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35 APPENDIX A Surveys

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36 TRANSIT COOPERATIVE RESEARCH PROGRAM SYNTHESIS PROJECT J-7, TOPIC SB-13 Transit Agency Participation in Medicaid Transportation Programs Survey Questionnaire for State Public Transit Departments Purpose: The objective of this synthesis is to research the real and perceived barriers to coordinating public transit services with Medicaid transportation services. The results of this survey will report on these barriers and develop case studies that profile innovative and successful practices, as well as lessons learned and gaps in information. Please return this survey to Elisabeth Fetting, Senior Transportation Planner, KFH Group via e-mail: efetting@kfhgroup.com. If you have any questions concerning the survey or the study, please call Ken Hosen or Elisabeth Fetting at (301) 951-8660. STATE CONTACT INFORMATION Name of State Public Transit Department: Address: City: State: Zip: Contact Person: Title: Phone: ( ) Fax: ( ) E-mail: 1. Does your department coordinate with your state's Medicaid agency? Yes No If yes, what is the level of coordination? Formal coordination agreement Regularly scheduled meetings Occasional contact Other, please describe: If no, why not: 2. Would you consider the relationship between your agency and your state's Medicaid agency as: Coordinated--actively pursue ways to coordinate Medicaid transportation services with public transit services.

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37 Cooperative--participate in coordination efforts when asked, but do not actively pursue such arrangements. Non-existent--do not participate in any coordination efforts. 3. Please describe any efforts your department has undertaken to foster coordination with your state's Medicaid agency. 4. Please indicate what your department's official position is with regard to non-emergency medical transportation: There should be cooperative arrangements between non-emergency medical transportation and public transportation. Non-emergency medical transportation and public transportation should be coordinated. Non-emergency medical transportation and public transportation should be consolidated. Non-emergency medical transportation and public transportation should be completely separate. We have no official position concerning the relationship between non-emergency medical transportation and public transportation. 5. Do you consider any of the following issues to be barriers to coordinating Medicaid transportation services with public transit services? Please explain each barrier. Transit regulatory/legal/compliance issues--such as the Americans with Disabilities Act (ADA), drug testing requirements, and Commercial Driver's Licensing (CDL) regulations. Jurisdictional boundary issues that may occur when a client needs to travel from his home to a facility that is not in the transit provider's operating area. Financial restrictions such as the need for the Medicaid agency to find the lowest cost trip, given the other modes that may be available at no cost to the client, and the need for the transit agency to receive the fully allocated cost of the trip. Political barriers, such as the perception of the misuse of transit passes by Medicaid clients and/or the level of political work necessary to effect coordination. Information/technology barriers, such as the need to collect and confidentially store client data that transit agencies do not typically collect concerning riders or problems with the compatibility of technologies.

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38 Different goals among the participants--i.e., the Medicaid agency is interested only in their clients accessing appointments in the most cost-effective way versus the transit agencies' need to fulfill all of the communities' transit needs. Other barriers: 6. Are there operational barriers to coordinating public transit services with Medicaid transportation services? Yes No If yes, please categorize and describe these barriers: Differences in the level of driver training needed: Eligibility concerns: Different equipment requirements: Different liability requirements: Different service standards: Service design not compatible with public transit: Other, please describe: 7. Are there any other barriers or issues regarding the coordination of NEMT and public transit on which you would like to comment? Thank you for your input! Please return this survey via e-mail to efetting@kfhgroup.com

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39 TRANSIT COOPERATIVE RESEARCH PROGRAM SYNTHESIS PROJECT J-7, TOPIC SB-13 Transit Agency Participation in Medicaid Transportation Programs Survey Questionnaire for Transit Agencies Purpose: The objective of this synthesis is to research the real and perceived barriers to coordinating public transit services with Medicaid transportation services. The results of this survey will report on these barriers and develop case studies that profile innovative and successful practices, as well as lessons learned and gaps in information. Please return this survey to Elisabeth Fetting, Senior Transportation Planner, KFH Group via e-mail: efetting@kfhgroup.com. If you have any questions concerning the survey or the study, please call Ken Hosen or Elisabeth Fetting at (301) 951-8660. SYSTEM AND CONTACT INFORMATION Name of Transit Agency: Address: City: State: Zip: Contact Person: Title: Phone: ( ) Fax: ( ) E-mail: 1. Please categorize your transit system (check all that apply): Urban Fixed-route and paratransit Rural Paratransit only Suburban Other, please describe: Please indicate your annual ridership: Total annual one-way trips--Fixed-route: Total annual one-way trips--Paratransit: 2. Please indicate how many vehicles you have in your fleet: No. fixed-route vehicles: _______ No. paratransit vehicles: _______

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40 3. Please indicate the appropriate organizational arrangement for your transit system: City or county agency Transit authority State agency Private non-profit agency Other: 4. Are your transit services operated directly by agency employees or do you contract with a transit service provider? Operate services directly Contract the direct operation of transit services, but not the administration Contract the direct operation of transit services and the administration of transit services Use a mix of contracted and directly provided services--Please describe: Other arrangements--Please describe: 5. Does your transit system provide transportation services for human service agency clients on a contractual basis? Yes No If yes, what percentage of your total ridership is represented by human service agency transportation? 6. Does your agency provide or has it ever provided brokerage services for non-emergency Medicaid transportation? Yes No 7. Does your transit agency provide or has it ever provided transportation services for Medicaid recipients to access their medical appointments? Yes No a. If yes, are these trips provided as general public passenger trips or do you provide Medicaid transportation on a contractual basis with your local Medicaid agency? General public Medicaid contract b. If yes, does your agency provide local trips only, or both local and long distance trips? Local only Long distance and local c. If yes, please indicate by percentage what modes are used to transport Medicaid clients to their appointments: % of Medicaid trips provided using fixed-route services: % % of Medicaid trips provided using paratransit services: % d. If yes, does the Medicaid Agency pay their full share of the costs incurred to transport Medicaid clients to their medical appointments on paratransit? Yes No

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41 e. Please explain the arrangements that you currently have with your local Medicaid agency: 8. Who makes the decision whether or not to participate in the provision of non-emergency Medicaid transportation? Transit agency board City or county government Transit agency management staff Transit agency staff Other: 9. What level of funding does your agency receive each year for the provision of non- emergency medical transportation: Annual funds for direct operation of services: $ Annual funds for administering the program: $ 10. What is your fully allocated cost per trip for paratransit trips? $ per trip 11. Do you consider any of the following issues to be barriers to coordinating Medicaid transportation services with public transit services? Please explain each barrier. Transit regulatory/legal/compliance issues--such as the Americans with Disabilities Act (ADA), drug testing requirements, and Commercial Driver's Licensing (CDL) regulations. Jurisdictional boundary issues that may occur when a client needs to travel from his/her home to a facility that is not in the transit provider's operating area. Financial restrictions, such as the need for the Medicaid agency to find the lowest cost trip, given the other modes that may be available at no cost to the client, and the need for the transit agency to receive the fully allocated cost of the trip. Political barriers, such as the perception of the misuse of transit passes by Medicaid clients and/or the level of political work necessary to effect coordination. Information/technology barriers, such as the need to collect and confidentially store client data that transit agencies do not typically collect concerning riders, or problems with the compatibility of technologies.

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42 Different goals among the participants--i.e., the Medicaid agency is interested only in their clients accessing appointments in the most cost-effective way versus the transit agencies' need to fulfill all of the communities' transit needs. Other barriers: 12. Are there operational barriers to coordinating public transit services with Medicaid transportation services? Yes No If yes, please categorize and describe these barriers: Differences in the level of driver training needed: Eligibility concerns: Different equipment requirements: Different liability requirements: Different service standards: Service design not compatible with public transit: Other, please describe: 13. For those agencies that do not participate in the provision of Medicaid transportation services, would you be interested in providing or brokering these services in the future? Yes, fixed-route only Yes, paratransit only Yes, fixed-route and paratransit only Yes, brokerage No If yes, under what conditions would you be interested in providing or brokering these services?

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43 If no, why not? Thank you for your input! Please return this survey form via e-mail to efetting@kfhgroup.com

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44 TRANSIT COOPERATIVE RESEARCH PROGRAM SYNTHESIS PROJECT J-7, TOPIC SB-13 Transit Agency Participation in Medicaid Transportation Programs Survey Questionnaire for State Medicaid Agencies Purpose: The objective of this synthesis is to research the real and perceived barriers to coordinating public transit services with Medicaid transportation services. The results of this survey will report on these barriers and develop case studies that profile innovative and successful practices, as well as lessons learned and gaps in information. Please return this survey to Elisabeth Fetting, Senior Transportation Planner, KFH Group via e-mail: efetting@kfhgroup.com. If you have any questions concerning the survey or the study, please call Ken Hosen or Elisabeth Fetting at (301) 951-8660. STATE CONTACT INFORMATION Name of State Medicaid Agency: Address: City: State: Zip: Contact Person: Title: Phone: ( ) Fax: ( ) E-mail: 1. Please categorize the way in which non-emergency medical trips are provided in your state under the Medicaid program (check all that apply): Brokerage, locally arranged within individual cities or counties Brokerage, regional in nature, involving several cities/counties Brokerage, statewide Direct service delivery using Medicaid agency employees Locally arranged contracts with private transportation providers Statewide contracts with private transportation providers Locally arranged contracts with public transit agencies (please provide examples) Statewide contracts with public transit agencies (please provide examples) Public fixed-route transit, with clients using vouchers/cards/tickets of some sort Freedom of choice Other: 2. Who makes the decision regarding the design of service for the provision of non-emergency medical trips? State level staff State level upper management Local level staff

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45 Local level political leaders Others: 3. Please provide a brief description of how services are delivered in your state: 4. How is the eligibility screening and verification process handled in your state? 5. Are you satisfied with the way in which non-emergency Medicaid transportation services are delivered in your state? Yes No If no, what areas need to be improved? 6. Does your agency coordinate with your state Department of Transportation? Yes No If yes, what is the level of coordination? Formal coordination agreement Regularly scheduled meetings Occasional contact Other, please describe: If no, why not? 7. Please describe the following service standards required in provider agreements/contracts: a. Driver training requirements: b. Driver experience/driving record: c. Vehicle standards/types of vehicles and accessibility: 8. How are services monitored (check all that apply)? Reports, electronic Reports, paper Field monitoring Customer surveys--Please list frequency Inspection of driver records Inspection of vehicle records Other:

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46 9. Are services monitored at the local or state level? Local State Both, please indicate percent local versus state: % state % local Please send us a sample copy of a contract with a public transit system or a recent RFP used to procure services or a broker. 10. Do you consider any of the following issues to be barriers to coordinating Medicaid transportation services with public transit services? Please explain each barrier. Medicaid regulatory/legal/compliance issues--such as waiver requirements, freedom of choice requirements, the need to provide the same level of service across the state, and prior approval requirements. Transit regulatory/legal/compliance issues--such as the Americans with Disabilities Act (ADA), drug testing requirements, and Commercial Driver's Licensing (CDL) regulations. Jurisdictional boundary issues that may occur when a client needs to travel from his/her home to a facility that is not in the transit provider's operating area. Financial restrictions, such as the need for the Medicaid agency to find the lowest cost trip, given the other modes that may be available at no cost to the client, and the need for the transit agency to receive the fully allocated cost of the trip. Political barriers, such as the perception of the misuse of transit passes by Medicaid clients and/or the level of political work necessary to effect coordination. Information/technology barriers, such as the need to collect and confidentially store client data that transit agencies do not typically collect concerning riders. Different goals among the participants--i.e., the Medicaid agency is interested only in their clients accessing appointments in the most cost-effective way versus the transit agencies' need to fulfill all of the communities' transit needs. Other barriers:

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47 11. Are there operational barriers to coordinating public transit services with Medicaid transportation services? Yes No If yes, please categorize and describe these barriers: Differences in the level of driver training needed: Eligibility concerns: Different equipment requirements: Different liability requirements: Different service standards: Service design not compatible with public transit: Other, please describe: 12. Are there any changes planned for your state's non-emergency Medicaid transportation program? If yes, please describe. Yes No 13. Are there any other barriers or issues regarding the coordination of NEMT and public transit on which you would like to comment? Thank you for your input! Please e-mail this survey back to efetting@kfhgroup.com