National Academies Press: OpenBook

Rural Transportation Issues: Research Roadmap (2021)

Chapter: Appendix H Transit Problem Statements

« Previous: Appendix G Final Fifteen Portfolios
Page 426
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 426
Page 427
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 427
Page 428
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 428
Page 429
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 429
Page 430
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 430
Page 431
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 431
Page 432
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 432
Page 433
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 433
Page 434
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 434
Page 435
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 435
Page 436
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 436
Page 437
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 437
Page 438
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 438
Page 439
Suggested Citation:"Appendix H Transit Problem Statements." National Academies of Sciences, Engineering, and Medicine. 2021. Rural Transportation Issues: Research Roadmap. Washington, DC: The National Academies Press. doi: 10.17226/26343.
×
Page 439

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Rural Transportation Issues: Research Roadmap H-1 A P P E N D I X H Transit Problem Statements

Rural Transportation Issues: Research Roadmap H-2 Transit Problem Statements • Design Guide for Rural Deviated Fixed Route Transit Systems • Guidebook for Improving Connectivity to Intercity Bus Services • Policy Coordination to Improve Rural Non-Emergency Medical Transportation (NEMT) Patient Care and Reduce Fiscal Risk

Rural Transportation Issues: Research Roadmap H-3 I. Problem Title Design Guide for Rural Deviated Fixed Route Transit Systems II. Research Problem Statement Traditional rural bus systems operate either a pre-scheduled fixed route, or an on-demand (dial-a-ride) type service. Deviated fixed route transit (DFRT) systems are an intermediate option: the general route and schedule are pre-determined, but the route can be varied to some degree based on requests from riders. In general, traditional fixed-route service is efficient for corridors with high ridership density, while demand-responsive service is suitable for low-density areas and specialized services. DFRT addresses intermediate and mixed cases. For example, some transit systems combine fixed-route service in a central business district with DFRT in outlying low-density residential areas. Similarly, some agencies switch from daytime fixed-route service to late-night DFRT. DFRT service presents a number of policy and service planning issues. These include: • How much deviation from the standard route will be permitted, and associated schedule impacts. • How far in advance a deviation must be requested, and penalties for cancellations and no-shows. • Whether all riders are allowed to request deviations, or only those passengers meeting certain criteria (e.g., a physician-certified disability). • Whether vehicles return to the normal route after making a deviation or proceed directly to the location of the next known passenger (which could bypass non-appointment passengers waiting at intermediate stops). • Coordination with neighboring transit systems and other travel modes. • Target markets, fare policies, adaptation to seasonal demand fluctuations, and fare revenue. • Eligibility and reimbursement rates for various governmental programs. • Public communication, service marketing, and customer orientation for elderly riders and people with physical and cognitive disabilities. • Effects of DFRT on travel time, ridership, operating costs, productivity, and customer satisfaction. All of these issues need to be considered in the context of the size and shape of the service area, local terrain and land use patterns, and the layout of the underlying fixed routes (unidirectional loop, bidirectional linear corridor, hub-and-spoke, etc.). In 2010, TCRP Report 140 developed general descriptions of several deviated fixed route systems (including their target productivity levels) (Potts 2010), and a 2019 brief from the National Rural Transit Assistance Program provides overviews of three rural transit systems that converted from demand- responsive services to DFRT (National Rural Transit Assistance Program 2019). A 2013 summary prepared by Errico et al offers an overview of the academic literature on DFRT and other forms of flexible transit service (Errico 2013). In general, the schedule-adherence and productivity effects of various deviation policies have only been explored in theoretical papers (Qiu 2015, Yang 2016, Fu 2002, Pratelli 2001, Chen 2017, and Rural Transportation Issues: Research Roadmap 2019). Unfortunately, these theoretical works generally lack field measurements of the productivity achieved by actual DFRT systems, and the absence of such validations severely limits their usefulness to practitioners. Additional field studies are necessary to evaluate the characteristics, benefits, drawbacks, and design considerations for rural deviated fixed route systems, including data that can help validate theoretical performance models. Additionally, the experiences of rural transit systems that have implemented DFRT service should be gathered and summarized to identify common issues and opportunities, to expand the resources available to agencies considering DFRT systems.

Rural Transportation Issues: Research Roadmap H-4 III. Research Objective The objective of this project is to develop practical guidance that can assist practitioners with all aspects of rural DFRT system design, including policy-setting, physical layout, service planning, and revenue forecasting. The guidebook should address methods for estimating effects on ridership, customer satisfaction, labor and equipment requirements, and operation and maintenance (O&M) costs. This includes consideration of the technical requirements for stops, vehicles, software, and employee training, and whether the locations of deviated stops should be pre-planned or determined in real-time based on operator discretion. The guidance should also address the use of modeling and analysis tools to develop objective methods for comparing proposed DFRT services with other service delivery methods, and validating performance measure estimates against existing service plans. IV. Research Proposed To accomplish these objectives, the research team will review published and unpublished reports about conversions to and from DFRT service in rural areas, gather performance data for existing DFRT systems, compare the DFRT service policies of various U.S. and Canadian agencies, survey passengers to compare DFRT satisfaction with other service delivery methods, and interview rural system managers to gather information about positive and negative DFRT experiences. V. Estimate of the Problem Funding and Research Period The estimated cost of the research is $650,000 for a 36-month study. VI. Urgency, Payoff Potential, and Implementation Aging populations, driver shortages, and the desire to increase ridership, productivity, and customer satisfaction are key motivators for the development of deviated fixed route services. Anecdotal information suggests that compared to fixed-route service, DFRT can boost ridership, potentially allowing rural transit agencies to serve more customers with existing resources. In some cases, DFRT offers productivity advantages compared to operating fixed-route services with overlapping paratransit. Publication of the guidebook has the potential to spark increased interest in converting existing services to DFRT, particularly if the findings of the customer satisfaction surveys and system manager interviews are favorable. Further implementation of the practices recommended in the guidebook may occur as rural transit agencies reconsider their service delivery methods in responses to changes in population, demographics, land use, finances, and labor availability. VII. Relationship to FTA Strategic Research Goals, TCRP Strategic Priorities, and/or TRB Strategic, Critical, and Emerging Issues This problem statement fits within the U.S. DOT Strategic goals of accountability and innovation. It also fits within 4 of the 5 TCRP strategic priorities including: place the public transportation customer first, continuously improve public transportation, flourish in the multimodal environment, and revitalize transit organizations.

Rural Transportation Issues: Research Roadmap H-5 VIII. References (Related Research) Chen, P. and Y. Nie. 2017. “Connecting E-Hailing To Mass Transit Platform: Analysis of Relative Spatial Position.” Transportation Research Part C: Emerging Technologies. 77: p. 444-461. 8. Errico, F., et al., 2013. “A Survey on Planning Semi-Flexible Transit Systems: Methodological issues and a Unifying Framework.” Transportation Research Part C: Emerging Technologies. 36: p. 324-338. Fu, L. 2002. “Planning and Design of Flex-Route Transit Services.” Transportation Research Record. 1791(1): p. 59-66. National Rural Transit Assistance Program. 2019. Moving from Demand Response to a Deviated Fixed- Route Best Practices. Potts, J.F., et al. 2010. TCRP Report 140: A Guide for Planning and Operating Flexible Public Transportation Services, Transportation Research Board, Washington, DC. Pratelli, A. and F. Schoen. 2001. “A Mathematical Programming Model for the Bus Deviation Route Problem.” Journal of the Operational Research Society. 52(5): p. 494-502. Qiu, F., W. Li, and A. Haghani. 2015. “A Methodology for Choosing Between Fixed-Route and Flex- Route Policies For Transit Services.” Journal of Advanced Transportation. 49(3): p. 496-509. Rural Transportation Issues: Research Roadmap, 2019. Rural Public and School Transportation Theme Report. Interim Report, NCHRP 20-122. Yang, H., et al. 2016. “A GIS-Based Method to Identify Cost-Effective Routes for Rural Deviated Fixed Route Transit.” Journal of Advanced Transportation. 50(8): p. 1770-1784. IX. Persons Developing the Problem John Shaw, Researcher at Institute of Transportation, Iowa State University, 2711 South Loop Drive, Suite 4700 Ames, IA 50010-8664, (515) 294-4366 (phone) and 515-294-0467 (fax) David Kack, Program Manager at the Western Transportation Institute, Montana State University, PO Box 174250 Bozeman, MT 59717, (406) 994-7526 (phone) and (406) 994-1697 (fax) X. Process Used to Develop Problem Statement This problem statement was developed at the direction the project panel for NCHRP Project 20-122, Rural Transportation Issues: Research Roadmap. More than 750 topics were identified across 14 theme areas through 4 workshops. Those 750 topics were winnowed through a prioritization exercise at the TRB Annual Meeting in January 2019 and a webinar in March 2019. This problem statement was selected by the NCHRP 20-122 panel through consensus discussion in May 2019 as one of the top 3 priorities under the Rural Public & School Transportation Theme, out of 116 topics considered in that theme. The research team prioritized production of the Rural Public and School Transportation Theme Report in order to provide panel-selected problem statements in time for the TCRP deadline in June 2019. The Rural Public and School Transportation Theme Report was accepted by the panel in May 2019 and distributed to relevant staff at AASHTO, APTA, TRB, CTAA, National RTAP, and other organizations for sharing with interested committees, councils, and so forth for their use. For the remaining theme reports, the NCHRP 20-122 panel will review and accept them, then share them in similar fashion as they are completed. The final report in October 2019 will include all of the theme reports as well as the problem statements generated by the project and collected from others. XI. Date and Submitted By Provide the specifics (i.e., name, title, address, telephone, and fax numbers) of the person(s) who submitted the problem and the date of submission.

Rural Transportation Issues: Research Roadmap H-6 Click here to submit: FY 2020 TCRP Problem Statement Submissions Gwen Chisholm Smith, Manager @202-334-3246 Transit Cooperative Research Program

Rural Transportation Issues: Research Roadmap H-7 I. Problem Title Guidebook for Improving Connectivity to Intercity Bus Services II. Research Problem Statement Accessible and affordable transit services are extremely important for access and mobility in rural areas. Without transit services, many rural residents would not have access to healthcare, employment, education, and recreation. The need is even more prevalent with “current trends increasing demand for non-auto travel options in rural communities, including aging populations, rising poverty, growing health and safety concerns, and growing tourist industries (Litman 2018).” For example, the availability of seasonal employees can be enhanced when a rural tourism community is served by intercity buses. Intercity bus services are a key component to increasing access and mobility for rural communities as they provide longer distance transportation to more populated areas with necessary services, particularly for disadvantaged populations. Unlike local/regional/tribal bus service, intercity buses have very limited stops: many routes stop only in larger communities, and some operate nonstop between major cities. Additionally, most rural intercity bus routes have limited schedules, perhaps stopping in a rural community only once daily per direction. In many cases local, regional, and tribal public transportation networks have the potential to serve as feeder-distributor routes for intercity bus service, yet rural transportation agencies report that it is often difficult to justify restructuring a local transit network to connect with an infrequent intercity service or extending a local bus route a great distance to reach an intercity carrier’s stop on the outskirts of the community. The idea of connecting and coordinating public transportation services is not new. In 2004, the Coordinating Council on Access and Mobility (CCAM) was established by executive order specifically to assist with federal coordination (Coordinating Council on Access and Mobility 2018). Many reports have also been written including those on creating coordinating councils (Regional Human Services Transportation Coordinating Council 2012 and TransitPlus 2009), a regional coordination guide (Lewis 2009), a toolkit on rural coordination (Burkhart 2004), and most recently a guidebook on rural public transportation consolidation (NCHRP Project 20-65 2017). However, these documents are either specific to a particular region of the U.S., urban in nature, or do not directly address coordination with intercity bus services. Due to the uniqueness of the intercity bus service, coordination planning techniques and/or guidebooks written with only traditional public transportation services in mind may not be applicable, beneficial, or efficient. Therefore, it is necessary to create a guidebook solely dedicated to these unique challenges, solutions and case studies. For instance, one of the most prevalent challenges in connecting these services is the public-private divide. The majority of intercity bus services are for-profit, operated by private industry whereas the traditional public transportation services tend to be non-profits, operated by a government agency. This creates a lack of institutional knowledge, and in some cases, even a lack of knowledge of service existence. Another significant barrier in communication and coordination is due to intercity bus services typically crossing state lines, which requires coordination with multiple states and challenges with jurisdictional subsidy programs. Another unique aspect of coordination with intercity bus services is the opportunity to treat revenue from unsubsidized portions of a route to serve as matching funds for Federal Transit Administration (FTA) subsidy of service to underserved communities. In recent years, several new carriers have entered the intercity bus business. Many of these new entrants have built their businesses around specific immigrant communities (notably Asian-Americans or

Rural Transportation Issues: Research Roadmap H-8 Hispanics). These companies may have limited awareness of the market opportunities associated with other ethnicities, and may be reluctant to discuss their business plans with local officials. III. Research Objective The objective of this project is to develop a practical, user-friendly, guidebook for implementing and improving public transportation service connectivity with intercity bus services. The guidebook should have simple explanations and lots of examples relating to some of the complex challenges mentioned below. The guidebook will be written to assist state, local, regional, tribal and Federal Land Management Agency service providers who are considering options for improving connectivity. IV. Research Proposed The guidebook should address the steps for connectivity including, but not limited to: • identifying intercity bus stakeholders and services in an area, • defining a “meaningful connection” between the intercity transit system and the local transit system, • documenting needs (e.g., customer, infrastructure, funding, planning, service delivery) for connectivity, • estimating and comparing the scheduling, operational, and financial effects of deviating one bus route to connect with another, • articulating to intercity bus stakeholders why connectivity is beneficial and how it may serve their needs, • developing mutual understanding of the goals of private for-profit carriers and local/tribal communities, • communicating the public agency decision-making process with the private sector, • methods to coordinate state intercity bus subsidy programs across jurisdictional boundaries, • incorporating intercity bus stakeholders and services into existing transit plans, • creating a coordinating council or incorporating intercity bus services into an existing one, • collaborating with intercity bus services even while consolidating rural public transportation services, • interagency collaboration mechanisms, • connectivity strategies, • funding sources, including FTA programs, • understanding how to use the unsubsidized miles in an intercity bus system for match for the local service, • connectivity for life-enhancing activities (e.g., social and recreational) vs life sustaining activities (e.g., medical), • travel training program strategies, • strategy evaluation techniques for measuring impact, and • best practices, lessons learned, and case study examples. To accomplish these objectives, the research team will review published and unpublished reports on public transportation connectivity and intercity bus services; contact existing coordinating councils to determine if any examples of connectivity with intercity bus exists; and interview rural system managers to identify challenges, lessons learned, and best practices. V. Estimate of the Problem Funding and Research Period The estimated cost of the research is $500,000 for a 30-month study.

Rural Transportation Issues: Research Roadmap H-9 VI. Urgency, Payoff Potential, and Implementation Providing better access and mobility for rural, underserved populations to key services such as healthcare, employment, education, and recreation are key motivators for improving the connectivity of local, regional and tribal public transportation services with intercity bus services. Publication of the guidebook has the potential to increase rural connectivity by highlighting best practices in collaborations between non-profit and for-profit transit agencies. Working collaboratively can be beneficial for rural residents by making new destinations accessible, for public transportation agencies by increasing ridership, and for intercity bus services by increasing revenues. Documentation of the implementation of the practices recommended in the guidebook will become even valuable as a resource to local decisionmakers as the number of rural residents choosing to age in place increases. VII. Relationship to FTA Strategic Research Goals, TCRP Strategic Priorities, and/or TRB Strategic, Critical, and Emerging Issues This problem statement fits within the U.S. DOT Strategic goals of accountability and innovation. It also fits within 4 of the 5 TCRP strategic priorities including: place the public transportation customer first, continuously improve public transportation, flourish in the multimodal environment, and revitalize transit organizations. VIII. References (Related Research) Burkhart, J.E., et al. 2004. TCRP Report 101: Toolkit for Rural Community Coordinated Transportation Services. Transportation Research Board of the National Academies. Washington, DC. Coordinating Council on Access and Mobility. 2018. https://www.transit.dot.gov/ccam Lewis, C.A. et al. 2009. Regional Transit Coordination Guidebook. Texas Transportation Institute. Litman, T.A. 2018. “Rural Multimodal Planning: Why and How to Improve Travel Options in Small Towns and Rural Communities.” Victoria Transport Policy Institute. NCHRP Project 20-65. 2017. Task 69 Consolidation of Rural Public Transportation Services Guidebook. Transportation Research Board. Washington, DC. Regional Human Services Transportation Coordinating Council. 2012. “Synthesis, Case Studies and Directory.” National Conference of State Legislatures. Rural Transportation Issues: Research Roadmap. 2019. Rural Public and School Transportation Theme Report, Interim Report, NCHRP 20-122. TransitPlus. 2009. A Handbook for Creating Local Coordinating Councils in Colorado. The Colorado Interagency Coordinating Council for Transportation Access and Mobility. IX. Persons Developing the Problem Jaime Sullivan, Research Engineer at the Western Transportation Institute, Montana State University, PO Box 174250 Bozeman, MT 59717, (774) 571-3503 (phone) and (406) 994-1697 (fax) X. Process Used to Develop Problem Statement This problem statement was developed at the direction the project panel for NCHRP Project 20-122, Rural Transportation Issues: Research Roadmap. More than 750 topics were identified across 14 theme areas through 4 workshops. Those 750 topics were winnowed through a prioritization exercise at the TRB Annual Meeting in January 2019 and a webinar in March 2019. This problem statement was selected by the NCHRP 20-122 panel through consensus discussion in May 2019 as one of the top 3 priorities under the Rural Public & School Transportation Theme, out of 116 topics

Rural Transportation Issues: Research Roadmap H-10 considered in that theme. The research team prioritized production of the Rural Public and School Transportation Theme Report in order to provide panel-selected problem statements in time for the TCRP deadline in June 2019. The Rural Public and School Transportation Theme Report was accepted by the panel in May 2019 and distributed to relevant staff at AASHTO, APTA, TRB, CTAA, National RTAP, and other organizations for sharing with interested committees, councils, and so forth for their use. For the remaining theme reports, the NCHRP 20-122 panel will review and accept them, then share them in similar fashion as they are completed. The final report in October 2019 will include all of the theme reports as well as the problem statements generated by the project and collected from others. XI. Date and Submitted By Provide the specifics (i.e., name, title, address, telephone, and fax numbers) of the person(s) who submitted the problem and the date of submission. Click here to submit: FY 2020 TCRP Problem Statement Submissions Gwen Chisholm Smith, Manager @202-334-3246 Transit Cooperative Research Program

Rural Transportation Issues: Research Roadmap H-11 I. Problem Title Policy Coordination to Improve Rural Non-Emergency Medical Transportation (NEMT) Patient Care and Reduce Fiscal Risk II. Research Problem Statement Federal law requires programs such as Medicare and Medicaid to cover the cost of Non-Emergency Medical Transportation (NEMT) to medical appointments. NEMT is often the only publicly available transportation service in rural areas. Many communities are underserved, and transportation from frontier and remote areas to urban medical centers is particularly problematic. Although NEMT is a substantial and growing public expenditure with considerable risk for financial improprieties and adverse patient outcomes, stakeholders report that it has a low public profile and is often poorly understood by policy makers, administrators, and the public. Aligning the NEMT services funded by various federal programs with the needs of riders and medical providers is an ongoing challenge for State transportation agencies and transportation providers. According to a 2014 report from the U.S. Government Accountability Office (GAO), there are 42 NEMT programs spread across six Federal departments (U.S. Government Accountability Office 2014). The largest single funder is the Centers for Medicare & Medicaid Services (CMS) in the Department of Health & Human Services (HHS). In 2013, CMS expended a total of $2.7 billion for NEMT services ($1.2 billion for Medicare and $1.5 billion for Medicaid). NEMT programs are also administered by the Veterans Administration (VA), Federal Transit Administration (FTA), the Department of Agriculture, Department of Education, and Department of Housing & Urban Development. GAO found that coordination of Federal NEMT programs is limited, with fragmentation, overlap, and potential for duplication. GAO also expressed concern that Medicare and VA were unwilling or unable to discuss coordination with their peers. A separate 2016 GAO report found NEMT to be at high risk for fraud and abuse (U.S. Government Accountability Office 2016). Since the eligibility status of individual riders can change rapidly, assuring that services are provided only to eligible riders is a key challenge for oversight agencies and service providers alike. The situation is made even more complicated by the array of programs, the large number of public agencies and private firms that provide NEMT services, outdated Federal guidance, and wide variation in the way states administer NEMT programs. GAO also raised concerns about lenient treatment of transportation providers that chronically arrive late or fail to show up for appointments. For the medical community, lack of standardization of NEMT services raises patient care concerns. For example, a 2010 review of several NEMT quality studies concluded that patient safety is sometimes compromised by poor service standardization, insufficient driver training, and communication failures. One manifestation of these problems is missed appointments, which can adversely impact the effectiveness of medical treatments and diminish the efficiency of medical clinics, resulting in increased medical costs. The complexity of NEMT programs results in numerous difficulties for riders and transportation service providers. For example, a 2013 report co-developed by Smart Growth America, Michigan DOT, and the Michigan State Housing Development Authority analyzed NEMT service delivery in three predominantly rural central Michigan counties (Smart Growth America 2013). The report found the current NEMT system to be “daunting and inefficient” for riders, social workers, agencies, and transportation providers. There was low public awareness of the available fixed-route and paratransit services and the process of arranging rides was “complex and time-consuming,” resulting in some patients missing their medical appointments. In the three-county area, a total of 42 companies and organizations provided NEMT services, including public transportation agencies, taxi companies, nursing homes, hospitals, and charitable organizations. As a result, there were “duplicated transportation services in some areas and no service and limited hours in

Rural Transportation Issues: Research Roadmap H-12 other areas.” Public transit providers were well-positioned to provide high quality NEMT service, but many struggled to do so at the Medicaid-approved reimbursement rates. The Smart Growth America report also identified a lack of transparency surrounding NEMT services in Michigan, partly arising from concerns that sharing information about the use of NEMT funds could raise auditing questions. Five years later, the U.S. Department of Health and Human Services audited Michigan’s Medicaid NEMT program for the Detroit area (U.S. Department of Health and Human Services 2018). Using a sample of 200 claims handled by the state’s NEMT broker, the DHHS Office of Inspector General found that 105 claims did not comply with State and Federal requirements. Problems cited in the audit included underqualified drivers, failure to meet vehicle inspection and insurance requirements, and inadequate documentation of claims. On this basis, the auditors recommended that the State repay the Federal government $4.5 million for over 243,000 improper claims. Other states audited by DHHS and found to have NEMT compliance issues include California, Louisiana, Nebraska, New Jersey, North Carolina, Minnesota, Oklahoma, and Texas. While the issues surrounding NEMT are complex and deeply intertwined, they can be distilled to a policy single research question: Would a simplified funding model improve the rural NEMT customer experience, improve patient care, allow service to be delivered more safely and efficiently, or reduce the potential for fraudulent claims? III. Research Objective The objective of this research is to prepare a policy analysis paper outlining the strengths and weaknesses of the existing rural NEMT system in the United States, policy options for overcoming the system’s shortcomings, and recommended administrative and policy actions. IV. Research Proposed The purpose of this research is twofold: • The first phase will compile a state-of-practice review that documents all of the agencies and programs that play a role in NEMT, the approaches to NEMT program administration adopted by various states, the methods currently used by rural transportation operators to coordinate NEMT services, inconsistencies/uncertainties in the interpretation of NEMT regulations, and alternative policy models used within the United States and internationally. This phase of the study will also conduct surveys of rural medical professionals and patients in the United States, Canada, and at least one Western European country. The survey will assess perceptions of NEMT service quality and identify effects on patient care and medical outcomes. The survey data will be used to explore the relationships between the quality/adequacy of NEMT services and variables such as geography, rural population density, service delivery methods, and administrative structures. • The second phase will convene a series of listening sessions involving various NEMT stakeholders including medical professionals, transit agencies, private NEMT service providers, and patients or patient advocates. This will be followed by working groups to allow State and Federal funding agency officials to confer with front-line service delivery agencies on methods for optimizing the outcomes of NEMT programs. Based on the results of the literature review, surveys, listening sessions, and working group meetings, this project will prepare a policy analysis paper outlining the strengths and weaknesses of the existing rural NEMT system in the United States, policy options for overcoming the system’s shortcomings, and recommended administrative and policy actions.

Rural Transportation Issues: Research Roadmap H-13 V. Estimate of the Problem Funding and Research Period The estimated cost of the research is $750,000 for a 24-month study. This project is considered suitable for co-funding under TCRP and NCHRP. VI. Urgency, Payoff Potential, and Implementation The wide range of medical, administrative, and fiscal challenges associated with the existing rural NEMT delivery system in the United States point toward considerable risks for State and Federal agencies: In the absence of service efficiency gains, the rapid growth in demand for NEMT services is likely to pose growing budgetary challenges for Federal and State agencies. Factors such as the ageing population and opioid crisis contribute to these challenges. • The 2014 and 2016 GAO audits highlighted fraud risks. A major fraud case could be highly damaging to public trust in NEMT programs and oversight agencies. • Inconsistent processes for hiring, training, and monitoring NEMT drivers point toward the potential for crashes, adverse medical outcomes, or misconduct. These problems could result in claims or negative publicity for oversight agencies. Potential benefits of the proposed research include: • Improved rural NEMT customer experience and patient care. • Improved operational efficiency to control NEMT cost growth. • Reduced costs for the administration of NEMT programs. • Reduced risk of fraudulent claims and chargebacks to State agencies. • Reduced risk of crashes, adverse medical outcomes, and mistreatment of riders. Implementation of the study recommendations is likely to require action by Congress and various Federal, State, and local agencies. Depending on the scale of the recommended changes, affected stakeholders could include patients, medical providers, private insurers, public transportation agencies, private transportation providers, and ridesourcing companies. VII. Relationship to FTA Strategic Research Goals, TCRP Strategic Priorities, and/or TRB Strategic, Critical, and Emerging Issues This problem statement fits within the U.S. DOT Strategic goals of accountability and safety. It also fits within 4 of the 5 TCRP strategic priorities including: place the public transportation customer first, continuously improve public transportation, flourish in the multimodal environment, and revitalize transit organizations. VIII. References (Related Research) Rural Transportation Issues: Research Roadmap. 2019. Rural Public and School Transportation Theme Report, Interim Report, NCHRP 20-122. Smart Growth America. 2013. Lansing Tri-County Mobility Management and Coordination for Non- Emergency Medical Transportation. Smart Growth America, Michigan Department of Transportation, and Michigan State Housing Development Authority, Washington, DC. U.S. Government Accountability Office. 2014. Transportation Disadvantaged Populations: Nonemergency Medical Transportation. U.S. Government Accountability Office (GAO), Washington, DC. U.S. Government Accountability Office. 2016. Nonemergency Medical Transportation: Updated Medicaid Guidance Could Help States. U.S. Government Accountability Office (GAO), Washington, DC. U.S. Department of Health and Human Services. 2018. Michigan Did Not Always Comply with Federal and State Requirements for Claims Submitted for the Nonemergency Medical Transportation Brokerage Program. U.S. Department of Health & Human Services: Office of Inspector General, Washington, DC.

Rural Transportation Issues: Research Roadmap H-14 IX. Persons Developing the Problem John Shaw, Researcher at Institute of Transportation, Iowa State University, 2711 South Loop Drive, Suite 4700 Ames, IA 50010-8664, (515) 294-4366 (phone) and 515-294-0467 (fax) X. Process Used to Develop Problem Statement This problem statement was developed at the direction the project panel for NCHRP Project 20-122, Rural Transportation Issues: Research Roadmap. More than 750 topics were identified across 14 theme areas through 4 workshops. Those 750 topics were winnowed through a prioritization exercise at the TRB Annual Meeting in January 2019 and a webinar in March 2019. This problem statement was selected by the NCHRP 20-122 panel through consensus discussion in May 2019 as one of the top 3 priorities under the Rural Public & School Transportation Theme, out of 116 topics considered in that theme. The research team prioritized production of the Rural Public and School Transportation Theme Report in order to provide panel-selected problem statements in time for the TCRP deadline in June 2019. The Rural Public and School Transportation Theme Report was accepted by the panel in May 2019 and distributed to relevant staff at AASHTO, APTA, TRB, CTAA, National RTAP, and other organizations for sharing with interested committees, councils, and so forth for their use. For the remaining theme reports, the NCHRP 20-122 panel will review and accept them, then share them in similar fashion as they are completed. The final report in October 2019 will include all of the theme reports as well as the problem statements generated by the project and collected from others. XI. Date and Submitted By Provide the specifics (i.e., name, title, address, telephone, and fax numbers) of the person(s) who submitted the problem and the date of submission. Click here to submit: FY 2020 TCRP Problem Statement Submissions Gwen Chisholm Smith, Manager @202-334-3246 Transit Cooperative Research Program

Next: Appendix I Policy Problem Statements »
Rural Transportation Issues: Research Roadmap Get This Book
×
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Although only 19% of the population lives in rural areas, more than 70% of the U.S.’s four million miles of roadways are in rural areas. The rural transportation system also includes numerous airports; railways; inland and coastal waterways; rural and intercity buses; and bicycle, pedestrian, and multi-use paths and trails. In addition, approximately 47% of the nation’s motor vehicle fatalities occur in rural areas.

The TRB National Cooperative Highway Research Program's pre-publication draft of NCHRP Research Report 988: Rural Transportation Issues: Research Roadmap is designed to assist state departments of transportation and other public agencies and help inform policy–driven investment decisions.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!