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Administration of ADA Paratransit Eligibility Appeal Programs (2018)

Chapter: Chapter 4 - Case Examples

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Suggested Citation:"Chapter 4 - Case Examples." National Academies of Sciences, Engineering, and Medicine. 2018. Administration of ADA Paratransit Eligibility Appeal Programs. Washington, DC: The National Academies Press. doi: 10.17226/25079.
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Suggested Citation:"Chapter 4 - Case Examples." National Academies of Sciences, Engineering, and Medicine. 2018. Administration of ADA Paratransit Eligibility Appeal Programs. Washington, DC: The National Academies Press. doi: 10.17226/25079.
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Suggested Citation:"Chapter 4 - Case Examples." National Academies of Sciences, Engineering, and Medicine. 2018. Administration of ADA Paratransit Eligibility Appeal Programs. Washington, DC: The National Academies Press. doi: 10.17226/25079.
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Suggested Citation:"Chapter 4 - Case Examples." National Academies of Sciences, Engineering, and Medicine. 2018. Administration of ADA Paratransit Eligibility Appeal Programs. Washington, DC: The National Academies Press. doi: 10.17226/25079.
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Suggested Citation:"Chapter 4 - Case Examples." National Academies of Sciences, Engineering, and Medicine. 2018. Administration of ADA Paratransit Eligibility Appeal Programs. Washington, DC: The National Academies Press. doi: 10.17226/25079.
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Suggested Citation:"Chapter 4 - Case Examples." National Academies of Sciences, Engineering, and Medicine. 2018. Administration of ADA Paratransit Eligibility Appeal Programs. Washington, DC: The National Academies Press. doi: 10.17226/25079.
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Suggested Citation:"Chapter 4 - Case Examples." National Academies of Sciences, Engineering, and Medicine. 2018. Administration of ADA Paratransit Eligibility Appeal Programs. Washington, DC: The National Academies Press. doi: 10.17226/25079.
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Suggested Citation:"Chapter 4 - Case Examples." National Academies of Sciences, Engineering, and Medicine. 2018. Administration of ADA Paratransit Eligibility Appeal Programs. Washington, DC: The National Academies Press. doi: 10.17226/25079.
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Suggested Citation:"Chapter 4 - Case Examples." National Academies of Sciences, Engineering, and Medicine. 2018. Administration of ADA Paratransit Eligibility Appeal Programs. Washington, DC: The National Academies Press. doi: 10.17226/25079.
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Suggested Citation:"Chapter 4 - Case Examples." National Academies of Sciences, Engineering, and Medicine. 2018. Administration of ADA Paratransit Eligibility Appeal Programs. Washington, DC: The National Academies Press. doi: 10.17226/25079.
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Suggested Citation:"Chapter 4 - Case Examples." National Academies of Sciences, Engineering, and Medicine. 2018. Administration of ADA Paratransit Eligibility Appeal Programs. Washington, DC: The National Academies Press. doi: 10.17226/25079.
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Suggested Citation:"Chapter 4 - Case Examples." National Academies of Sciences, Engineering, and Medicine. 2018. Administration of ADA Paratransit Eligibility Appeal Programs. Washington, DC: The National Academies Press. doi: 10.17226/25079.
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32 C H A P T E R 4 This chapter elaborates on the eligibility appeal processes for five transit agencies that responded to the survey. These five transit agencies employ a variety of processes to conduct the initial eligibility certification and the appeal hearings. They draw their appeal panel membership from various sources within the agency, from other public agencies, and from among private contractors and volunteers. They undertake a variety of activities both before and during the in-person hearing. The eligibility staff at each agency responded that they have good relations with their eligi- bility contractors and believe that their appeal programs work well. Respondents also discussed areas in which they seek to improve. Table 9 presents key data on the five agencies. Valley Metro Regional Public Transportation Authority The Valley Metro Regional Public Transportation Authority (Valley Metro) is the public transit provider in the Phoenix, Arizona, metropol- itan area. The agency operates bus, light rail, vanpool, and paratransit service. Total ridership exceeded 33.3 million trips in 2016, including 308,000 ADA paratransit trips. Contractors conduct Valley Metro’s in-person eligibility interviews and functional assess- ments. Valley Metro makes eligibility determinations and manages eligibility appeals. As of FY 2016, Valley Metro had certified more than 22,600 individuals as eligible for complementary paratransit service. Table 10 summarizes Valley Metro’s recent eligibility determinations. Valley Metro publicizes information on eligibility appeals through its rider guide, during staff visits to targeted rider groups, and in an attachment to eligibility determination letters for those not granted unconditional eligibility. The information on the appeal process is available in multiple formats, including print, large print, fax, audio, and an electronic file. An applicant may request an appeal up to 60 days after the date of the initial determination letter. After receiving a request for an in-person appeal, Valley Metro schedules the hearing for the next available date; hearings take place on the second Tuesday of each month, but no later than 60 days after the request. Valley Metro does not offer appeals solely in writing in place of an in-person hearing. At a minimum, the paratransit program supervisor calls the applicant to under- stand why the applicant disagrees with the original determination. In addition, an applicant may participate in an appeal via conference call. If the appeal takes place in person, Valley Metro offers free paratransit service to the hearing, which takes place at Valley Metro’s office. Case Examples

Case Examples 33 Transit Agency Who Conducts Initial Eligibility Process Eligibility Determinations (2016 new applicants and recertifications) Appeals Committee Appeals: 2015 Appeals: 2016 Valley Metro Regional Public Transportation Authority (Valley Metro), Phoenix, AZ Contractor 4,324 Three (3) members: Valley Metro fixed- route customer service staff Occupational and physical therapist Paratransit user 27 12 Regional Transportation Commission of Southern Nevada (RTC), Las Vegas, NV RTC and contractor 3,608 One (1) member: Contractor has law and sociology degrees, teaches ADA at university (No data) 139 Tri-County Metropolitan Transportation District of Oregon (TriMet), Portland, OR TriMet and contractor 3,731 Three (3) members, all TriMet: Legal counsel ADA compliance administrator Transportation manager 32 23 Capital Metropolitan Transportation Authority (Capital Metro), Austin, TX Capital Metro and contractor 1,952 Three (3) members: Capital Metro ADA coordinator Access Advisory Committee member Rotating member with expertise in disabilities 37 33 King County Department of Transportation Metro Transit Division (King County Metro), Seattle, WA King County Metro and contractor 4,428 One (1) member: Contractor is registered nurse, retired from state Department of Social and Health Services, Division of Vocational Rehabilitation 15 13 Table 9. Key data on case example transit agencies. Table 10. Valley Metro eligibility determinations. Determination New Applicants FY 2016 Recertifications FY 2016 New Applicants FY 2015 Unconditional 2,613 319 2,212 Conditional 690 118 839 Temporary 418 25 411 Visitor 57 0 0 Not eligible (denied) 73 11 122 Total 3,851 473 3,584

34 Administration of ADA Paratransit Eligibility Appeal Programs Valley Metro’s ADA eligibility coordinator reviews the applicant’s eligibility file together with any additional information the applicant provides with the appeal request. On rare occasions— about five times per year, according to the paratransit program supervisor—the agency may revise its initial determination based on this pre-hearing review. The likely reason for a change is additional information provided with the request, either directly from the applicant or from the applicant’s medical professional. The appeal committee (or panel) has three members. Each member serves for 12–18 months and hears all appeals during that period. At the time of the case example interview, the three panel members included: • A member with experience as an occupational and physical therapist who is employed for a local company that works with persons with disabilities. • A Valley Metro staff member who works in customer service on the fixed-route side and who uses Valley Metro’s paratransit service. • A member who works at a local disability agency and who also uses Valley Metro’s paratransit service. The two non–Valley Metro panel members do not receive compensation for their work on the committee. Valley Metro requires all three panel members to hear each appeal. If a panel member is not available, Valley Metro reschedules the hearing. The steps of the in-person hearing include: 1. In advance of the hearing, the facilitator (the paratransit program supervisor) provides an information packet to each panel member. The packet includes the complete file of the applicant, including any information provided by the applicant after the initial determination. 2. The facilitator provides an overview of the process. 3. The applicant receives time to share why the applicant does not agree with the initial deter- mination. The applicant may provide more input on additional factors to be considered and other medical documentation. 4. Panel members ask questions. 5. The facilitator tells the applicant that the panel will consider all information when making the determination. 6. After the final hearing of the day, the panel members discuss all the appeals. The applicant receives a decision within 30 days of the hearing. If no decision is made within 30 days, the applicant receives presumptive eligibility until there is a decision. The panel strives to come to a unanimous decision, though Valley Metro rules do not require this. In FY 2016, Valley Metro completed 12 eligibility appeal hearings, including appeals con- ducted in person or via conference call. The hearing outcomes were as follows: uphold the initial determination, 10; change “Not eligible” to “Conditional,” one; and “Other decision,” one. In FY 2015, Valley Metro completed 27 eligibility appeal hearings. The outcomes were as follows: uphold the initial determination, 20; change “Not eligible” to “Conditional,” six; and other decision, one. The “Other decision” outcome accounts for cases in which Valley Metro had granted conditional eligibility and, upon appeal, the panel revised the conditions but did not grant unconditional eligibility. Valley Metro attributes the low proportion of eligibility appeals relative to the number of applications (below 0.3%) to the quality of the agency’s initial determinations. The ADA eligibil- ity coordinator reviews and approves all initial decisions. This individual has more than 30 years’ experience in working with persons with disabilities. Overturning the initial decision is usually the result of new information presented at the appeal hearing.

Case Examples 35 Valley Metro estimates it requires 2 hours of staff time to prepare for an appeal hearing. The three panel members spend a combined 12 hours for each hearing. The Valley Metro budget has no separate line item for handling appeals. Valley Metro is generally satisfied with its eligibility appeal process. The process has remained in its existing form for a number of years. The number of appeals (and applications for paratransit service) decreased significantly in 2012 when Valley Metro began conducting in-person interviews and functional assessments. The paratransit program supervisor cited two areas in which the process could improve. First, because Valley Metro requires all three members to hear all appeals and each member serves for at least 12 months, it can be difficult to recruit panel members. Second, having a third member representing the disability community may be limiting if the representative has limited knowl- edge of the range of disabilities. For example, a member who uses a wheelchair and has a mobil- ity disability may not have knowledge and experience about cognitive disabilities. Regional Transportation Commission of Southern Nevada The Regional Transportation Commission of Southern Nevada (RTC) pro- vides public transit for the Las Vegas, Nevada, metropolitan area. In FY 2016, RTC’s fixed-route bus service provided more than 60 million passenger trips, and the agency’s ADA paratransit ridership was 1.14 million trips. RTC shares responsibility for paratransit eligibility determination with a contractor. RTC conducts interviews, maintains records, and arranges for appeals. The contractor conducts func- tional assessments and conducts appeal hearings. As of FY 2016, RTC had certified nearly 20,000 individuals as eligible for complementary paratransit service. Table 11 summarizes the outcomes for RTC’s recent paratransit determinations. RTC publicizes its eligibility appeals process through its paratransit rider guide, public meet- ings, and visits to targeted groups. It also summarizes the appeal process in its eligibility deter- mination letters. RTC works with its Transportation Access Advisory Committee on the appeal process and other paratransit policies. Information on the appeal process is made available in multiple formats, including print, large print, audio, and an electronic file. An applicant may request an appeal up to 65 days after the date of the initial determination letter. After receiving a request for an in-person appeal, RTC schedules the appeal to take place within 60 days. Starting in 2016, applicants were allowed to request an appeal solely in writing in Determination New Applicants FY 2016 Recertifications FY 2016 New Applicants FY 2015 Unconditional 1,353 111 1,504 Conditional 607 147 742 Temporary 419 55 460 Visitor 0 0 0 Not eligible (denied) 716 200 1076 Total 3,095 513 3,782 Table 11. RTC eligibility determinations.

36 Administration of ADA Paratransit Eligibility Appeal Programs place of an in-person hearing. According to RTC’s ADA certification supervisor, RTC receives 5–10 requests for appeals solely in writing each month. In practice, an applicant may appeal a determination of conditional eligibility. According to RTC’s ADA certification supervisor, however, this does not happen. When RTC grants applicants conditional eligibility, the agency also informs them that it does not enforce conditions for service. In effect, all riders with conditional eligibility receive all paratransit trips. At the time of the case example interview, RTC did not have a timetable to begin enforcing conditional eligibility. If an applicant requests an in-person appeal and submits information with the request, RTC first reviews the submitted documents. Occasionally, RTC may revise its initial determination based on the new information in place of holding a hearing. RTC contracts with one hearing officer to hear all appeals. This individual has been RTC’s appeals hearing officer for more than 8 years. The contractor’s credentials include advanced degrees in law and sociology, and the contractor teaches ADA issues at a local university. Compensation to the hearing officer is $175 per hearing. An RTC representative (ADA certification officer or other staff) also attends the hearings, which occur twice per month and include the following steps: 1. The hearing officer facilitates introductions and outlines the hearing process. 2. The hearing officer advises the appellant of all records on file that have been reviewed in preparation to hear the case. 3. The hearing officer explains what the appellant’s rights are if the appellant does not agree with the determination and informs the appellant how long RTC has to provide a determination. 4. The RTC representative covers the initial interviewer’s observation notes and the functional assessment evaluator’s recommendation as a basis of the initial determination. 5. The appellant and anyone present supporting the appellant receives time to make a statement. 6. The hearing officer asks follow-up questions related to the appellant’s statement. RTC provides a decision within 30 days of the hearing. If no decision is made within 30 days, the appellant receives presumptive eligibility until there is a decision. In FY 2016, RTC completed 139 eligibility appeals, which included appeals in writing, appeals in person, and revised decisions that took place prior to a formal hearing. The outcomes were as follows: uphold the initial determination, 90; change “Not eligible” to “Unconditional,” five; change “Not eligible” to “Temporary,” 14; and “Other decisions,” 30. The “Other decisions” category consists of cases that the hearing officer remands. This out- come means that the hearing officer is not prepared to change the initial determination based on the appellant’s statement and written information, but the hearing officer recommends that the appellant have a second functional assessment and/or provide further medical information. In effect, the initial determination is tentatively upheld, but RTC is giving the appellant the chance to provide further information. RTC does not track the eventual determination of remanded appeals. According to the ADA certification supervisor, in a small portion of the remanded cases, the appellant does not follow through, which leads to an upholding of the initial determination. Appendix D to this synthesis presents a sample notification letter for the “appeal remanded” decision. The sample notifica- tion letter could be used as a template. RTC’s budget for appeals consists primarily of fees paid to the hearing officer. In FY 2016, fees totaled $20,000, with an additional $2,500 for other costs. RTC estimates that the average level of effort for an eligibility appeal is 1 hour for RTC staff and 3 hours for the contractor. RTC is satisfied with the current contractor and with the hearing process. The tran- sit agency does not have plans to change the existing process. The contractor has gained

Case Examples 37 significant experience over the years in hearing all of the RTC eligibility appeals. A single hearing officer also removes the issues of inconsistent decision making. Before using a single hearing officer, RTC had encountered difficulty scheduling hearings at times when all panel members could attend. One challenge RTC continues to face is a high proportion of appellants (approximately 75%) who fail to appear at the appeals hearing. The ADA certification supervisor estimated that only one-third of this 75% reschedule their hearings. The officer believed that “seven out of 20” rep- resents a good turnout for a day of scheduled appeal hearings. RTC does not offer free transpor- tation to the appeal hearing, but the ADA certification supervisor does not believe that doing so would significantly improve the no-show rate. Tri-County Metropolitan Transportation District of Oregon The Tri-County Metropolitan Transportation District of Oregon (TriMet) is the public transit provider in the Portland, Oregon, region. TriMet operates bus, light rail, commuter rail, and paratransit (LIFT) service. Total ridership exceeded 78.2 million trips in FY 2016, and LIFT ridership was nearly 1.1 million passenger trips. All LIFT operations are contracted. TriMet staff administer the program. TriMet uses a con- tractor for functional assessments. TriMet staff make the eligibility determinations and carry out all aspects of eligibility appeals. As of FY 2016, TriMet had certified more than 20,000 individuals as eligible for complemen- tary paratransit service. Of these, nearly 10,000 individuals were “active riders,” meaning that they had used LIFT within the previous calendar year. Table 12 summarizes the outcomes for TriMet’s recent paratransit determinations. TriMet publicizes its eligibility appeals process in all of its eligibility and application materials, on the agency’s website, and through public meetings. The information on the appeal process is available in multiple formats, including print, large print, Braille, audio, and an electronic file. An applicant may request an appeal up to 65 days after the date of the initial determination letter. This request may be made in writing, over the telephone, or in person. Appendix E presents two documents that describe TriMet’s policies and procedures for eligi- bility appeals. The first document, titled LIFT Paratransit Eligibility Determination Appeal Pol- icy, is a public document (available on the TriMet website). The second document, titled LIFT Paratransit Eligibility Determination Appeal Procedure, is made available when an applicant Determination New Applicants FY 2016 Recertifications FY 2016 New Applicants FY 2015 Unconditional 1,013 1,120 955 Conditional 545 444 561 Temporary 453 35 406 Visitor 60 0 60 Not eligible (denied) 50 11 94 Total 2,121 1,610 2,076 Table 12. TriMet eligibility determinations.

38 Administration of ADA Paratransit Eligibility Appeal Programs appeals an eligibility decision. The procedure document focuses on the process of applying for and participating in an appeal. Both documents are thorough and well written. After receiving a request for an in-person appeal, TriMet will arrange for a “timely” appeal date. The applicant may request a written appeal in place of an in-person hearing. According to TriMet’s manager of LIFT eligibility and community relations, since 2010, there have been only six requests for appeals without in-person hearings. When an applicant submits new or additional information with the request for an in-person appeal, TriMet reviews that information. Since TriMet began its current eligibility appeal process in 2010, the agency has undertaken “administrative reviews” for 119 appeal requests. The appeal policy document in Appendix E explains this step, which takes place before the formal hearing. Of the 119 appeal requests, TriMet has revised 89 initial determinations based on the administra- tive review. According to the manager of LIFT eligibility and community relations, changes to initial determinations due to TriMet errors are rare; changes usually are based on having received additional medical information from the applicant. If TriMet revises a determination, it notifies the applicant and asks whether the applicant wants to proceed with the formal appeal. The TriMet appeal panel consists of three members, all of whom are TriMet employees: • Legal counsel. Several individuals rotate in this member slot. The legal counsel clarifies ADA questions and also prepares the written correspondence for the appeal decision. • ADA compliance administrator. This individual has no day-to-day involvement with LIFT service. • Transportation manager. Typically, this role is filled by one of several TriMet station manag- ers, who rotate in this member slot. Station managers work for fixed-route operations and have experience in fixed-route accessibility. Appeal hearings take place as often as two mornings per month. TriMet offers free paratransit service to the hearing, which takes place at a TriMet office. Because all panel members are TriMet employees, they can arrange to participate as part of their overall job duties. Based on schedule availability, alternates are available to fill the legal counsel and transportation manager seats. The steps of the in-person hearing include: 1. TriMet staff (not a panel member) open the meeting and review the hearing procedure. 2. TriMet staff present the agency’s position. 3. The appellant makes a presentation which includes any information presented by advocates. 4. Each party has the right to ask about the information provided. 5. The appeal panel may choose to continue the hearing at a later date. 6. The appeal panel may also request further information before making a decision. 7. The appeal panel notifies the appellant of the process for a final decision and follow-up communications. TriMet provides a decision within 30 days of the hearing. If no decision is made within 30 days, the appellant receives presumptive eligibility until there is a decision. The vote of the panel does not need to be unanimous; however, split votes are rare. In FY 2016, TriMet completed 23 eligibility appeals, including appeals in writing, in person, and initial determinations revised prior to a formal hearing. The outcomes were as follows: uphold initial determination, seven; change “Not eligible” to “Unconditional,” four; change “Not eligible” to “Conditional,” six; change “Conditional” to “Unconditional,” three; and change “Not eligible” to “Temporary,” three. In FY 2015, TriMet completed 32 eligibility appeals. The outcomes were as follows: uphold initial determination, six; change “Not eligible” to “Unconditional,” five; change “Not eligible”

Case Examples 39 to “Conditional,” six; change “Conditional” to “Unconditional,” eight; change “Not eligible” to “Temporary,” two; and additional conditions placed on a “Conditional” determination, five. Since the existing process began in 2010, the highest number of appeals in a single year was 40. In FY 2016, TriMet staff (both LIFT staff and appeal panel members) used an estimated 240.5 hours to handle the agency’s eligibility appeals. TriMet has no separate estimate of the budget for conducting appeals; the agency does not track the time that panel members dedicate to appeal hearings. TriMet’s manager of LIFT eligibility and community relations cited the availability of panel members as an ongoing challenge. Even though panel members are drawn solely from TriMet staff, coordinating and scheduling appeal hearings is still difficult. Often, the TriMet employee assigned to the panel’s transportation manager slot will be called away at the last minute to tend to other primary job responsibilities. Another challenge is providing sufficient training on how functional abilities may or may not be impacted by a variety of disabilities. The manager of LIFT eligibility and community relations said that this is generally not crucial for most hearings. TriMet panel members have gained knowledge by serving on the panel. However, TriMet may consider ways to incorporate individuals with expertise in various disabilities. If there was a belief that the panel was not doing a good job, the manager of LIFT eligibility and community relations said that TriMet would review the process. The agency’s policy document states, “TriMet shall have the burden of demonstration that the Appellant’s eligibility for paratransit service was appropriately determined” (see Appendix E). In effect, this statement reinforces the underlying principle that public transit is a civil right, and that the transit agency has the burden to demonstrate that an individual is not eligible for paratransit service. Capital Metropolitan Transportation Authority The Capital Metropolitan Transportation Authority (Capital Metro) is the public transit provider in the Austin, Texas, region. It operates bus, com- muter rail, and paratransit service (MetroAccess). In FY 2016, total ridership was nearly 23 million trips, including 662,000 ADA paratransit trips. Capital Metro and its contractors share responsibility for eligibility determinations, including in-person interviews and functional assessments. Capital Metro staff conduct appeal hearings. As of FY 2016, Capital Metro had certified more than 5,641 individuals as eligible for comple- mentary paratransit service. Table 13 summarizes the outcomes for Capital Metro’s recent paratransit determinations. New Applicants FY 2016 Recertifications FY 2016 New Applicants FY 2015 Unconditional 365 475 323 Conditional 110 292 78 Temporary 369 131 405 Visitor 76 0 82 Not eligible (denied) 78 56 74 Total 998 954 962 Table 13. Capital Metro eligibility determinations.

40 Administration of ADA Paratransit Eligibility Appeal Programs Capital Metro publicizes its eligibility appeal process through its rider guide and public meet- ings. An advisory committee has an ongoing role in the process, and one of its members is on the eligibility appeal panel. Information on the appeal process is available in multiple formats including print, large print, Braille, and an electronic file. Capital Metro staff also are available to read and review the material over the phone upon request. An applicant may request an appeal up to 60 days after the date of the initial determination letter. After receiving a request for an in-person appeal, Capital Metro schedules the appeal to take place within 60 days. The applicant may request the appeal solely in writing, although this has not happened since the current system went into effect in 2011. An applicant may participate in an appeal hearing via conference call. When an applicant requests an appeal, the MetroAccess paratransit eligibility manager calls the applicant to explain the process. That call may lead to the applicant submitting additional information or even preparing a new application (along with having a new in-person interview and functional assessment if the applicant is reporting a change in conditions since the initial assessment). The paratransit eligibility manager estimates that this happens 3–4 times per year. The manager reviews the files of all applicants who request an appeal. Capital Metro’s appeal panel consists of three members: • The ADA coordinator. This is a Capital Metro employee who generally works in the fixed- route bus division. Backups are available when the ADA coordinator cannot attend a hearing. • An Access Advisory Committee (AAC) member. This slot rotates among the AAC members. A participating AAC member takes a 1-year term on the panel. • An outside member with expertise in disabilities. This individual also serves a 1-year term. Recent members have included a mental health specialist, a university system disabilities ser- vices expert, a vocational rehabilitation counselor, the department head of an occupational therapy department, and a professor/occupational therapist. The AAC member and outside member with expertise in disabilities serve without payment. At the time of the interview, Capital Metro had plans to provide transit passes to these two members. Appeal hearings take place as frequently as 2 days per month. Capital Metro offers free paratransit service to the hearing, which takes place at a Capital Metro office. The steps of the in-person hearing include: 1. Introduce all attendees. 2. Provide a summary of MetroAccess service and eligibility requirements. 3. Provide a summary of the appellant’s application process, in-person interview, and assess- ment from agency staff (usually the paratransit eligibility manager). The summary is a pre- pared statement. 4. The appellant and/or advocate speaks, presents the appellant’s case, and provides additional information. 5. Questions are taken from panel members. 6. Wrap up; inform appellant of next steps. Capital Metro provides a decision within 30 days of the hearing. If no decision is made within 30 days, the appellant receives presumptive eligibility until there is a decision. The panel usually makes a unanimous decision, although there are occasional 2–1 votes. Appendix F presents the determination form used by MetroAccess to provide official written notification of the appeal decision to the appellant. A contractor completes the form, and the

Case Examples 41 paratransit eligibility manager reviews it before sending it to the appellant. The document in Appendix F can be used as a template. In FY 2016, Capital Metro completed 33 eligibility appeals, including appeals in writing and revised decisions prior to a formal hearing. The outcomes were as follows: uphold initial deter- mination, 27; change not eligible to unconditional, one; change not eligible to conditional, one; change conditional to unconditional, three; and change not eligible to temporary, one. In FY 2015, Capital Metro completed 37 eligibility appeals. The outcomes were as follows: uphold initial determination, 32; change not eligible temporary, three; change temporary to conditional, one; and change temporary conditional to temporary unconditional, one. Capital Metro estimates that the average level of effort for an eligibility appeal involves 4 hours for its own staff and 1 hour for the contractor. Capital Metro has no separate estimate of the budget for conducting appeals; the work is built into the time of the participating staff. The biggest issue for Capital Metro has been the inconsistency of the appeal outcomes, both from appeal to appeal, and compared to the initial determinations. The MetroAccess manager thinks that it is good for an AAC member to participate. However, that member may not be fully considering an appellant’s ability to use fixed-route service. She noted that MetroAccess is now providing more comprehensive individualized training to help the AAC member understand the eligibility process and the role of appeals. The paratransit eligibility manager noted other challenges with the structure of the appeal panel. First, the collective panel for any given appeal may not have the necessary level of exper- tise, especially as related to an appellant’s specific disability; however, it is too hard to identify and schedule the third member of the panel to match the medical diagnosis of the appellant. The paratransit eligibility manager would rather all panel members have “all-purpose” knowledge of disabilities and paratransit to make good decisions. The manager believed that, as recently as 2014, the panel was often too generous toward appellants in their decisions. Second, scheduling hearings is a challenge due to the uneven availability of all panel members— which makes trying to match panel members with appropriate expertise to particular cases prob- lematic. On a positive note, the high proportion of initial determinations upheld by the appeal panel (82% and 86% over the past 2 years) leads the paratransit eligibility manager to believe that Capital Metro is doing a good job in making the initial eligibility determinations. King County Metro The King County Department of Transportation Metro Transit Division (King County Metro) is the public transportation agency for Seattle, Washington, and the surrounding cities within King County. Among all transit modes, which include bus, light rail, commuter rail, trolley, and vanpool, King County Metro provided more than 168 million passenger trips in 2016. ADA paratransit ridership was 914,000 trips. King County Metro is responsible for the paratransit eligibility determinations. The agency and its contractors share responsibility for in-person interviews and assessments. A contractor conducts appeal hearings. As of FY 2016, King County Metro had certified more than 14,000 individuals as eligible for complementary paratransit service. Table 14 summarizes the outcomes for King County Metro’s recent paratransit determi- nations. The transit agency does not keep records to distinguish between new applicants and

42 Administration of ADA Paratransit Eligibility Appeal Programs recertifications. It also does not distinguish temporary determinations of eligibility. All para- transit applicants can receive a maximum eligibility term of up to 3 years, depending on the individual’s specific condition(s). King County Metro also conducts quarterly customer surveys from applicants attending in-person evaluations. The compiled results from 2016 regarding the applicants’ experience at their in-person evaluation are as follows: • Excellent: 91% • Good: 8% • Fair: 1% • Poor: 0% The agency publicizes its eligibility appeals process through public meetings and a brochure it encloses with each determination letter (see Appendix G). King County Metro’s transit advisory group has provided feedback on the eligibility appeal process. Information on the appeal process is available in multiple formats, including print, large print, Braille, audio, electronic file, and speaking with a customer service coordinator. The tran- sit agency has no specific applicant appeal form. An applicant may request an appeal by any means that the applicant prefers. Applicants may request an appeal up to 60 days after the date of the initial determination let- ter. After receiving a request for an in-person appeal, King County Metro seeks to schedule the appeal within 30 days. Applicants may request an appeal solely in writing in place of an in-person hearing; however, the ADA certification administrator stated that, in 10 years of overseeing appeals, no one had requested this option. If an applicant requests an in-person appeal and submits new or additional information with the request, King County Metro conducts an appeal evaluation of that information. The bro- chure reproduced in Appendix G describes this step, which occurs prior to a formal hearing. In FY 2016, there were five instances in which the applicant submitted additional information (sometimes citing a new condition) that led the agency to change its initial determination with- out holding a hearing. King County Metro uses a single individual (the “appeal officer”) who works through a pri- vate contractor to hear all eligibility appeals. The current appeal officer is a registered nurse who retired from the state Department of Social and Health Services, Division of Vocational Reha- bilitation. According to the transit agency’s ADA certification administrator, the current appeal officer is knowledgeable in a wide range of disabilities. Appeal hearings take place at Harborview Medical Center, which is operated by the University of Washington and Washington State (a separate entity from King County Metro). The medical Determination All Applicants FY 2016 All Applicants FY 2015 Unconditional 3,176 3,066 Conditional 1,218 1,253 Temporary * * Visitor 118 129 Not eligible (denied) 34 31 Total 4,546 4,479 * King County Metro does not distinguish temporary determinations of eligibility. Table 14. King County Metro eligibility determinations.

Case Examples 43 center is in the same building where the initial functional assessments take place. Hearings take place to accommodate the schedules of the appeal officer and the applicant. King County Metro offers free paratransit to the hearing. The steps at the in-person hearing include: 1. The appeal officer escorts the appellant into the meeting room and introduces the agency rep- resentative (the ADA certification administrator or a colleague) and the functional evaluator. 2. The appeal officer reads the application aloud and asks additional questions as applicable. Written information is read into the record. 3. The functional evaluator reads aloud the observations and recommendations of the in-person functional evaluation. 4. The appellant presents additional information, orally or in writing. 5. The appeal officer asks additional questions based on the new information. 6. The appeal officer makes a determination based on all the information provided or may choose to gather additional information. King County Metro sets a 7-day deadline to inform the appellant of the decision. For many hearings, the appeal officer makes the decision by the end of the hearing, followed by a written notification. On the rare occasions when no decision has been made within 7 days, the appellant receives presumptive eligibility. King County Metro has not had to provide presumptive eligibil- ity for any appellant during the past 10 years. In FY 2016, King County Metro completed 13 eligibility appeals, including only those appeals that proceeded to hearings. In FY 2015, the agency completed 15 eligibility appeals. The agency was not able to provide detailed information on the outcomes of these appeals. Based on esti- mates of the ADA certification administrator, nearly all of the appeals are from individuals who initially received conditional eligibility. About half of these appeals result in changes to the appli- cants’ conditional eligibility, a quarter result in unconditional eligibility, and a quarter result in no change (the initial decisions are upheld). For those applicants who are denied eligibility, the certification administrator said, “since we have a very thorough and comprehensive certification process, it’s generally pretty clear to the applicant why they are being denied paratransit whenever that is the determination.” The ADA certification administrator estimates that an average appeal requires 3 hours of staff time and 2 hours of appeal officer time. In FY 2016, the payment to the appeal officer was $393 per appeal. In FY 2015, the payment to the appeal officer was $383 per appeal. No separate budget allocation exists for eligibility appeals. King County Metro is satisfied with its current eligibility appeal process. According to the ADA certification administrator, the key is a good initial determination process that educates applicants about the certification criteria and the nature of the paratransit service. The appeal rate is less than 0.5% of all applications. In its survey response, the transit agency noted that the process “is structured in a way to be more personalized, and less bureaucratic and confronta- tional. We find that appellants are less intimidated when there are fewer individuals to meet with when discussing their abilities to independently use public transit.” The setting is less formal, even to the extent that the appeal officer, transit agency staff, and the applicant all sit at a round table. During the hearing, agency staff and the appeal officer also discuss other transit options available to the applicant.

Next: Chapter 5 - Conclusions and Suggestions for Future Research »
Administration of ADA Paratransit Eligibility Appeal Programs Get This Book
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TRB's Transit Cooperative Research Program (TCRP) Synthesis 133: Administration of ADA Paratransit Eligibility Appeal Programs identifies ADA eligibility appeal processes and documents current practices of transit systems.

ADA paratransit eligibility appeal programs allow appellants the opportunity to present new information not provided or available during the initial eligibility decision that may warrant a change in eligibility determination. At the same time, any appeal program must consistently apply the decision-making standards established by the agency’s ADA paratransit certification program. As more agencies employ some form of conditional eligibility, eligibility appeal processes are emerging as a significant area of vulnerability. If the eligibility appeal process is not administered properly, transit agencies run the risk of violating applicants’ civil rights under the ADA or Title VI requirements.

Although several reports describe transit agency practices for determining eligibility for ADA paratransit service, little has been documented about how transit agencies manage appeals by applicants who are determined to be “not eligible” or who are found “conditionally eligible,” including temporary eligibility.

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