State departments of transportation (DOTs) are responsible for providing mobility services to the transit-dependent public while maximizing investments of state and federal dollars in public transportation. Available funds often leave needed projects partially or wholly unfunded. Mobility managers, frequently housed within DOTs, are responsible for coordinating transportation resources for individuals with unique access needs and are sometimes challenged to find suitable transportation options for the individuals they serve.
People who are unable to transport themselves and require recurring medical trips for chronic conditions not served through telehealth, such as diabetes or cancer, face challenges when seeking access to care. Public or healthcare transportation may help individuals without a support network, however, transit service limitations, prohibitive costs, or the lack of access to public transportation may cause restricted healthcare access. Additionally, those with access to public transportation may experience service delays, interruptions, or closures.
Healthcare transportation, known as Non-Emergency Medical Transportation (NEMT), is provided by some health insurance plans, but the uninsured, underinsured, or those who have insurance without this transportation benefit struggle to gain access to healthcare services. Private healthcare organizations that do not contribute financially to NEMT need information about the potential benefits, costs, and advantages, which may include greater service delivery. NEMT affects healthcare providers and patients and is necessary for healthcare customers. Research is needed to provide actionable solutions with multifaceted benefits of providing improved NEMT services for patients resulting from the healthcare industry’s increased investment.
The objective of this research is to develop a guide and tool kit for a diverse set of stakeholders, aimed at determining and communicating the costs and benefits of healthcare providers and hospitals providing healthcare customer transportation.
The accomplishment of the project objective will require at least the following tasks.
Task descriptions are intended to provide a framework for conducting the research. The NCHRP is seeking the insights of proposers on how best to achieve the research objective. Proposers are expected to describe research plans that can realistically be accomplished within the constraints of available funds and contract time. Proposals must present the proposers' current thinking in sufficient detail to demonstrate their understanding of the issues and the soundness of their approach to meeting the research objective.
Task 1. Perform a review of literature related to providing transportation to and from healthcare providers and the healthcare sector’s investments in non-emergency medical transportation. Provide a summary in a Task 1 Report.
Notes: NCHRP approval of the Task 1 Report and the proposed approach to accomplishing Task 2 is required before advancing to Task 2.
Task 2. Identify the state of practice related to providing transportation to and from healthcare providers.
Note: Enabling rules, legislation, regulations, and guidance should be considered when preparing Task 2.
Task 3. Prepare an Interim Report No.1 that documents the work completed in Tasks 1 and 2. Include a detailed work plan for the work anticipated in Phase II.
Note: NCHRP approval of the Interim Report 1 and proposed Phase II work plan are required before initiation. This shall occur at a face-to-face meeting to be convened in Washington, DC, at TRB offices. TRB will cover the costs associated with meetings at TRB facilities, teleconference services, and any approved panel travel.
Task 4. Identify the key performance indicators used by healthcare providers and hospital systems (HPHS) impacted by customers’ limited transportation access.
Task 5. Summarize the benefits, opportunities, challenges, and barriers encountered by HPHS investing in and supporting accessible transportation for customers.
Task 6. Describe the risk factors associated with underfunded customer healthcare transportation.
Task 7. Identify successfully implemented models of collaboration between healthcare providers and transit agencies to provide transportation services.
Task 8. Recommend strategies that would incentivize funding sustainable healthcare transportation.
Task 9. Prepare an Interim Report No.2 that documents the work completed in Tasks 4 through 8. Include a detailed work plan for the work anticipated in Phase III.
Note: NCHRP approval of the Interim Report 2 and proposed Phase III work plan are required before initiation. This shall occur during a virtual meeting. TRB will cover the costs associated with teleconference services.
Task 10. Develop a guide and a communication and marketing tool kit, targeting a diverse set of stakeholders, to help summarize the costs and benefits of providing funding for healthcare customer transportation.
Task 11. Prepare final deliverables, which at a minimum include:
- A conduct of research report documenting the entire research effort and includes a literature review summary, a compendium of research papers, collected data, and a prioritized list of recommendations for future research;
- A practitioner's guide;
- A communications and marketing tool kit;
- A logo-free PowerPoint presentation describing the background, objective, approach, findings, and conclusions;
- A virtual presentation of findings to two AASHTO committees;
- A stand-alone technical memorandum titled “Implementation of Research Findings and Products.” See Special Note I for additional information; and
- A draft article suitable for publication in TR News (information regarding TR News publication may be found on the TRB webpage http://onlinepubs.trb.org/onlinepubs/trnews/info4contributors.pdf).
Proposers may recommend additional deliverables to support the project objective.
1. No commitment to publish a TR News article is implied.
2. Following receipt of the draft final deliverables, the remaining 3 months shall be for NCHRP review and comment and for research agency preparation of the final deliverables.
Consideration shall be given to, but not limited to, the following concepts or factors:
- Funding structures and profitability of HPHS and transportation agencies;
- Near-term and long-term benefits (e.g., social, financial, and equity) of collaboration between transportation providers and the healthcare community;
- Successful practices related to healthcare providers that address customers’ transportation;
- Analysis of rural, small urban, and large urbanized areas, as defined by the Federal Transit Administration (FTA), in at least four states representing each of the AASHTO regions, with varying geography, demographics, and economies; and representation from states without expanded Medicaid; and
- Technological impacts, limitations, accessibility, and solutions.
A. The Information and Instructions for Preparing Proposals for the Transportation Research Board’s Cooperative Research Programs were revised in May 2022. Please take note of the new and revised text which is highlighted in yellow.
B. Proposals must be submitted as a single PDF file with a maximum file size of 10 MB. The PDF must be formatted for standard 8 ½” X 11” paper, and the entire proposal must not exceed 60 pages (according to the page count displayed in the PDF). Proposals that do not meet these requirements will be rejected. For other requirements, refer to chapter V of the instructions.
C. The Information and Instructions for Preparing Proposals for the Transportation Research Board’s Cooperative Research Programs have been modified to include a revised policy and instructions for disclosing Investigator Conflict of Interest. For more information, refer to chapter IV of the instructions. A detailed definition and examples can be found in the CRP Conflict of Interest Policy for Contractors. The proposer recommended by the project panel will be required to submit an Investigator Conflict of Interest and Disclosure Form as a prerequisite for contract negotiations.
D. Proposals will be rejected if any of the proposed research team members work for organizations represented on the project panel. The panel roster for this project can be found at https://www.mytrb.org/OnlineDirectory/Committee/Details/6776. Proposers may not contact panel members directly; this roster is provided solely for the purpose of avoiding potential conflicts of interest.
E. Proprietary Products - If any proprietary products are to be used or tested in the project, please refer to Item 6 in the Information and Instructions for Preparing Proposals.
F. Proposals are evaluated by the NCHRP staff and project panels consisting of individuals collectively knowledgeable in the problem area. The project panel will recommend their first choice proposal considering the following factors: (1) the proposer's demonstrated understanding of the problem; (2) the merit of the proposed research approach and experiment design; (3) the experience, qualifications, and objectivity of the research team in the same or closely related problem area; (4) the plan for ensuring application of results; (5) how the proposer approaches inclusion and diversity in the composition of their team and research approach, including participation by certified Disadvantaged Business Enterprises; and, if relevant, (6) the adequacy of the facilities. A recommendation by the project panel is not a guarantee of a contract. The National Academy of Sciences (NAS - the contracting authority for the National Academies of Sciences, Engineering, and Medicine) will conduct an internal due diligence review and risk assessment of the panel’s recommended proposal before contract negotiations continue.
Note: The proposer's approach to inclusion and diversity as well as participation by Disadvantaged Business Enterprises should be incorporated in Item 11 of the proposal.
G. Copyrights - All data, written materials, computer software, graphic and photographic images, and other information prepared under the contract and the copyrights therein shall be owned by the National Academy of Sciences. The contractor and subcontractors will be able to publish this material for non-commercial purposes, for internal use, or to further academic research or studies with permission from TRB Cooperative Research Programs. The contractor and subcontractors will not be allowed to sell the project material without prior approval by the National Academy of Sciences. By signing a contract with the National Academy of Sciences, contractors accept legal responsibility for any copyright infringement that may exist in work done for TRB. Contractors are therefore responsible for obtaining all necessary permissions for use of copyrighted material in TRB's Cooperative Research Programs publications. For guidance on TRB's policies on using copyrighted material please consult Section 5.4, "Use of Copyrighted Material," in the Procedural Manual for Contractors.
H. Proposals should include a task-by-task breakdown of labor hours for each staff member as shown in Figure 4 in the Information and Instructions for Preparing Proposals. Proposals also should include a breakdown of all costs (e.g., wages, indirect costs, travel, materials, and total) for each task using Figures 5 and 6 in the brochure. Please note that TRB Cooperative Research Program subawards (selected proposers are considered subawards to the National Academy of Sciences, the parent organization of TRB) must comply with 2 CFR 200 – Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. These requirements include a provision that proposers without a "federally" Negotiated Indirect Costs Rate Agreement (NICRA) shall be subject to a maximum allowable indirect rate of 10% of Modified Total Direct Costs. Modified Total Direct Costs include all salaries and wages, applicable fringe benefits, materials and supplies, services, travel, and up to the first $25,000 of each lower tier subaward and subcontract. Modified Total Direct Costs exclude equipment, capital expenditures, charges for patient care, rental costs, tuition remission, scholarships and fellowships, participant support costs and the portion of each lower tier subaward and subcontract in excess of $25,000.
I. The required technical memorandum titled “Implementation of Research Findings and Products” should (a) provide recommendations on how to best put the research findings/products into practice; (b) identify possible institutions that might take leadership in applying the research findings/products; (c) identify issues affecting potential implementation of the findings/products and recommend possible actions to address these issues; and (d) recommend methods of identifying and measuring the impacts associated with implementation of the findings/products. Implementation of these recommendations is not part of the research project and, if warranted, details of these actions will be developed and implemented in future efforts.
The research team will be expected to provide input to an implementation team consisting of panel members, AASHTO committee members, the NCHRP Implementation Coordinator, and others in order to meet the goals of NCHRP Active Implementation: Moving Research into Practice, available at http://onlinepubs.trb.org/onlinepubs/nchrp/docs/NCHRP_ActiveImplementation.pdf
J. If the team proposes a Principal Investigator who is not an employee of the Prime Contractor, or if the Prime Contractor is proposed to conduct less than 50% of the total effort (by time or budget), then section five of the proposal should include: (1) a justification of why this approach is appropriate, and (2) a description of how the Prime Contractor will ensure adequate communication and coordination with their Subcontractors throughout the project.
K. All budget information should be suitable for printing on 8½″ x 11″ paper. If a budget page cannot fit on a single 8½″ x 11″ page, it should be split over multiple pages. Proposers must use the Excel templates provided in the Information and Instructions for Preparing Proposals for the Transportation Research Board’s Cooperative Research Programs.
L. Proposers should note that the following research study, related to this proposed effort, is available and should be considered when preparing a research plan.
TCRP Research Report 203: Dialysis Transportation: The Intersection of Transportation and Healthcare: https://www.trb.org/Main/Blurbs/178786.aspx