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Pages 23-52

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From page 23...
... 23 Introduction Improving the role of transportation for health-care access requires that the transportation and health-care sectors communicate so that each understands the perspectives of the other and the actions needed to improve access. Effective communication can lead to collaboration and a partnership so that the two sectors work together to address not only each sector's objective -- transportation in serving its passengers and health care in serving its patients -- but also a shared objective of improving access to health care.
From page 24...
... 24 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services Support from the Public Health Sector It is important to recognize that the public health sector also understands the importance of community transportation. Health care and public health are related as two components of the overall health sector.
From page 25...
... Working Toward a Partnership: Health Care and Transportation 25 may not have the capacity to wait at a stop or navigate a transfer among routes. Americans with Disabilities Act (ADA)
From page 26...
... 26 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services Why Should the Health-Care and Transportation Sectors Communicate and Collaborate? Perhaps the most straightforward answer is that communication can lead to collaboration and then a partnership to improve transportation access to health care, benefiting both an individual's and societal health.
From page 27...
... Working Toward a Partnership: Health Care and Transportation 27 • Addressing the social determinants of health. Health-care providers, insurers, and stakeholders are increasingly moving toward addressing the social determinants of health.
From page 28...
... 28 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services • Promoting healthy communities by actively increasing access to health care while improving local mobility. • Providing financial support by sponsoring public transportation service through a partnership with a health-care provider.
From page 29...
... Working Toward a Partnership: Health Care and Transportation 29 Health Care: Identifying Stakeholders and Collaborators Primary and Specialty Care Facilities and Hospitals Primary and specialty care facilities and hospitals are all health-care organizations that may have a direct interest in promoting transportation access for patients (Exhibit 3-2)
From page 30...
... 30 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services • Health-care providers. In individual practices, health-care providers often serve as champions for organizational change.
From page 31...
... Working Toward a Partnership: Health Care and Transportation 31 department, and hospitalizations. As health insurers are motivated to decrease costly emergency and hospital services, they often invest in transportation services to help ensure that enrollees can access the care they need.
From page 32...
... 32 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services whether the health-care organization has a department that focuses on building community relations and addressing the social determinants of health. Transportation: Identifying Stakeholders and Collaborators On the transportation side, a key participant is the community's public transportation provider.
From page 33...
... Working Toward a Partnership: Health Care and Transportation 33 Community Transportation Providers Who/How to Contact Public Transportation Provider Executive director Mobility manager Planning director/manager www.apta.com "Transit links by state" at the top of the Information on a state's rural public transit agencies can be requested from each state's www.nationalrtap.org) under the link "State RTAP." Human Service Agencies The community's 211 service Volunteer Services The community's 211 service Taxi Companies Taxi company owner or manager community's business licensing department or Chamber of Transportation Network Companies (TNCs)
From page 34...
... 34 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services Other Potential Stakeholders and Collaborators Health-care and transportation organizations are the primary participants for improving transportation access to health care. However, other community organizations and individuals may also play a role supporting efforts to improve access to health care: • Local non-profit agencies providing services for low-income individuals and families, seniors, and people with disabilities.
From page 35...
... Working Toward a Partnership: Health Care and Transportation 35 appointments because they cannot get a ride understands there is a problem. However, effectively addressing a transportation problem requires data.
From page 36...
... 36 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services transportation providers understand the barriers to health-care access in order to successfully address objectives of health-care providers, such as decreasing no-show rates and missed appointments. In addition, funders often require applicants to describe the scope of the issue in order to determine eligibility for grants.
From page 37...
... Working Toward a Partnership: Health Care and Transportation 37 Transportation providers may choose to use needs assessment tools to capture existing data about their service area and community needs. For example, the University of Missouri Extension's Center for Applied Research and Engagement Systems (CARES)
From page 38...
... 38 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services Insured, Medicaid/Means-tested coverage, percent by tract, ACS 2013-2017 Exhibit 3-5. Medicaid coverage and access to transportation services in Washington, D.C.
From page 39...
... Working Toward a Partnership: Health Care and Transportation 39 collect in-depth information from a select group of people. For example, a focus group with older adults could provide information about specific health-care needs and accommodations for that population.
From page 40...
... 40 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services Addressing the identified transportation access issue may be accomplished with direct coordination and collaboration between one transportation provider and one health-care organization. Other issues may be more complicated and need attention from multiple community partners, stretch across county lines, and/or require regular ongoing contact among stakeholders.
From page 41...
... Working Toward a Partnership: Health Care and Transportation 41 and people with low incomes. An application that documents a partnership between a transportation provider and health-care organization and showcases a shared-goal statement to improve access to health-care services would strengthen a grant application.
From page 42...
... 42 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services Potential Barrier Issue/Rationale Solution Potential Solutions Found in the Guidebook Bridging gaps and building understanding and relationships between the health-care and transportation sectors. Health-care providers may need to demonstrate improved health outcomes to justify investment in transportation services.
From page 43...
... Working Toward a Partnership: Health Care and Transportation 43 Potential Barrier Issue/Rationale Solution Potential Solutions Found in the Guidebook Special needs that in some cases can be inappropriate for �ixedroute and even ADA paratransit. Public transportation agencies have concerns that a partnership with dedicated service for a health-care facility may be disallowed because of the FTA Charter Rule.
From page 44...
... 44 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services According to the FTA, "charter service" means, but does not include demand response service to individuals: • Transportation provided by a recipient at the request of a third party for the exclusive use of a bus or van for a negotiated price. The following features may be characteristic of charter service: – A third party pays the transit provider a negotiated price for the group; – Any fares charged to individual members of the group are collected by a third party; – The service is not part of the transit provider's regularly scheduled service, or is offered for a limited period of time; or – A third party determines the origin and destination of the trip as well as scheduling.
From page 45...
... Working Toward a Partnership: Health Care and Transportation 45 • Charter service is service to a group, whereas demand response service is service to individuals. Service to individuals can be identified by a vehicle trip that includes multiple origins, multiple destinations, or both, even when the clients have exclusive use of the vehicle.
From page 46...
... 46 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services Revisions to the Safe Harbors Under the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements The U.S. Department of Health and Human Service issued a ruling in December 2016 that revised previous restrictions on the ability of health-care providers to provide patient transportation.
From page 47...
... Working Toward a Partnership: Health Care and Transportation 47 • The health-care provider is to establish a set policy regarding the availability of free or discounted transportation and must apply that policy uniformly and consistently. However, the Department of Health and Human Service's Office of Inspector General's revisions to the statute do not mandate specific parameters for such policy other than mandating that it cannot be based on the type of patients' insurance.
From page 48...
... 48 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services and regulations that govern privacy of health information. While transportation providers and brokers are not considered covered entities, some states may consider transit agencies to meet HIPAA's definitions of a business associate or subcontractor.
From page 49...
... Working Toward a Partnership: Health Care and Transportation 49 Eligibility. Eligible applicants are organizations that are eligible to be recipients and subrecipients of the Enhanced Mobility for Seniors and Individuals with Disabilities Program, (defined under FTA's Section 5310 program)
From page 50...
... 50 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services transportation options for older adults and people with disabilities, including projects related to coronavirus response. Grants of up to $30,000 each will be awarded.
From page 51...
... Working Toward a Partnership: Health Care and Transportation 51 – Public housing authorities/Indian housing authorities – Small businesses – Special district governments Rural Health Information Hub (RHIhub) RHIhub, formerly the Rural Assistance Center, is funded by the Federal Office of Rural Health Policy to be a national clearinghouse on rural health issues, with resources that support health care and population health in rural communities.
From page 52...
... 52 Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services 12. "Direct Liability of Business Associates." HHS.gov, Health Information Privacy, U.S.

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