Rural Transportation Issues: Research Roadmap (2022)

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I-1   Policy Problem Statements Policy Problem Statements • Policy Coordination to Improve Rural Non-Emergency Medical Transportation (NEMT) Patient Care and Reduce Fiscal Risk • Sustainability and Mode Choice in the Essential Air Service (EAS) Program: Comprehensive Policy Review • Clarifying Relationships Between Rural Economic Development and Transportation Invest- ments: An All-Modes Policy Review • Realistic Solutions for Funding Rural and Small-Town Pedestrian Infrastructure 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 consider- able 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 Account- ability 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 Affairs (VA), Federal Transit Admin- istration (FTA), the Department of Agriculture, Department of Education, and Depart- ment of Housing & Urban Development. GAO found that coordination of federal NEMT programs is limited, with fragmentation, overlap, and potential for duplication. GAO also A P P E N D I X I

I-2 Rural Transportation Issues: Research Roadmap 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. Govern- ment Accountability Office 2016). Since the eligibility status of individual riders can change rapidly, ensuring 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 transpor- tation 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 avail- able 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 orga- nizations. As a result, there were “duplicated transportation services in some areas and no service and limited hours in other areas.” Public transit providers were well-positioned to provide high quality NEMT service, but many struggled to do so at the Medicaid-approved reimburse- ment 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 under- qualified 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?

Policy Problem Statements I-3   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 stake- holders 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 over- coming the system’s shortcomings, and recommended administrative and policy actions. 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 aging 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.

I-4 Rural Transportation Issues: Research Roadmap Potential benefits of the proposed research include the following: • 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 trans- portation 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 four of the five TCRP strategic priorities including: place the public trans- portation customer first, continuously improve public transportation, flourish in the multi- modal 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. 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 of the project panel for NCHRP Project 20-122, Rural Transportation Issues: Research Roadmap. More than 750 topics were identified across 14 theme areas through four workshops. Those 750 topics were winnowed through a prio ritization 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 discus- sion in May 2019 as one of the top three priorities under the Rural Public & School Transportation Theme, out of 116 topics considered in that theme. The research team prioritized production

Policy Problem Statements I-5   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 I. Problem Title Sustainability and Mode Choice in the Essential Air Service (EAS) Program: Comprehensive Policy Review II. Research Problem Statement When the airline industry was deregulated in 1978, Congress created the Essential Air Service (EAS) program to address concerns about loss of air service to small communities, especially those distant from major airports. As of February 2017, the program currently subsidizes service to 173 cities (112 in the lower 48 states and 61 in Alaska) (U.S. Department of Transportation 2017a and U.S. Department of Transportation 2017b). These subsidies have been controversial since the program’s inception. As part of the federal appropriations cycle, the program has repeatedly faced threats of major budget cuts, followed by last-minute reprieves by legislators intent on retaining air service to their districts. In recent years, this brinksmanship has been accompanied by rapid growth in program expenditures. The program’s harshest criticism tends to originate from fiscally conservative policy institutes, which argue that the heavy per-passenger subsidies distort the passenger transportation market, draw passengers away from airports where services could be provided more efficiently, and encourage overexpansion of smaller airports. Currently only aviation services are eligible for subsidy, but program critics argue that, in many cases, comparable services could be provided at much lower cost using ground transportation modes. Program critics have also noted that EAS routes often operate in competition with unsubsidized airport shuttles or other ground transportation providers, and sometimes overlap with aviation services available through nearby airports. Program supporters respond by arguing that EAS subsidies support rural economic development by allowing businesses and industries to locate in smaller and more remote com- munities and provide direct benefits to tourism.

I-6 Rural Transportation Issues: Research Roadmap In the early days of commercial aviation, frequent refueling stops were necessary (EAA c. 2015), leading to the establishment of scheduled passenger service in many smaller communities. For example, a 1939 route map indicates that the United Airlines service between Chicago and San Francisco made 13 intermediate stops, some in cities with populations as small as 4,000 (United Airlines 1939, U.S. Census Bureau c. 1952). Thus, the passenger aviation network that exists today was shaped by the technological limitations of early aircraft. Before 1978, passenger airfares in the United States were regulated by the federal govern- ment (airlines competed on service, but not price). The pre-deregulation fare structure provided a guaranteed rate of return to the air carriers, with profits on high-volume routes offsetting losses on low-volume routes (U.S. Department of Transportation 2017c). Deregulation raised concerns that smaller communities would lose service as carriers shifted their focus to larger, presumably more lucrative markets. In response, the EAS program was established to ensure that numerous small communities would continue to receive a minimal level of scheduled air service. In 1978, a total of 620 cities in the mainland United States, Alaska, Hawaii, and Puerto Rico were eligible for the EAS program. Due to the program’s cost, Congress tightened the EAS eligibility rules over time; by 1995, it served only 95 communities. The number has rebounded in recent years: the program currently subsidizes service to 173 cities (112 in the lower 48 states and 61 in Alaska). Among the lower 48 states, Michigan had the most EAS-subsidized desti- nations (9 cities as of 2015) (U.S. Department of Transportation 2017a, U.S. Department of Transportation 2017b). EAS carriers generally utilize aircraft with 9 to 50 seats and operate routes that connect with other carriers at hub airports. Under current legislation, communities in the “lower 48” states are limited to a maximum subsidy of $200 per passenger if they are less than 210 miles from the nearest large- or medium-hub airport. The subsidy cap for communities more than 210 miles from a hub is $1,000. Communities located more than 175 driving miles from the nearest large- or medium-hub airport lose EAS eligibility if average passenger traffic falls below 10 enplane- ments per service day. (The complexity of these rules reflects the conflicting policy influences that shape the program) (Congressional Research Service 2017). EAS program expenditures have increased sharply over time. In constant 2016 dollars, spending has increased 600% since 1996 and 132% since 2008. In FY 2018, the program budget was $283 million (Congressional Research Service 2017). As of February 2017, the most heavily subsidized airport was Presque Isle, Maine, which received $5.1 million for service to Boston (Congressional Research Service 2017). FAA also administers two related programs: • The Small Community Air Service Development Program (SCASDP) provides funding to address air service deficiencies in smaller communities through revenue guarantees, marketing programs, and start-up cost subsidies (U.S. Department of Transportation 2017c). • The Air Transportation to Noneligible Places (ATNEP) program provides funding for air service to a small number of communities that were not served by commercial aviation in 1978, subject to a 50% local cost share (Congressional Research Service 2017). Beyond the direct costs of EAS, SCASDP, and ATNEP, the presence of passenger services requires the operation of TSA security checkpoints at numerous small airports. Some airport officials report that, in some of these locations, it is not unusual for TSA screeners to outnumber departing passengers; the federal security fee ($5.60 per one-way trip) is certainly insufficient to cover the associated costs. Additionally, it is likely that state and local governments incur significant costs for construction and maintenance of passenger facilities.

Policy Problem Statements I-7   III. Research Objective To resolve the ongoing uncertainty over the value and long-term direction of the EAS program, this policy study will: • Conduct an economic and financial analysis of the EAS program, including utilization trends and the geographic and socioeconomic distribution of EAS program benefits. This will include assessing the objective evidence as to whether the program is successful in supporting rural economic development, and if so, whether the program tends to increase overall national economic activity, or mainly tends to shift economic activity from one place to another. • Develop a mode-neutral methodology for assessing the most effective means of connecting rural communities with hub airports. The methodology would likely need to take into consid- eration distances between airports, the catchment areas for rural service points, travel times to the hub via various modes (air, shuttle bus, rail, ferry, etc.), expected passenger volumes, and similar factors. Given the geographical distribution of EAS routes, the methodology will need to address the “lower 48” states, Alaska, Hawaii, and Puerto Rico. • Evaluate the potential for EAS route consolidation and substitution of ground transportation. This will include determining the extent to which each EAS community is served by other aviation, ground, or maritime passenger transportation services (including the quality and frequency of service); comparing aviation travel time, cost, and ridership with other modal alternatives; and identifying opportunities to improve efficiency, connectivity, and customer service. • Develop a recommended policy framework aimed at providing convenient, cost-effective connections between smaller communities and regional/national air, rail, bus, and maritime networks through a rational combination of aviation, maritime, and ground passenger services. IV. Urgency, Payoff Potential, and Implementation Based on the experiences of some of the EAS airports, the perpetual threat of EAS service cutbacks appears to undermine many of the program’s intended benefits. For example, cyclical threats to service continuation probably discourage businesses from investing in rural tourism and economic development projects that would otherwise make use of EAS service. Such uncertainties also adversely impact the ability of state and local governments to make informed decisions about investments in airfield infrastructure and passenger facilities supporting EAS services. From a fiscal perspective, it is unlikely that the rapid growth in EAS expenditures can be sustained over the long term. One potential solution is to work toward growing passenger traffic to self-sustaining levels, yet in the face of ongoing program uncertainties, air carriers and local airport authorities have little incentive to invest heavily in marketing the services. The EAS program also requires consideration from an environmental sustainability perspec- tive. Aviation is a fuel- and emissions-intensive mode, and it is likely that there are many EAS routes where services of comparable quality and convenience could be provided using vans, buses, or rail. Potentially, a restructuring of the EAS program could support better integration of air and ground transportation services, making all modes more efficient and sustainable. Potential benefits of the proposed policy study include the following: • More efficient use of public resources • Better alignment between program goals and program outcomes • Improved fiscal and environmental sustainability • Improved integration of the aviation, intercity bus, passenger rail, and maritime networks

I-8 Rural Transportation Issues: Research Roadmap V. Duration and Cost Estimate The estimated cost of the policy study is $750,000 for a 24-month study. VI. References Congressional Research Service. 2017. “Essential Air Service (EAS).” Retrieved 19-Feb-2021 from https:// crsreports.congress.gov/product/pdf/R/R44176/7. EAA. c. 2015. “Ford Trimotor.” Oshkosh, WI, EAA. United Air Lines. 1939. “United Air Lines Route Map.” Chicago, IL, United Air Lines. U.S. Census Bureau. c. 1952. Number of Inhabitants: Nevada. Washington, DC, United States Census Bureau: 28–6. U.S. Department of Transportation. 2017a. Subsidized EAS Report for Communities in Alaska February 2017. Retrieved 19-Feb-2021 from https://www.transportation.gov/office-policy/aviation-policy/subsidized-eas- report-communities-alaska-february-2017 U.S. Department of Transportation. 2017b. Subsidized EAS Report for non-Alaska Communities February 2017. Retrieved 19-Feb-2021 from https://www.transportation.gov/office-policy/aviation-policy/subsidized-eas- report-non-alaska-communities-february-2017 U.S. Department of Transportation. 2017c. Essential Air Service. Retrieved 19-Feb-2021 from https://www. transportation.gov/policy/aviation-policy/small-community-rural-air-service/essential-air-service. VII. Persons Developing the Problem John Shaw, Iowa State University I. Problem Title Clarifying Relationships Between Rural Economic Development and Transportation Investments: An All-Modes Policy Review II. Research Problem Statement Mainstream economists have traditionally regarded transportation as a “derived demand” in the sense that economic activities such as manufacturing and agricultural production generate the need to transport workers, raw materials, and finished products. Conversely, many elected officials have taken a “build it and they will come” approach to rural economic development, arguing that transportation infrastructure investments that improve access or reduce travel time will stimulate tourism and make local products more competitive in national and inter- national markets. According to state and local decision makers, these divergent viewpoints have led to great confusion about the extent to which transportation investments can successfully stimulate economic development, and whether some investments are better than others. Decision- making can become even more muddled when public sentiments oscillate between exuberance and gloom in response to the ups and downs of local, national, and global economies. For example, in response to the early 1990s recession, a number of prominent elected officials in the Midwestern United States advanced the view that investing heavily in four-lane divided highways would help industries in their states gain an edge in national and global markets. Thirty years later, there is little evidence that rural communities benefit much from these expansions. Optimism bias may have played a role in this mismatch between expectations and outcomes. The new facilities were, of course, two-way roads. Thus, while some economic sectors probably

Policy Problem Statements I-9   benefited from reduced costs for outbound freight, it is likely that, in other sectors, the reduced cost of inbound freight made local products less competitive with items produced elsewhere. Similarly, the improved facilities probably made it easier for rural destinations to attract tourists, but it also made it easier for local residents to spend their leisure time far from home. Consumers were often enthusiastic about easier access to suburban megastores, but the resulting loss of sales often made it difficult for small-town retailers to remain profitable. Much of the conventional wisdom about relationships between transportation investments and economic development originated at a time when the American economy was quite different from today. For example, the construction of the first transcontinental railroad in the 1860s and the interstate highway system in the 1960s are often mentioned as examples of the links between transportation investment and economic development. Nevertheless, the relevance of these examples requires careful consideration in light of our rapidly changing economy. Consider these recent changes: • Agricultural and industrial automation has fundamentally changed the relative amounts of labor and capital required to produce both commodities and finished goods. • U.S. domestic energy production has risen sharply, accompanied by a shift from coal and oil to natural gas and wind. • The internet has profoundly altered the mix of products and services that are bought locally and those that are obtained from sources across the country or across the globe. This is true not only for business and industry, but also for individual consumers. • In some cases, virtual goods have replaced physical goods. For example, downloaded enter- tainment has replaced most traditional audio and video recordings. This in turn has all but eliminated the record shops and video rental stores that were once common in rural communities. • Manufacturing technologies such as precision micromachining and three-dimensional printing have allowed startups to challenge incumbent businesses in sectors that once required very large investments in plant and equipment. • National economic and trade policies have become increasingly intertwined with partisan politics—making the overall policy direction less and less predictable across election cycles. • Large businesses increasingly play one jurisdiction off another to demand transportation infrastructure investments and other development incentives, making it more and more challenging for public officials to determine whether they are overpaying for new jobs. Today, state and local decision makers report that they find it more difficult than ever to determine which transportation investments truly support sustainable rural economic devel- opment, and which are unlikely to pay off. To regain a grasp on these vital decisions, there is a pressing need for up-to-date, objective, fact-based, non-partisan policy guidance on the relation- ships between transportation investments and economic development. Practitioners wish to know the circumstances that result in transportation investments with demonstrable economic development results, as well as the warning signs of projects whose outcomes are likely to be tenuous or unpredictable. It is also important for this guidance to be universally applicable across modes. At the federal level, the funding and oversight of various transportation modes continues to be spread across numerous agencies and programs. At the municipal, county, and state levels however, all transportation modes compete for essentially the same revenue sources. Since each mode has adherents who claim (correctly or incorrectly) that new expenditures will generate jobs and tax revenue—and there is not enough money to do everything—state and local officials increasingly need to make side-by-side comparisons of investments in highways, aviation, freight rail, passenger rail, public transit, paratransit, and even bicycle and pedestrian facilities.

I-10 Rural Transportation Issues: Research Roadmap III. Research Objective The objective of this project is to develop a concise guidebook that will assist state and local decision makers in understanding the characteristics of transportation economic development projects that successfully contribute to sustainable economic growth. Recommended compo- nents of the guidebook include a framework for considering mixed impacts of a transportation project (i.e., positive impacts on some economic sectors and negative impacts on others); case examples that illustrate the principles of economic development and help users distinguish high-risk and low-risk projects; and a technical framework for objective analysis of transpor- tation economic development projects, including mathematical techniques for analyzing the variability of possible outcomes. Most important, the guidebook should assist decision makers in understanding which proposed rural transportation economic development projects are likely to stimulate new economic activity, and which are more likely to simply move jobs from one rural community to another. IV. Urgency, Payoff Potential, and Implementation Numerous state and local governments have transportation economic development pro- grams that endeavor to create/retain jobs or accomplish other tangible economic benefits. These programs span a wide range of transportation modes, encompassing projects such as highway and bridge upgrades, airport runway extensions, railroad spurs, and tourism-oriented facilities for pedestrians, bicyclists, snowmobilers, ATV enthusiasts, and more. While transportation economic development programs are often popular with elected officials, it is frequently unclear how much new employment has been generated. One critique of these programs is that they mainly benefit large, well-established businesses, while the majority of innovation and job creation occurs in startups and small businesses. Skeptics also suggest that the programs often simply redistribute economic activity, or worse, provide windfalls for private investments that would have occurred without taxpayer-funded incentives. Thus, there appears to be considerable potential for the cost of transportation economic development projects to exceed their benefits, or equivalently, for the projects to result in a net negative impact on economic wellbeing. Indeed, the history of these programs shows decidedly mixed results. The political backlash can be formidable when private entities that have received public incentives go bankrupt or renege on job-creation commitments. Potential benefits of the proposed policy study include the following: • Improved methods for selecting and managing transportation economic development projects • More efficient use of public resources • Better alignment between program goals and program outcomes • Reduced risk of failed projects and the accompanying damage to agency reputations V. Duration and Cost Estimate The estimated cost of the policy study is $750,000 for a 24-month study. VI. Persons Developing the Problem John Shaw, Iowa State University

Policy Problem Statements I-11   I. Problem Title Realistic Solutions for Funding Rural and Small-Town Pedestrian Infrastructure II. Research Problem Statement Active transportation has been promoted as a means to reduce automobile dependency while increasing physical activity, improving multimodal access, and spurring economic development (Loh et al. 2012). Yet the majority of rural America does not have dedicated pedestrian facilities including sidewalks, pedestrian pathways, and pedestrian crossings. This infrastructure is critical to ensuring safe access to walking opportunities for rural residents, but efforts to fund active infrastructure often face limited resources and higher-speed, auto-oriented development. Lack of access to dedicated pedestrian infrastructure has resulted in pedestrians walking in risky conditions. In 2016, of the 5,987 pedestrian fatalities in the United States, 23 percent were in a rural area (National Highway Traffic Safety Administration 2018). In rural areas, approximately 40 percent of all trips are less than three miles long and half of these trips are less than a mile— there is potential to increase active modes of transportation within these trips through investing in dedicated pedestrian infrastructure (Loh et al. 2012). Providing pedestrian infrastructure would not only provide safe access for active transporta- tion, but it could also provide many public health benefits as well. Obesity has reached epidemic proportions in the United States. According to the Centers for Disease Control and Prevention (CDC), 70.7 percent of adults are either overweight or obese, in addition, 17 percent of children are obese (U.S. Department of Health and Human Services 2017). There is growing evidence that rural residents living in auto-oriented communities are increasingly obese or overweight when compared with the urban areas and the national average (Patterson et al. 2004). Providing opportunities to walk in a safe environment can encourage physical activity. In a study by the U.S. Department of Transportation’s Bureau of Transportation Statistics, rural Americans ranked sidewalks as the most important transportation-related infrastructure, ahead of major roads, and nearly 90 percent of rural residents ranked pedestrian-friendly communities as a priority (Guarino and Weidman 2011). Though rural residents often support improvements to active transportation infrastructure, these communities continue to face many unique challenges when it comes to implementation. While funding for motorized transportation facilities is typically derived from federal, state, and local fuel taxes and motor vehicle registration fees along with smaller local sources such as parking fees, funding for active transportation infrastructure is less predictable. In particular, investments from federal government programs like Transportation Enhancements and Safe Routes to School have played an essential role in promoting active transportation infrastruc- ture in rural and small-town communities (Loh et al. 2012). Other funding sources for many active transportation projects are often assembled by combining grants from state DOTs and natural resource agencies with local property tax revenue and donations from private founda- tions, businesses, and the public. Special property tax assessments are a traditional means of funding sidewalks in many areas, but this can be highly controversial due to equity issues. Many rural and small-town communities face economic constraints due to a poor property tax base which can make funding pedestrian infrastructure a difficult sell when competing with local road maintenance and other priorities. III. Research Objective This policy study will first define and investigate the problem and then create a synthesis of practice for funding active transportation infrastructure in rural and small towns, while

I-12 Rural Transportation Issues: Research Roadmap acknowledging the unique challenges these communities face. To achieve this objective, the proposed research project will: • Define “safe access” in rural terms. This could include but is not limited to access from a bike/ pedestrian facility to amenities (e.g., a crosswalk in a local community across a state owned road), access for on-road biking (e.g., wide shoulders, no rumble strips, etc.), multimodal access (e.g., bike racks on transit, facilities leading to bus, closure of Amtrak stations impact- ing multimodal travel), and long distances between communities (how to access larger rural communities for shopping, employment, etc.). This will include documenting and evaluating the many unique access challenges in a rural area and provide countermeasures and case studies for addressing these. • Evaluate trends of local elected officials in acceptance and funding for ADA compliance and pedestrian safety investments in small towns. • Evaluate if the underinvestment in rural facilities and its underlying causes may have an impact on “safe access” for bicyclists and pedestrian users in rural America. • Identify and document methods for funding sidewalk installation/upgrades and mainte- nance obligations with a particular focus on methods that do not require property tax special assessments. • Develop case studies of innovative funding strategies used to implement active transportation infrastructure in rural and small towns. • Create guidance for rural and small towns to promote and secure funding for active transportation. • Identify potential partners and stakeholders as well as “niche” funding opportunities for active transportation. IV. Urgency, Payoff Potential, and Implementation This research project is expected to assist rural and small-town communities in identifying potential funding opportunities for pedestrian infrastructure that have been successful in peer communities. Potential benefits of the policy study include the following: • Additional resources for rural and small towns • More efficient use of available funding • Improvements in the equity disparity between rural and urban active transportation infrastructure • Improved active transportation safety for rural and small towns V. Duration and Cost Estimate The estimated cost of the policy study is $500,000 for a 24-month study. VI. References (Related Research) Guarino, J., and P. Weidman. 2011. Public Perceptions on Transportation Characteristics of Livable Communi- ties: The 2009 Omnibus Household Survey. Bureau of Transportation Statistics, Research and Innovative Technology Administration, U.S. Department of Transportation, Washington, DC. Loh, T.H., J. Walljasper, D. Sonenklar, K. Mills, and D. Levinger. 2012. Active Transportation Beyond Urban Centers: Walking and Bicycling in Small Towns and Rural America. Rails-To-Trails Conservancy. Patterson, P.D., C.G. Moore, J.C. Probst, and J.A. Shinogle. 2004. Obesity and Physical Inactivity in Rural America. Journal of Rural Health. Spring 2004; 20(2):151–9.

Policy Problem Statements I-13   National Highway Traffic Safety Administration. 2018. Traffic Safety Facts - Rural/Urban Comparison of Traffic Fatalities. Washington, DC. U.S. Department of Health and Human Services. 2017. Health, United States, 2016: With Chartbook on Long- Term Trends in Health. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD. VII. Persons Developing the Problem Karalyn Clouser, Western Transportation Institute

Abbreviations and acronyms used without denitions in TRB publications: A4A Airlines for America AAAE American Association of Airport Executives AASHO American Association of State Highway Officials AASHTO American Association of State Highway and Transportation Officials ACI–NA Airports Council International–North America ACRP Airport Cooperative Research Program ADA Americans with Disabilities Act APTA American Public Transportation Association ASCE American Society of Civil Engineers ASME American Society of Mechanical Engineers ASTM American Society for Testing and Materials ATA American Trucking Associations CTAA Community Transportation Association of America CTBSSP Commercial Truck and Bus Safety Synthesis Program DHS Department of Homeland Security DOE Department of Energy EPA Environmental Protection Agency FAA Federal Aviation Administration FAST Fixing America’s Surface Transportation Act (2015) FHWA Federal Highway Administration FMCSA Federal Motor Carrier Safety Administration FRA Federal Railroad Administration FTA Federal Transit Administration GHSA Governors Highway Safety Association HMCRP Hazardous Materials Cooperative Research Program IEEE Institute of Electrical and Electronics Engineers ISTEA Intermodal Surface Transportation Efficiency Act of 1991 ITE Institute of Transportation Engineers MAP-21 Moving Ahead for Progress in the 21st Century Act (2012) NASA National Aeronautics and Space Administration NASAO National Association of State Aviation Officials NCFRP National Cooperative Freight Research Program NCHRP National Cooperative Highway Research Program NHTSA National Highway Traffic Safety Administration NTSB National Transportation Safety Board PHMSA Pipeline and Hazardous Materials Safety Administration RITA Research and Innovative Technology Administration SAE Society of Automotive Engineers SAFETEA-LU Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (2005) TCRP Transit Cooperative Research Program TDC Transit Development Corporation TEA-21 Transportation Equity Act for the 21st Century (1998) TRB Transportation Research Board TSA Transportation Security Administration U.S. DOT United States Department of Transportation

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