ESD Initiatives:TxDOT is very interested in the use of ESD, to register transit payment and to collect trip information through the fare collection device. POS reader equipment for transit systems is on the market now. Most big Texas cities currently have electronic fare card readers that could be upgraded. The equipment would have to read the card, deduct the fare, and enter a new dollar amount (or number of trips) left. A system could use ATM machines or special kiosks to load value or number of authorized rides on the card. Or disposable cards could be mailed. Taxis could use the system as well as buses. Such a system would have positive benefits:
- Would be easier for passengers;
- If every rider had a card it would remove the stigma of public supported services;
- Would allow more efficient accounting and data collection (number of trips, most used routes, etc.); and
- Could reduce administrative costs.
TxDOT conducted a pilot system in Temple, using bar coding. This was fairly primitive technology, but even with that simple system they got positive results. They wanted to use the Lone Star EBT card and they would like to have done a region-wide Medicaid pilot, but they were not able to negotiate either.
The agency is interested in conducting another pilot using more sophisticated ESD technology. TxDOT would prefer to conduct the pilot in an entire health region first, then roll it out statewide. If TxDOT provides equipment or covers costs, they can require the transit operators to use it. The local transit systems seem eager to move in this direction.
4. Issues Related to ESD:
- The interface technology must be very fast, so as not to hold up entry to transit vehicles. A contactless card would be good - readable five feet from the fare box.
- Eligibility issues would have to be negotiated. Perhaps an allocation of total rides to different programs based on documented usage would work.
5. General Comments:
- TxDOT has not looked at costing. Cost information is available from the regional transit operators, e.g., Capital Area Rural Transportation (CART) in Austin, or Hill Country Transit, in Kileen/San Saba.
- Federal grant money is available for transit technology investments, but it is very competitive. These monies are mostly aimed at traffic management and increasing system efficiency, but
EBT-related activities are eligible as well.
- We may want to talk to Texas Transit Association, in Austin, an association of transit providers.
GULF COAST RETAILERS ASSOCIATION
MEETING DATE: June 1, 2000
The primary discussion with this group focused on EBT in general and WIC specifically. There is overwhelming concern in the retail grocer community about the use of smart cards to distribute WIC benefits. Listed below are the comments, concerns, and ideas expressed during this meeting.
Points of Discussion
- Recommend a consolidated approach by the state for development, procurement, and operation of a "one-card, one-platform" system for the distribution of state and state-administered federal benefits.
- The 'Aggie Card' has limited acceptability because it requires specialized equipment that is expensive particularly considering the restricted number of users. In addition, the retailer pays the bank a fee. Discussion on the use of smart cards at Texas A&M University.
- Entry level clerks frequently are the ones processing Lone Star Card transactions. To be successful, decision making requirements must be removed from the systems as much as possible, and the card and processes should be integrated.
- Interoperability of the system is a major concern.
- Fee for transactions must be addressed.
- It is imperative that the banks are involved and that the retailers are relieved of some of the responsibility for 'banking' services.
- Banks have not been interested in participating in the EBT system because of the fee for transaction issue.
- Adequate training must be provided to both the customers and the clerks/checkers using the system.
- Small, independent retailers lose customers because the retailers can not accept payment for public utilities because they have moved to a different electronic form of accepting payments at selected retail sites.
- An average household on FS makes 10 to 12 transactions a month. Clients on WIC only have the opportunity to purchase items on their voucher once. If WIC clients do not purchase all items, needed or not at that time, on the one transaction, they lose the opportunity to purchase items at a later date when they may need them.
- Most fraud associated with the Lone Star system is through the PIN, either by selling the PIN to non-qualified users or by dishonest clerks using the PIN without the client's authorization. The retailers support the use of finger imaging to reduce PIN fraud.
- Retailers are concerned about the potential increase in cost for processing Smart Cards. Retailers want some assurance that the new system/equipment will be compatible with and allow other transactions to be completed on the same equipment at the same location (for example, credit card and debit cards).
- Language is a concern with a greater percent of Hispanic residents. Projections are that the Hispanic population in Texas by 2020 will be 50 percent. This increase could occur much sooner. Training and education is a major concern.
- Issues and concerns related to ESD/EBT:
- High cost of disbursement of the benefit;
- Retailers taking on the role of the bank;
- Problems with the WIC vouchers; 30 day turnaround before money is paid to retailer; Lone Star is immediate; sometimes the WIC card shows the incorrect product and amounts (for example, amounts for milk instead of formula - keypunch error).
- When the Lone Star system is down more than a few minutes, benefits can not be provided. Grocers can not allow the purchases.
- WIC sales are below cost, and frequently the reimbursement is 45 days or more.
- WIC reimbursements are based on average pricing for the products. The volume discounts allow large chain stores to bring down the average price to below the cost for some of the small retailers. As a result, small retailers frequently lose money on sales. For these small retailers, the only motivation for staying with the WIC program is the anticipated purchases of other items through FS or cash. If the state wants to maintain the current level of availability for the WIC system, the process must be changed to a more equitable method for reimbursement.
- The failure rate is close to 20 percent for all transactions.
- Retailers using third party equipment are charged .03 to .04 cents per transaction. State owned equipment allows Lone Star Card transactions only.
- Retailers would like the financial community to become involved in the state EBT program as the state looks at additional expansion and use of the system.
- Retailers believe it is not a good business decision to make an investment in equipment, software, and training for development of an off-line platform when the only proposed transaction (WIC) represents less than .01% of an average WIC retailer's sales.
- Retail grocers are opposed to an off-line or hybrid system of transactions until the commercial infrastructure has developed, consumers accept the system, standards are approved and supported nationally, discrimination issues are resolved, and the benefits are interoperable.
- Retailers do not feel that limiting the number of stores that service WIC is a good state policy because it unnecessarily limits access and client participation.
- Retailers do not share TDH's opinion that smart card use for WIC will reduce losses.
- The retail community has several concerns and is not as optimistic as TDH about smart card use in the WIC program. These concerns include cost, integration, standards, limitations of retailers, and discrimination or lack of full-lane coverage forcing clients to be singled out.