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Americans with Disabilities Act (ADA) Paratransit Eligibility Manual - Draft
DOT-T-93-17 DRAFT Americans with Disabilities Act (ADA) Paratransit Eligibility Manual September 1993 Advance Copy Americans with Disabilities Act (ADA) Paratransit Eligibility Manual Prepared for the Volpe National Transportation Systems Center Funded through the Office of Grants Management Acknowledgements This manual was prepared by EG&G Dynatrend under contract to Battelle. Funding was provided by the Federal Transit Administration's Office of Grants Management through the Volpe National Transportation Systems Center. Several individuals in each of these organizations were involved in the development of the manual. Robert Stout, Nancy Solkowski, Gary DeLorme, and Irv Chor of the Office of Grants Management, and David Spiller of the Transportation Systems Center were instrumental in defining and initiating the project. David Norstrom of Battelle assisted in the preparation of the initial document outline and provided administrative support throughout the project. Nancy Solkowski and David Spiller also served as Project Managers and provided valuable guidance and input on the structure and content of the manual. Much of the information in this report was gathered from selected transit providers across the country. Several individuals assisted in identifying providers with particular experience in the development of ADA paratransit eligibility materials and processes. Recommendations and referrals were provided by John Balog, John Morrison, and Anne Schwarz of the Ketron Division of the Bionetics Corporation, Nancy Coburn of Battelle, David Cyra of the University of Wisconsin-Milwaukee, Rich Garrity of AG Planning & Management, David Koffman of Crain & Associates, and Robbie Sarles of RLS Associates. This report would not have been possible without the cooperation of the employees of each of the transit agencies contacted. Special thanks to each of the following persons for sharing insights and for developing and providing the materials and information contained in this manual: - Robin Boshell, Delaware Administration for Specialized Transportation (DAST) - Daniel Brogan, OMNITRANS, San Bernardino, California - Jan Choti, City of Durango, Colorado - Margaret Coffey, New York City Transit Authority - Lisa Darnall, Mass Transportation Administration, Baltimore, Maryland - Richard DeRock and Chip Hazen, Los Angeles County Metropolitan Transportation Authority - Ed Frost, Ben Franklin Transit, Richland, Washington - Gail Heald and Mary Ellen Blunt, Central Massachusetts Regional Planning Commission, Worcester, Massachusetts - Susan Hafner and Tessie Johnston, Riverside Transit Agency, Riverside, California - Mark Huddleston, Oshkosh Transit System, Oshkosh, Wisconsin - Robert Johnson, Waukesha Transit System, Waukesha, Wisconsin - Micki Kaplan, Lane Transit District, Eugene, Oregon - Kimberlee Kelly, Greater Bridgeport Transit District - Dianna Lake, San Mateo County Transit District, San Carlos, California - Paul Larrousse, Madison Metro Transit System - Terry Lathrop, City of Charlotte, North Carolina - John Lee, City of Greeley, Colorado - Avon Makel, Washington Metropolitan Area Transit Authority - Kathy McCune, Utah Transit Authority, Salt Lake City - Tina Morris, Transit Authority of River City, Louisville, Kentucky - Lynn Ritter Otte and Shirley Fraser, Regional Transportation Authority, Chicago - Nancy Poultney, Seattle Metro - Jon Roth, Southeastern Pennsylvania Transportation Authority, Philadelphia - Christopher White, Ann Arbor Transportation Authority - Cathy Williams, Port Authority of Allegheny County, Pittsburgh Finally, several employees at EG&G Dynatrend provided input, assistance and support. Karla Karash reviewed draft material. Carol Schweiger and Larry Harman provided information on the final chapter concerning advanced technologies. Marsha Gangi provided administrative support and assisted in document preparation. Table of Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Chapter 1. Understanding ADA Paratransit Eligibility . . . . . . . . 3 Section 1. Who Must Develop an ADA Paratransit Eligibility Determination Process and When Must it be Implemented? 3 Section 2. How is ADA Paratransit Eligibility Defined in the Regulations? 4 Category 1 Eligibility . . . . . . . . . . . . . . . . . . . . 5 Category 2 Eligibility . . . . . . . . . . . . . . . . . . . . 7 Category 3 Eligibility . . . . . . . . . . . . . . . . . . . . 8 Companions/Personal Care Attendants. . . . . . . . . . . . . . 12 Visitors . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Temporary Disabilities . . . . . . . . . . . . . . . . . . . . 14 Section 3. Key Differences between ADA Paratransit Eligibility and Past Paratransit Eligibility . . . . . . . . . . . . . . . . . 15 ADA Paratransit Eligibility as a Civil Right . . . . . . . . . 15 Functionally-based Determinations of Eligibility . . . . . . . 16 Conditional or "Trip-by-Trip" Eligibility. . . . . . . . . . . 16 Determining Eligibility Based on the Most Limiting Factors . . 20 Section 4. The Importance of a Thorough Initial Determination . 21 Managing Demand. . . . . . . . . . . . . . . . . . . . . . . . 21 Documenting an Undue Financial Burden. . . . . . . . . . . . . 21 Chapter 2. Elements of an ADA Paratransit Eligibility Policy . . . . 23 Section 1. Required Elements. . . . . . . . . . . . . . . . . . 23 Strictly Limiting Eligibility. . . . . . . . . . . . . . . . . 23 Accessible formats . . . . . . . . . . . . . . . . . . . . . . 24 Processing Time/Presumptive Eligibility. . . . . . . . . . . . 25 Notice of Initial Determination. . . . . . . . . . . . . . . . 25 Documentation of Eligibility . . . . . . . . . . . . . . . . . 25 Administrative Appeal Process. . . . . . . . . . . . . . . . . 26 Section 2. Optional Elements. . . . . . . . . . . . . . . . . . 27 Recertification of ADA Paratransit Eligibility . . . . . . . . 27 Recertification of Other Paratransit Customers . . . . . . . . 28 No-Show Suspension Policy. . . . . . . . . . . . . . . . . . . 28 Chapter 3. Establishing an ADA Paratransit Eligibility Determination Process 29 Section 1. General Considerations . . . . . . . . . . . . . . . 30 Public Participation . . . . . . . . . . . . . . . . . . . . . 30 Public Information and Marketing . . . . . . . . . . . . . . . 31 Additional Charges and Fees. . . . . . . . . . . . . . . . . . 33 Section 2. Alternative Processes. . . . . . . . . . . . . . . . 34 Self-certification with professional verification as needed. . 34 Self-certification and professional verification . . . . . . . 36 In-Person Assessments. . . . . . . . . . . . . . . . . . . . . 39 Combined Approaches. . . . . . . . . . . . . . . . . . . . . . 40 Considerations for Future Recertification of Riders. . . . . . 42 Section 3. Deciding Who Will Do Initial Determinations. . . . . 48 In-House Determinations. . . . . . . . . . . . . . . . . . . . 48 Utilizing Contract Reviewers . . . . . . . . . . . . . . . . . 48 In-House Determination with Third-Party Assistance as Needed . 51 Reviewer Training. . . . . . . . . . . . . . . . . . . . . . . 52 Section 4. Developing Application Forms and Materials . . . . . 53 Accessible Formats . . . . . . . . . . . . . . . . . . . . . . 53 Terminology. . . . . . . . . . . . . . . . . . . . . . . . . . 54 Transmittal/Cover Letter . . . . . . . . . . . . . . . . . . . 54 Application/Assessment Forms . . . . . . . . . . . . . . . . . 55 General Information. . . . . . . . . . . . . . . . . . . . . . 57 Questions about Mobility Aids Used . . . . . . . . . . . . . . 58 Questions about the Applicant's Disability . . . . . . . . . . 59 Questions/Functional Tests Regarding Travel Capabilities . . . 60 Travel Training Information. . . . . . . . . . . . . . . . . . 68 Other Service Information. . . . . . . . . . . . . . . . . . . 69 Administrative Information . . . . . . . . . . . . . . . . . . 69 Request for Professional Reference(s). . . . . . . . . . . . . 70 Professional Verification Form . . . . . . . . . . . . . . . . 72 Section 5. Reviewing Applications and Making Determinations . . 73 Pre-Tests of Materials . . . . . . . . . . . . . . . . . . . . 73 Regulatory Review Timetable and Presumptive Eligibility. . . . 73 Establishing a Management Information System to Track Determinations. . . . . . . . . . . . . . . . . . . . . . 74 Developing Reviewer Guidelines and Maintaining Consistency in Reviews . . . . . . . . . . . . . . . . . . . . . . . . . 78 Observing Privacy Rights . . . . . . . . . . . . . . . . . . . 79 Recent Certification Experiences of Selected Providers . . . . 79 Section 6. Notifying Individuals of Initial Determinations. . . 85 Section 7. Documentation of ADA Paratransit Eligibility . . . . 92 Section 8. Appeals Procedures . . . . . . . . . . . . . . . . . 94 Structuring an Appeal Process. . . . . . . . . . . . . . . . . 96 Holding an Appeal Hearing. . . . . . . . . . . . . . . . . . .102 Section 9. Refusing, Conditioning, or Suspending Service. . . .103 Circumstances Under which Service Can be Refused . . . . . . .103 Circumstances Under which Service Can be Conditioned . . . . .104 Circumstances Under Which Service Can be Suspended . . . . . .104 Developing a "No-Show" Suspension Policy . . . . . . . . . . .105 Process Issues Associated with Suspending Service. . . . . . .111 Section 10. Visitor Policies . . . . . . . . . . . . . . . . . .112 Chapter 4. Applying Eligibility Determinations to Daily Operations .115 Section 1. Important Operational Information. . . . . . . . . .115 Section 2. Trip-by-Trip Eligibility Determinations. . . . . . .118 Review Subscription Trips. . . . . . . . . . . . . . . . . . .119 Review Other Frequently Made Trips . . . . . . . . . . . . . .119 Generalize Limitations of Eligibility. . . . . . . . . . . . .119 Consideration of Easily Tracked Eligibility Conditions . . . .120 Section 3. Using Advanced Technologies to Make Trip Eligibility Determinations . . . . . . . . . . . . . . . . . . .122 Relational Database Management Systems (RDMS). . . . . . . . .122 Automated Client Information Systems . . . . . . . . . . . . .122 Automated Routing and Scheduling Systems . . . . . . . . . . .123 GIS and Computer Mapping Systems . . . . . . . . . . . . . . .133 Section 4. Providing Alternatives/Market-Based Approaches . . .133 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135 Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Appendix A. 49 CFR Part 37 Sections 37.121 through 37.127 and related sections of Appendix D Appendix B. ADA Paratransit Eligibility Policy Checklist Appendix C. Listing of Selected Transit Providers Contacted for Information in the Preparation of this Manual Appendix D. Sample Marketing and Public Information Materials Appendix E. Sample Eligibility Material Developed by the San Mateo County Transit District (SAMTRANS) Appendix F. Sample Eligibility Material Developed by the Madison Metro Transit System Appendix G. Sample Eligibility Material Developed by the Utah Transit Authority Appendix H. Sample Eligibility Material Developed by the Worcester Regional Transit Authority Appendix I. Sample Eligibility Material Developed by the Municipality of Metropolitan Seattle (Metro) Appendix J. Sample Eligibility Material Developed by the Washington Metropolitan Area Transportation Authority Appendix K. Sample Eligibility Material Developed by the Delaware Administration for Specialized Transportation (DAST) Appendix L. Sample Eligibility Material Developed by the Regional Transportation Authority (Chicago) Appendix M. Sample Eligibility Material Developed by the Port Authority of Allegheny County (PAT) Appendix N. Information about the Applicant Tracking System used by Seattle Metro List of Tables Table 1. Eligibility by Functional Impairment/Disability. . . . . . . . 18 Table 2. Eligibility Determination Processes Used by Selected Transit Providers 43 Table 3. Eligibility Determination Results for Selected Transit Providers 80 Table 4. Descriptions of Appeal Procedures for Selected Transit Providers 99 Table 5. Details of No-Show Suspension Policies for Selected Transit Providers 107 Table 6. Capabilities of Selected Computer Scheduling and Dispatching Systems to Capture and Display ADA Paratransit Eligibility Information.125 Table 7. Capabilities of Selected Computer Scheduling and Dispatching Systems to Display the ADA Paratransit Service Area and Calculate Distances to and From Stops/Stations . . . . .127 Table 8. Capabilities of Selected Computer Scheduling and Dispatching Systems to Track Service Provided to Visitors . . . . . . . .129 Table 9. Capabilities of Selected Computer Scheduling and Dispatch Systems to Track and Analyze Capacity Constraints and Subscription Service .131 List of Figures Figure 1. Examples of Eligibility Under Category 3. . . . . . . . . . . 11 Figure 2. Required and Optional Policy Elements . . . . . . . . . . . . 23 Figure 3. Steps in Developing an ADA Paratransit Eligibility Process. . 29 Figure 4. Examples of Types of Professionals that can Assist with Eligibility Determinations. . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Figure 5. Sample Flow Chart of Eligibility Determination Process (sheet 1 of 3) 75 Figure 6. Sample Photo ID Format for ADA Paratransit Eligibility Documentation 93 Figure 7. Letter Sent by SEPTA to Riders with Greatest Number of No-Shows Each Month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110 Introduction Section 223 of the Americans with Disabilities Act of 1990 (ADA) requires that public entities which operate non-commuter fixed route transportation services also provide complementary paratransit service for individuals unable to use the fixed route system. The regulations issued by the U.S. Department of Transportation, which implement this portion of the law, specify to whom and under what circumstances this service is to be provided. In addition, the regulations require public entities which are subject to the complementary paratransit requirements to develop and administer a process for determining if individuals who request service meet the regulatory criteria for eligibility. Initial guidance on the development of complementary paratransit plans, including the establishment of eligibility determination processes, was provided in the ADA Paratransit Handbook immediately following the issuance of the regulations. Since that time, numerous questions about the definition of eligibility and about the determination process have been raised. The review of initial ADA paratransit plans and first year updates also has identified innovative approaches used by transit providers in the development of eligibility determination programs. This manual has been prepared to provide further guidance to transit providers in the development and implementation of ADA paratransit eligibility determination processes. The most common questions raised about eligibility are addressed. Experience gained in the first one and a half years of implementation of the paratransit provisions is also summarized. As part of the preparation of this manual, public entities that had particular expertise and positive experiences with eligibility determination were contacted and copies of the forms and procedures which they had developed were collected. Key issues raised by these transit providers are included in the text and copies of sample forms and policies are provided in the appendices. This manual is organized in three parts. The first part, which includes Chapters 1 and 2, presents a thorough discussion of the concept of ADA paratransit eligibility and describes the regulatory requirements which apply. The second part, Chapter 3, offers practical advice in all aspects of designing and administering an eligibility determination process. This chapter is structured to lead the reader through the process of eligibility determination as it would occur in actual practice. The sequence of presentation is: deciding on the appropriate process; creating appropriate forms for the selected process; conducting the initial determination; notifying individuals about determinations; providing documentation of eligibility; establishing and conducting an appeals process; policies for suspending service to eligible persons; and providing service to visitors. The final chapter focuses on key operational issues. It discusses the use of eligibility information in daily operations. Possible approaches to determining the eligibility of specific trip requests are reviewed and advanced technologies which can assist with trip-by-trip determinations are presented. This manual is also intended to be a comprehensive guide to eligibility issues. In addition to practical information and suggestions, all regulatory information has been included. The full text of those portions of the regulation that address eligibility issues are reprinted in Appendix A. Applicable sections of the appendix to the regulation which provide interpretation of the eligibility provisions are also included. Throughout the manual, relevant portions of the regulations and interpretive guidance are inserted. While this manual offers extensive guidance on the development of application material and an eligibility process, it does not provide a single model for eligibility determination applicable in all cases. As noted in Chapter 3, there are many different ways that the process can be structured. Application forms and materials will vary depending on the approach selected. Instead, the appendices contain several model forms and materials that apply to all of the possible approaches. Chapter 3 also offers advice on the types of questions and information that should be included in eligibility materials, regardless of the approach which is selected. Public input is required in the design of the eligibility determination process. The importance of involving people with disabilities and local disability organizations in the development of all aspects of the eligibility policy and process cannot be overemphasized. The guidance and advice offered in this manual should be shared with and reviewed together with these individuals and organizations. Chapter 1 Understanding ADA Paratransit Eligibility Section 1. Who Must Develop an ADA Paratransit Eligibility Determination Process and When Must it be Implemented? Access to mainline, fixed route transportation services is the main goal of the transportation provisions of the ADA. The law recognizes, however, that some persons with disabilities are not able to use fixed route services even if these services are fully accessible. The law also acknowledges that many fixed route systems are not accessible and that alternative means of transportation are needed until full accessibility is achieved. Complementary paratransit service is required by Section 223 of the ADA to serve those persons whose needs cannot be met by fixed route systems. All public entities which operate non-commuter fixed route transportation services for the general public are required to also provide complementary paratransit service. This paratransit service must be comparable to the fixed route service. Six service criteria which define comparability are detailed in the USDOT implementing regulations. Complementary paratransit service is to be provided to those individuals determined to be ADA paratransit eligible when these individuals are unable to use the fixed route service to meet particular trip needs. As described in Section 2 of this Chapter, the regulations provide detailed guidelines which define who is to be considered ADA paratransit eligible and what trips are to be considered eligible. All public entities which operate complementary paratransit services must establish a process for certifying individuals as ADA paratransit eligible. Requests for certification must be accepted and processed for local residents and long-term visitors. An eligibility determination process must be established even if the public entity operates a paratransit system with broader eligibility requirements than the ADA. All potentially ADA paratransit eligible persons may be covered by the broader system, but individuals must have the opportunity to apply for and receive documentation of ADA paratransit eligibility which can be used in other areas. The regulations required that the implementation of complementary paratransit service begin on January 26, 1992. Services must be fully implemented (i.e., must meet all of the regulatory service criteria) by January 26, 1997 unless an "undue financial burden waiver" is granted by the FTA Administrator. The determination of those persons who are eligible to receive service is a necessary first step in this process. Therefore, an eligibility determination process is required early in the five-year implementation period. Regardless of local implementation schedules, all public entities should have an eligibility determination process in place by January 26, 1994. Section 2. How is ADA Paratransit Eligibility Defined in the Regulations? Eligibility for complementary paratransit service is directly related to the inability of a person with a disability to use the existing fixed route service. A person's inability to use the fixed route service could be related to the fact that the system has not yet been made fully accessible. It could also result from the nature of a person's disability. The person may not be able, due to their disability, to get to or from the system or to board, ride, and disembark from the vehicles even if they are fully accessible. While eligibility is conferred on individuals, it is conferred based on the fact that there are certain trips that the person cannot make on the fixed route system. For some individuals, their disabilities may prohibit them from ever using the fixed route service. For others, however, they may not be able to use the fixed route service under certain circumstances. ADA paratransit eligibility can, therefore, be considered as having two elements. First, an individual is considered ADA paratransit eligible if there are any circumstances under which the fixed route system cannot be used. Second, the extent of eligibility conferred on an individual depends on the conditions and circumstances under which they are not able to travel on the fixed route service. Individuals who can never use the fixed route service are unconditionally eligible. Persons who can use fixed route service in certain circumstances are conditionally eligible and the limitations on their eligibility should be determined. Because the regulations establish this concept of trip-by-trip eligibility, it is important that the eligibility determination process be detailed enough to identify not only eligible individuals but to determine the conditions under which their specific trip requests would be eligible. The regulations describe three specific circumstances under which a person would be considered ADA paratransit eligible. Within the industry, these have been referred to as the three "categories" of eligibility. The regulations also require that service be provided to personal care attendants and companions of eligible individuals and to visitors from outside a transit district's jurisdiction. Following is a detailed discussion of each of the three "categories" of eligibility and of requirements for serving companions, personal care attendants, and visitors. Category 1 Eligibility The first category of eligibility includes those persons unable to use fully accessible fixed route services. Included in this category is: "Any individual with a disability who is unable, as the result of a physical or mental impairment (including a vision impairment), and without the assistance of another individual (except the operator of a wheelchair lift or other boarding assistance device), to board, ride, or disembark from any vehicle on the system which is readily accessible to and usable by individuals with disabilities." [37.123(e)(1)] Examples of eligibility under this category would include: a person with a mental disability who cannot "navigate the system". Navigating the system might involve obtaining and understanding system information, recognizing and boarding the correct vehicle, having available the correct fare and/or using the fare collection system, recognizing destinations, and understanding transfers that might have to be made; a person with a vision impairment who cannot "navigate the system". Entering and traveling through a busy station or transit center may not be possible. Recognizing and boarding the correct vehicle, and recognizing the appropriate destination - even though announcements are made - are also considerations; a person with a physical disability who cannot stand on a crowded bus or rail car when seats, including priority seats, may not be available; a person with a physical disability who uses a wheelchair and who cannot get on or off the lift or to or from the wheelchair securement area without assistance. It is important to note that eligibility under this category depends on the complexity of the fixed route system. The type and extent of disability that would confer eligibility in a rural area with a one or two route bus system would be different from that in a large urban system. Transit providers should base determinations on the characteristics of their fixed route service and the abilities needed to use it. Other key issues and questions associated with this category of eligibility are summarized below. (1) Travel training: Many persons who cannot negotiate the entire fixed route system can be travel trained for certain trips. Typically, training is provided for trips that the person makes frequently, such as to work or school. These individuals would only be ADA paratransit eligible for trips they have not been trained to make. As part of the application and determination process, it should be determined if such training has been provided. Individuals cannot, however, be required to participate in travel training. The public entity may choose to offer training and may encourage individuals to take advantage of this service. Until the individual takes advantage of this service and is adequately trained, paratransit service must be provided. (2) Operator assistance: Eligibility under this category is not necessarily based on a person's ability to get on and off the lift, up and down a ramp, to and from the securement area, or secure their mobility device. While the regulation states that a person is eligible for paratransit service if they cannot independently use the fixed route system, operator assistance is assumed. The regulations, in fact, specify the level of assistance that must be provided by the public entity. Section 37.165(f) of the regulations states that "the drivers or other personnel must provide assistance with the use of lifts, ramps, and securement devices." Beyond this level of required assistance, however, public entities may choose to offer additional assistance, such as assistance getting to and from the securement area, in order to enable persons to utilize the fixed route service. If the individual is able to use the fixed route system with this assistance, complementary paratransit service does not have to be provided. Local policy concerning operator assistance should be developed with full public participation, including the input of persons with disabilities; (3) Assistance of another person: With the exception of assistance provided by the driver or other employees of the service, eligibility under this category is based on a person's ability to independently use the service. A person traveling with a friend or attendant is still eligible for paratransit service even if they would be able to use the fixed route system with this other person's help. (4) Accommodating mobility aids: The regulations set standards for vehicle and station/stop accessibility. To be considered accessible, equipment and facilities must be able to accommodate mobility aids of a certain size and persons and mobility aids up to a certain weight. The regulations define a "common wheelchair" as a "wheelchair" which does not exceed 30 inches in width and 48 inches in length (measured two inches above the ground) and which does not weigh more than 600 pounds when occupied. A "wheelchair" is defined as any mobility aid belonging to any class of three or four-wheeled devices, usable indoors, designed for and used by individuals with mobility impairments, whether operated manually or powered. All common wheelchairs and their users are to be accommodated on accessible fixed route and complementary paratransit systems. The regulations do not, however, require public entities to provide service to persons using mobility aids that are not "common wheelchairs". An individual would not be eligible for paratransit service under category 1 if they could not use an accessible bus because their mobility aid is too large or too heavy for the lift. (5) Standees on lifts: The regulations require public entities to allow persons with ambulatory disabilities who do not use wheelchairs ( e.g., persons who use leg braces and canes) to enter the vehicle by standing on the lift. Therefore, individuals who cannot climb the steps to get into a bus would not be eligible for paratransit service if they could enter the vehicle using the lift. Category 2 Eligibility The second category of eligibility includes: "Any individual with a disability who needs the assistance of a wheelchair lift or other boarding assistance device and is able, with such assistance, to board, ride, and disembark from any vehicle which is readily accessible to and usable by individuals with disabilities if the individual wants to travel on a route of the system during the hours of operation of the system at a time, or within a reasonable period of such time, when such a vehicle is not being used to provide designated public transportation on the route." [37.123(e)(2)] The majority of persons eligible under this category would be those with ambulatory disabilities who could not enter an inaccessible rail facility or would need to travel on a vehicle with a lift or ramp and other accessibility features. This would include persons who use wheelchairs as well as persons who use other mobility aids such as walkers, leg braces, or canes. Eligibility under this category depends on the accessibility of vehicles and stations/stops. A person is eligible for paratransit service if the fixed route on which they want to travel is not yet accessible. Guidance on exactly what constitutes an "accessible" fixed route is provided in the regulations and explanatory appendix. For example: A person is eligible if the bus route on which they want to travel is not 100 percent accessible. The requested trip would be eligible if the fixed route that would otherwise be used is only partially accessible (e.g., every other bus is accessible). Similarly, a person is eligible if they need to travel on a rapid or light rail system that is not yet accessible - meaning that all key stations are accessible and one car per train is accessible. An individual would be eligible in this example even if accessible fixed route bus service is provided in the same area. An individual is eligible for paratransit if a vehicle's lift or boarding device cannot be deployed at the stop which they want to use. An individual who uses a "common wheelchair" but cannot be served by the fixed route system because the lift on the vehicle they need to use does not meet the equipment standards contained in Part 38 of the regulation is eligible for paratransit service. One important issue related to category 2 eligibility is the use of on-call bus services as a way to increase the overall accessibility of the fixed route service. Basically, on-call bus programs allow an individual to call in advance and request that an accessible bus be assigned to a particular route at a time when they need to travel. Typically, an on-call bus program is implemented when a significant percent of the fixed route fleet is accessible. Successful programs have been implemented when 20-30 percent of all peak hour vehicles are accessible. On-call bus services do not technically make the fixed route fleet fully accessible. Therefore, even if an on-call bus service is offered, individuals who are eligible under category 2 must be certified. On-call bus service is, however, considered an acceptable form of complementary paratransit service and can be provided in lieu of a separate van service to those who are eligible under this category. A second important issue is how this category of eligibility should be treated by transit providers whose fixed route systems are fully accessible. Clearly, individuals who could use accessible vehicles would not be Category 2 eligible in these areas and transit districts are not required to include questions that address this category of eligibility in their application materials or assessment processes if the fixed route service is 100 percent accessible. These same individuals may not, however, be able to use inaccessible vehicles if they travel to other transit districts. Therefore, transit providers are encouraged to address this category of eligibility even if it is not applicable to their local system and to note on the eligibility documentation provided that individuals are ADA paratransit eligible if accessible fixed route vehicles are not available when needed. Category 3 Eligibility The third category of eligibility includes: "Any individual with a disability who has a specific impairment-related condition which prevents such individual from traveling to a boarding location or from a disembarking location on such system." [37.123(e)(3)] Two important qualifiers to this category are included in the regulations. First, environmental conditions and architectural barriers not under the control of the public entity do not, when considered alone, confer eligibility. If, however, travel to or from a boarding location is prevented when these factors are combined with the person's specific impairment- related condition, paratransit service must be provided. Examples of architectural and environmental factors that, in combination with certain disabilities, could prevent travel include: a lack of curb-cuts the distance from the stop/station to the trip origin or destination steep terrain snow and/or ice extremes in temperature (hot or cold) major intersections or other difficult to negotiate architectural barriers temporary construction projects severe air pollution Second, the specific impairment-related condition must prevent the person from using the fixed route system. Conditions which make getting to or from stops/stations more difficult do not confer eligibility. A determination of whether travel is difficult rather than "prevented" will need to be made. Appendix D of the regulations offers the following guidance to clarify the concepts of "prevented" travel and the relationship between architectural and environmental conditions and a person's disability: "For anyone, going to a bus stop and waiting for a bus is more difficult and less comfortable than waiting for a vehicle at one's home. This is likely to be all the more true for an individual with a disability. But for many persons with disabilities, in many circumstances, getting to a bus stop is possible. If an impairment-related condition only makes the job of accessing transit more difficult than it might otherwise be, but does not prevent the travel, then the person is not eligible. For example, in many areas, there are not yet curb cuts. A wheelchair user can often get around this problem by taking a less direct route to a destination than an ambulatory person would take. That involves more time, trouble, and effort than for someone without a mobility impairment. But the person can still get to the bus stop. On the basis of these architectural barriers, the person would not be eligible. Entities are cautioned that, particularly in cases involving lack of curb cuts and other architectural barrier problems, assertions of eligibility should be given tight scrutiny. Only if it is apparent from the facts of a particular case that an individual cannot find a reasonable alternative path to a location should eligibility be granted. If we add a foot of snow to the scenario, then the same person taking the same route may be unable to get to the bus stop. If it is not the snow alone that stops him; it is the interaction of the snow and the fact that the individual has a specific-impairment related condition that requires him to push a wheelchair through the snow that prevents the travel. Inevitably, some judgment is required to distinguish between situations in which travel is prevented and situations in which it is merely made more difficult. In the Department's view, a case of "prevented travel" can be made not only where travel is literally impossible (e.g., someone cannot find the bus stop, someone cannot push a wheelchair through the foot of snow or up a steep hill) but also where the difficulties are so substantial that a reasonable person with the impairment-related condition in question would be deterred from making the trip. The regulation makes the interaction between an impairment-related condition and the environmental barrier (whether distance, weather, terrain, or architectural barriers) the key to eligibility determinations. This is an individual determination. Depending on the specifics of their impairment-related condition, one individual may be able to get from his home to a bus stop under a given set of conditions, while his next-door neighbor may not." Given the judgement required to determine if travel is truly prevented and the relationship between environmental conditions and an individual's disability, making eligibility determinations based on this third regulatory category is likely to be the most difficult. Figure 1 on the following page provides additional hypothetical examples to further define eligibility under this category. It includes situations that would result in a person being determined eligible as well as examples that would not confer eligibility. Figure 1. Examples of Eligibility Under Category 3 Companions/Personal Care Attendants Paratransit service also must be provided to a personal care attendant (PCA) traveling with an eligible rider. In addition to a personal care attendant, the regulations require that service be provided to one companion accompanying an eligible rider. Other persons accompanying the rider are to be accommodated on a "space available" basis. Persons are considered to be accompanying the eligible rider if they are picked up and dropped off at the same locations as the eligible rider. Companions must be charged the same fare as the eligible rider and PCAs must ride free. The following additional guidance on requirements for serving PCAs and companions is provided in the interpretive appendix to the regulations: "The one individual who is guaranteed space on the vehicle can be anyone-family member, business associate, friend, date, etc. The provider cannot limit the eligible individual's choice of type of companion. The transit authority may require that the eligible individual reserve a space for the companion when the individual reserves his or her own ride. This one individual rides even if this means that there is less room for other eligible individuals. Additional individuals beyond the first companion are carried only on a space available basis; that is, they do not displace other ADA paratransit eligible individuals. A personal care attendant (i.e., someone designated or employed specifically to help the eligible individual meet his or her personal needs) always may ride with the eligible individual. If there is a personal care attendant on the trip, the eligible individual may still bring a companion, plus additional companions on a space available basis. The entity may require that, in reserving the trip, the eligible individual reserve the space for the attendant. To prevent potential abuse of this provision, the rule provides that a companion (e.g., friend or family member) does not count as a personal care attendant unless the eligible individual regularly makes use of a personal care attendant and the companion is actually acting in that capacity. As noted under 37.125, a provider may require that, as part of the initial eligibility certification process, an individual indicate whether he or she travels with a personal care attendant. If someone does not indicate the use of an attendant, then any individual accompanying him or her would be regarded simply as a companion." [Appendix D to 49 CFR Part 37, 37.123] As indicated above, a PCA may be an employee of the ADA paratransit eligible rider or may be a family member or friend. Regardless of the relationship, a PCA is clearly meant to be someone whose services are required by the rider. In determining if eligible individuals require PCA services, it is important to realize that the need for a personal care attendant is not necessarily related to travel on the paratransit service. PCAs are often needed by individuals with disabilities to assist with other activities of daily living. For example, a quadriplegic may be assisted by a PCA in filing and holding papers at work or in eating meals. A blind person may need a PCA to assist with shopping or to serve as a reader at work. Individuals may need PCAs for these activities but be fully capable of traveling on the paratransit service with the assistance provided by transit personnel. The need for PCA services can be intermittent or occasional and still be considered "regularly" needed. "Regular" use should be interpreted to be consistent with the underlying need - for example, a blind person regularly using a PCA for shopping. It is also important to note that once a person has been certified as needing to travel with a PCA, it should be the eligible individual, not the transit agency, that determines if a PCA is needed for a particular trip. Section 4 of Chapter 3 of this manual offers guidance on questions that can be added to the application form or assessment process to determine if eligible individuals will need the services of PCAs when using the paratransit program. Visitors The needs of visitors with disabilities who cannot use the fixed route system also are addressed in the regulations. Complementary paratransit service must be provided to ADA eligible individuals who travel to areas outside of the region in which they live. If these individuals have been certified as "ADA paratransit eligible" by a public entity, that certification must be honored and the host transit agency must provide up to 21 days of paratransit service. If individuals have not been certified as eligible by another public entity but claim that they are ADA paratransit eligible, they are entitled to "presumptive eligibility" and must be provided with 21 days of service. Individuals who are not certified by another transit provider and who claim presumptive eligibility can be requested to provide certain documentation such as their place of residence and the nature of their disability. Individuals are only considered "visitors" if they reside outside of the transit provider's jurisdiction. The "jurisdiction" means the total area within which the provider is authorized to operate, not the sub-area designated as the ADA paratransit service area. In joint paratransit plans, the jurisdiction is considered the total area of all partners in the plan. The interpretive appendix to the regulation offers the following explanation and example: "A visitor is defined as someone who does not reside in the jurisdiction or jurisdictions served by the public entity or other public entities with which it coordinates paratransit service. For example, suppose a five-county metropolitan area provides coordinated paratransit service under a joint plan. A resident of any of the five counties would not be regarded as a visitor in any of them. Note that the rule talks in terms of "jurisdiction" rather than "service area." If an individual lives in XYZ County, but outside the fixed route service area of that county's transit provider, the individual is still not a visitor for purposes of paratransit in PQR County, if PQR is one of the counties with which XYZ provides coordinated paratransit service." Visitors from communities outside the transit agency's jurisdiction must be served even if the community in which they reside does not contribute financially to the transit system. The "21 days" of service that must be provided are to be calculated as 21 days of service over a defined period of time, not as a 21 calendar day period of time, beginning from the first day that service is provided. For example, a person may travel to the ADA service area two-days a week on the commuter rail system. Eligibility should be extended in this case over the eleven week period of time within which 21 days of paratransit service would be required. Visitors who require more than 21 days of service within the period of time established can be required to apply for local eligibility. Finally, the level of service provided to visitors must be the same as that provided to local ADA paratransit eligible individuals who would be traveling in the same area. This means that there can be no difference in the area within which visitors can travel, the times that they can travel, the fares charged, or any of the other service criteria established in the regulations. Visitors are to be treated exactly like eligible local customers. Temporary Disabilities Persons with temporary disabilities are to be considered for ADA paratransit eligibility. This may include: someone with a medical condition such as a broken leg who temporarily is unable to use the fixed route service; someone who has recently undergone an operation or other medical treatment and who is unable to use the fixed route service; or someone with a cognitive disability that can be expected to be resolved over time through treatment or medication. Temporary eligibility should be granted for the period of time that the disabling condition is expected to last. An expiration date should be included on the documentation provided to individuals determined temporarily ADA paratransit eligible. Section 4 of Chapter 3 of this manual includes a suggested approach for determining the period of disability as part of the application/assessment process. Section 3. Key Differences between ADA Paratransit Eligibility and Past Paratransit Eligibility Many public transit providers offered paratransit services prior to the enactment of the ADA. In the mid-1970's, eligibility was determined by governing boards based on expressed local needs. Throughout the 1980's, transit providers which opted to meet their Section 504 obligations by offering paratransit service adopted the general definition of eligibility provided in that regulation. Eligibility for ADA complementary paratransit service is different from these past notions of paratransit eligibility in four key ways. These differences are discussed below. ADA Paratransit Eligibility as a Civil Right Failure to conduct a determination process that meets the regulations or failure to provide complementary paratransit service in accordance with the requirements established in the regulations are violations of the civil rights of the affected individual. This difference between ADA paratransit and past services has several important implications for the eligibility determination process. First, in designing review procedures and policies, it is important that they adhere to all of the requirements contained in 37.123 and 37.125, described above and in Chapter 2 of this manual. All elements of the policy and process also should be formally adopted by each public entity with the public participation required in 37.137 of the regulations. Second, due process standards must be observed in appeals, suspensions of service, or in any other actions which affect a person's right to the service. This is particularly true once individuals have been determined eligible. In addressing the suspension of service for "no-shows", the interpretive appendix states: "Once an entity has certified someone as eligible, the individual's eligibility takes on the coloration of a property right. (This is not merely a theoretical statement. If one depends on transportation one has been found eligible for to get to a job, and the eligibility is removed, one may lose the job. The same can be said for access to medical care or other important services.) Consequently, before eligibility may be removed "for cause" under this provision, the entity must provide administrative due process to the individual."[Appendix D to 49 CFR Part 37, Federal Register, Sept. 6, 1991, page 45747]. Finally, transit providers should maintain adequate records of certification requests, reviews completed, notification provided, and any appeals requested and should be prepared to demonstrate that regulatory requirements were met in the handling of each request for eligibility. Applications should be dated upon receipt. Decisions made throughout the review process (e.g., the completeness of the application, the need for more information, reasons for determinations, requests for appeals, etc.) should be recorded. Functionally-based Determinations of Eligibility Many policies prior to the ADA conferred paratransit eligibility based on a particular medical condition, disability, or on the use of a particular mobility aid. For example, persons who were certified as paratransit eligible if they were "blind" or "legally blind". Individuals who used wheelchairs, walkers, or leg braces were considered eligible for paratransit. Certification from a social service agency or a medical professional that the person used a particular aid or had a particular disability automatically conferred paratransit eligibility. ADA paratransit eligibility, however, is based not just on the presence of a disability, but on the effect that the disability has on the person's ability to use the fixed route service. Several factors must be considered in determining ADA paratransit eligibility. These include: (1) the applicant's disability; (2) the accessibility of the fixed route system; (3) architectural barriers that, in combination with the person's disability, prevent use of the fixed route service; and (4) environmental conditions that, in combination with the person's disability, prevent use of the fixed route service. While documentation of a particular disability or use of a mobility aid is still important, this information alone can not be used to make an eligibility determination. Questions about the functional ability of the applicant to use fixed route transit must be included in the application or assessment process. The accessibility of the fixed route service and the effects of environmental and architectural barriers must also be considered. Conditional or "Trip-by-Trip" Eligibility The paratransit eligibility processes employed by most transit providers prior to the ADA used an "all or nothing" determination approach. If it was determined that certain persons met the criteria established for eligibility, they could call and request paratransit service for any trip. If they were determined to not be eligible, they could not request any rides. The ability to use the fixed route system for some trips and not for others was not considered. Under the ADA, complementary paratransit service is only required for trips that cannot be made on the fixed route system. Many persons may qualify because there are certain specific conditions which prevent them from using the fixed route service. For example, a paraplegic wheelchair user may be able to use accessible fixed route buses during most of the year, but may require paratransit service when traveling on a route that is not fully accessible or when traveling when there is a significant accumulation of snow. Such a person would be ADA paratransit eligible. Eligibility would be for trips that are not served by accessible fixed routes and might be limited to certain months of the year. The documentation of ADA paratransit eligibility provided to this individual should identify these conditions of eligibility. While transit providers must identify whether or not applicants are conditionally or unconditionally eligible and must include limitations of eligibility in the documentation provided, they are not required to conduct trip-by-trip determinations in daily operation. If full compliance with the paratransit requirements can be achieved within the allowed implementation period, a broader service can be provided. If an undue financial burden waiver is eventually requested, however, only those costs associated with the provision of eligible trips can be used to calculate ADA paratransit costs. An ability to distinguish between trips that are eligible and those that are not will be needed. Table 1 on the following pages, adapted from the ADA Paratransit Handbook, illustrates the relationship between ADA paratransit eligibility and selected types of disabilities/medical conditions/functional impairments. For selected disabilities, the applicability of eligibility conditions is indicated. The types of conditions that should be considered are also noted. While the table is not intended to be an exhaustive listing of disabilities or eligibility conditions, it does illustrate the fact that conditions of eligibility need to be considered in most cases. There are limited instances in which it would be reasonable to assume that paratransit service is needed "in all cases". This would include, for example, individuals with profound mental retardation who are unable to negotiate the fixed route system even with travel training. It would also include persons with disabilities that are episodic or intermittent (i.e., the extent of disability can vary from day to day). In this latter instance, it would probably be unrealistic to specify the condition that would trigger an inability to use fixed route service. Table 1. Eligibility by Functional Impairment/Disability Functional Impairment/ Disability Type of Eligibility Determining Factors Ambulatory Disability, Uses Wheelchair Conditional (2,3)* - Availability of accessible fixed route service - Distance to/from bus stop or rail station for trip requested - Environmental conditions (terrain) Ambulatory Disability, Uses Walker Conditional (2,3) - Distance to/from bus stop or rail station for trip requested - Availability of accessible fixed route service - Environmental conditions (terrain) Ambulatory Disability Uses Braces Conditional (2,3) - Distance to/from bus stop or rail station for trip requested - Availability of accessible fixed route service - Environmental conditions (terrain) Ambulatory Disability, Uses Other Mobility Aid Conditional (2,3) - Distance to/from bus stop or rail station for trip requested - Availability of accessible fixed route service - Environmental conditions (terrain) Temperature Sensitivities Conditional (3) - Distance to/from stop/station - Waiting time at Stop/station - Temperature Cardiac Condition Conditional (3) - Distance to/from stop/station - Environmental conditions (temperature, terrain) Pulmonary Condition Conditional (3) - Distance to/from stop/station - Environmental conditions (temperature/terrain) Arthritis Conditional (3) - Distance to/from stop/station - Environmental conditions (temperature/terrain) * Indicates category of eligibility. (1) = unable to board, ride, or disembark from an accessible vehicle; (2) = able to use accessible vehicle but accessible vehicle is not available; (3) = unable, due to impairment related conditions to get to stop/station. Table 1 (continued) Functional Impairment/ Disability Type of Eligibility Determining Factors Conditions resulting in severe fatigue (HIV, radiation/chemotherapy, dialysis) Conditional (1,3) - Distance to/from stop/station - Environmental (temp./terrain) Severe lack of coordination/motor function (e.g., cerebral palsy, brain/spinal/peripheral nerve trauma, neurological conditions) In all cases (1,3) Moderate lack of coordination/motor function (e.g., cerebral palsy, brain/spinal/peripheral nerve trauma, neurological conditions) Conditional (2,3) - Distance to/from stop/station - Availability of accessible fixed route service Profound or severe mental retardation In all cases (1,3) Mild or moderate mental retardation Conditional (1,3) - Has person received travel training for trip requested? Psychiatric disabilities causing disorientation (as distinct from behavioral) In all cases (1,3) Visual impairments (blindness, restricted vision) Conditional (1,3) - Has person received travel training for trip requested? - Effective fixed route communications practices in place (announcements, card systems, etc.)? - Physical barriers in the environment Hearing Impairments Conditional (1) - Effective fixed route communications practices in place (signage, card system, etc.) Communication Disabilities (disability related speech or reading impairments) Conditional (1) - Effective fixed route Communications practices in place (signage, card system, etc.) Determining Eligibility Based on the Most Limiting Factors Determinations of ADA paratransit eligibility must consider the ability of applicants to travel to any origins and destinations in the paratransit service area under all possible conditions. Determinations cannot be based on a person's ability to use fixed route service some of the time or under "typical" conditions. For example, a person with an ambulatory disability may live only one block from the nearest bus stop and the terrain between their home and the stop may be level and accessible. They may not be able, though, to independently travel more than 1/2 mile and may not be able to negotiate steep terrain. Even though this person could get to the fixed route system from their home, there would be possible destinations more than 1/2 mile from fixed routes that she or he would not be able to reach. There may be other destinations in areas of steep terrain that would also be inaccessible. Conditional eligibility would therefore be appropriate. Section 4. The Importance of a Thorough Initial Determination The development of a process that can accurately determine ADA paratransit eligibility, including conditions and limitations of eligibility, is important for several reasons. First and foremost, as mentioned in Section 3 above, individuals who are unable to use fixed route service have a right to receive complementary paratransit service within the service limits established by the regulations. Because this is a right established in national law, the ultimate arbiter of eligibility for complementary paratransit service is the judicial system. An applicant who feels that a local determination of eligibility is not consistent with the regulatory criteria can take this concern to court. It is therefore in the interest of all involved that initial determinations of ADA paratransit eligibility are made accurately and in keeping with the established criteria and procedures. In addition, an accurate determination of eligibility has important operational and planning implications. These include: Managing Demand In many systems, the level of paratransit service that must be provided to persons determined ADA paratransit eligible exceeds that which was provided prior to the ADA. Once complementary paratransit service is brought into full compliance, individuals can request any and all trips for which they have been determined eligible. Essentially, unconstrained service must be provided in corridors served by fixed routes at all times that the service is in operation. Unless granted an "undue financial burden waiver," transit providers will not be permitted to ration service, by limiting supply or by other means, for these customers. If the cost of providing fully compliant ADA paratransit service is a local concern, it is important to carefully identify those individuals who are eligible, determine when these persons can use the fixed route system, and when paratransit is necessary. Unless eligibility and appropriate limitations/conditions are determined at the outset, it may not be possible to implement a trip-by-trip scheduling system (see Chapter 4) as a way to manage paratransit demand. Documenting an Undue Financial Burden In the event that providing fully compliant ADA paratransit service presents an undue financial burden, the regulations permit transit providers to request a waiver from the Administrator of the Federal Transit Administration. Undue financial burden waiver requests must document the cost of providing fully compliant service and must detail why this cost is an undue burden. In developing service costs, the regulations specifically note in 37.155(b) that costs must be limited to those "required by (the regulations) to ADA paratransit individuals" and "attributable to ADA-mandated trips". Transit providers requesting waivers must be able to document that they have counted only those costs associated with eligible trips made by persons who have been determined ADA paratransit eligible. They must also be prepared to show that local determination of eligible individuals and trips is consistent with the regulations. The local eligibility determination process is, therefore, an important concern in any decision regarding a request for an undue financial burden waiver. If there is reason to believe that the process has not accurately determined ADA paratransit eligibility consistent with the regulations, the costs of ADA complementary paratransit service included in a waiver request may be questioned. Chapter 2 Elements of an ADA Paratransit Eligibility Policy In addition to providing a definition of ADA paratransit eligibility, the USDOT regulations establish requirements for several aspects of the determination process. As shown in Figure 2 below, six specific process requirements are included in 37.125 of the regulations. Additional process issues are discussed but left to the option of transit providers. Each of these required and optional policy elements is described in this chapter. Figure 2. Required and Optional Policy Elements All transit providers should establish a written eligibility policy as part of their ADA paratransit plan. The policy should detail exactly how the ADA paratransit eligibility determination process is structured. The policy must address the requirements of 37.125 and indicate how compliance with each is being achieved. It can also address the optional elements noted above. A checklist which can be used to ensure that all key elements are included in an ADA eligibility policy is provided in Appendix B. Section 1. Required Elements Strictly Limiting Eligibility The certification process that is established must strictly limit ADA paratransit eligibility to the regulatory definition of eligibility. Only those persons who meet the regulatory definition can be given documentation indicating that they are "ADA Paratransit Eligible". In addition, if individuals who are determined to be ADA paratransit eligible can use fixed route service under certain conditions, the documentation which they are given must indicate the limitations/conditions of their eligibility. Public entities which foresee no financial difficulty fully meeting the complementary paratransit requirements and who wish to offer a broader service can do so. A parallel process for determining eligibility for this broader service can be established and documentation of eligibility for this non-ADA service can be provided. Documentation for this broader service cannot, however, indicate that these other customers are ADA paratransit eligible. Entities also may develop an integrated eligibility determination process which they use for all local paratransit services. Questions included in the application material can be used to determine if individuals qualify for broader services even if they do not qualify as ADA paratransit eligible. Documentation of eligibility must, however, distinguish between those who qualify for the broader service and those who meet ADA paratransit eligibility standards. Similarly, if full compliance with the complementary paratransit requirements poses no undue financial burden, entities may opt to accept all trip requests, regardless of conditions and circumstances, from individuals determined ADA paratransit eligible. It may be too administratively burdensome to implement trip-by-trip eligibility or may not be cost effective to attempt to operationalize all aspect of trip eligibility. The determination process and the documentation provided must still, however, be designed to identify the extent of eligibility conferred on individuals. Application or assessment forms and guidelines must be detailed enough to allow for conditions of eligibility to be noted where applicable. The process must also be thorough enough to reasonably ensure that the criteria for eligibility are being properly interpreted and applied. As noted in Section 4 of the previous chapter, should it become necessary to request an undue financial burden waiver, only those costs attributable to ADA-mandated trips can be counted in the request. Accessible formats Subsection (b) of 37.125 states that "All information about the process, materials necessary to apply for eligibility, and notices and determinations concerning eligibility shall be made available in accessible formats upon request." Accessible formats include large print, audio tape, braille, and computer disk. Information does not need to be made available in the format a requester prefers, but does have to be made available in a format that the person can use. There is no use, for example, giving a braille document rather than a document on tape to a person who does not read braille. Section 4 of Chapter 3 of this manual includes a more detailed discussion of this requirement and suggests ways to assist individuals with sensory impairments. Processing Time/Presumptive Eligibility Applicants are to be granted presumptive eligibility if a determination of eligibility has not been made within 21 calendar days of the submission of a completed application. Service must be provided, and the applicant presumed to be eligible, until and unless the determination is complete and the person is found to be ineligible. An application is considered to be complete once the person has provided all of the information required. Subsequent investigations or requests for additional information by the public entity would be considered part of the review process and within the 21 day timetable. For example, if an application process requires that individuals complete a form which includes the name of a professional who can be contacted for further information, the application would be considered "complete" once the requested information and professional contact were indicated. Follow-ups by the public entity in getting additional professional verification and information would be part of the 21 day review process. Notice of Initial Determination Applicants must be notified in writing of the initial determination of eligibility. If the determination is that the person is not eligible, the written notification must state the reasons for the finding. Appendix D to the regulations indicates that notification of ineligibility must be specific. Information provided in the application or obtained in the review process must be related to the eligibility criteria (e.g., the categories of eligibility) and to the review process which the entity has designed. Simply indicating that the person is not ADA paratransit eligible because it has been determined that they "are able to use the fixed route system" is not sufficient. Section 6 of Chapter 3 provides more information and suggestions on the notification process. Documentation of Eligibility If an applicant is determined to be eligible, documentation of eligibility must be provided. This documentation must specifically state that the person is "ADA Paratransit Eligible". It must also contain, at a minimum, the following information: the name of the eligible individual; the name of the transit provider providing the certification; the telephone number of the transit provider's paratransit coordinator; an expiration date for eligibility (if applicable); any conditions or limitations on the individual's eligibility; and the need for a personal care attendant. The telephone number of the transit provider's paratransit coordinator is meant to facilitate communication between transit providers if additional eligibility information is needed when the person travels to another area. The person identified (and the phone number listed) should be the individual who has access to and can readily provide eligibility information. Administrative Appeal Process Section 37.125(g) of the regulations requires that an administrative appeal process be available to any individuals who are determined to be ineligible for complementary paratransit service. Because the provision of ADA complementary paratransit service is a civil right, the denial of eligibility is a serious matter. A fair and effective appeal process is not only required but is in the interest of all parties. The appeal process must be available not only to individuals who are determined ineligible in all situations, but to persons who are deemed conditionally eligible. Limiting eligibility is in fact denying eligibility for certain trips. The appeal process established must comply with the following requirements: Individuals must be permitted to request an appeal within 60 days of the initial eligibility decision; Individuals must have an opportunity to be heard in person and to present additional information and arguments regarding their disability and ability to use the fixed route service; There must be a "separation of function" between those involved in the initial eligibility determination and those selected to hear appeals; Applicants must be notified of appeal decisions in writing, or in accessible format if requested, and the notification must state the reasons for the decision if eligibility is still denied; If a decision on the appeal is not made within 30 days of the completion of the process, individuals must be considered "presumptively eligible" and must be provided paratransit service until and unless a decision to deny the appeal is issued. Paratransit service does not have to be provided, however, during other phases of the appeal. Section 8 of Chapter 3 offers guidance on establishing an appeal process and includes information about the processes adopted by several selected transit agencies. Section 2. Optional Elements In addition to the above items, eligibility determination policies can include the following three additional features. These are not, however, required elements of the process. Recertification of ADA Paratransit Eligibility Transit providers can require that individuals periodically reapply for ADA paratransit eligibility. While a person's disability may be permanent, other factors which go into the determination of eligibility may change. For example, the percent of accessible vehicles in the fixed route service may increase. Improved technologies and/or operating procedures also may be introduced which would permit greater use of the fixed route service by individuals with disabilities. While the regulations do not specify the period for which individuals should be certified as ADA paratransit eligible, some general guidance is provided. The ADA Paratransit Handbook suggests recertification every three to five years. It also notes that the period of recertification can be flexible and can consider the applicant's particular disability. For example, a person who is frail and 75 years old could be determined eligible without any expiration date while an applicant whose disability might be expected to change can be certified for a specific period of time. Another important factor in setting the recertification interval is whether or not changes in the level of fixed route accessibility are planned. A longer interval might be appropriate in an area where fixed route service is already 100 percent accessible versus a system that is just beginning to make fixed route vehicles and stations accessible. Regardless of the policy regarding recertification, individuals have the right to request a new determination if they believe that there have been changes in their situation. This would include individuals determined ineligible as well as those whose eligibility has been limited or conditioned. Recertification of Other Paratransit Customers If paratransit service was provided prior to the ADA, transit providers may elect to require that all current riders be recertified. Such a recertification is not, however, required by the regulations. Current riders can continue to receive service and can apply for ADA paratransit eligibility as they choose. If existing riders are allowed to choose whether or not to apply for ADA paratransit eligibility, transit providers should make these riders aware of any potential benefits of certification. This would include the ability to use paratransit services in other areas and "priority" service should capacity constraints exist. It would also provide individuals with certain rights and "due process" protections. A recertification of existing riders will become important, however, if fully compliant paratransit service cannot be developed in the five year implementation period provided by the regulation. Any request for an undue financial burden waiver can only count those costs associated with the provision of required paratransit service. A recertification of existing riders will be needed to determine which individuals and which trips are in fact required. No-Show Suspension Policy Finally, the regulations permit transit providers to suspend paratransit service to those persons who establish a "pattern or practice" of missing scheduled rides (i.e., "no-show"). Service can be suspended for a "reasonable period of time". Allowances must be made for missed trips that are beyond the control of the individual. The number of no-shows considered a pattern or practice and the period of suspension must be developed through the public participation process required for the development and updating of paratransit plans. Before service can be suspended for cause under this provision, individuals must be provided with an opportunity to appeal the proposed suspension. A two-stage notification and appeal process is detailed in 37.125(h) of the regulations. Section 9 of Chapter 3 provides further guidance on no-show policies and includes information about policies established by selected transit agencies. Chapter 3 Establishing an ADA Paratransit Eligibility Determination Process The establishment of an appropriate eligibility determination process involves several key decisions. Figure 3 summarizes the basic steps that must be taken to establish a determination process. At the outset, a decision must be made as to the process that will be used. It is then necessary to decide who will conduct initial determinations. An appeal process must be structured and no-show and recertification policies considered. Application materials and forms must then be developed. Public participation in all of these aspects of the process is required. A management information system for tracking reviews should be created before the process is implemented. Training also should be provided to those involved in the process. Consideration should be given to pre-testing materials before they are widely distributed. Once established and operational, administrative oversight of the process should be maintained, particularly in the initial months. This chapter details and provides guidance on each of these steps and decisions. Section 1 discusses overall considerations, including public participation in the development of the process and the issue of application/assessment fees and charges. Sections 2 and 3 present alternative processes that can be used for conducting determinations, and discuss issues Figure 3. Steps in Developing an ADA Paratransit Eligibility Process associated with conducting determination in-house versus contracting with an outside agency or agencies for this service. Section 4 addresses the development of application forms and related materials. Suggestions for the development of application forms and other materials are presented. Issues associated with conducting reviews, providing notification of determinations, structuring an appeal process, and establishing details of a no-show policy and a visitor policy are discussed in Sections 5 through 10. Much of the information in this chapter is based on the policies, procedures, and materials that have been developed by selected transit providers during the first year and a half of implementation of the complementary paratransit service requirement. Detailed information about eligibility determination was obtained from 25 selected transit providers across the country. Reference is made to these systems throughout this chapter. Appendix C provides a listing of the transit systems contacted, addresses, phone numbers, and contact persons should additional information be desired. Section 1. General Considerations Public Participation Major elements of the process must be developed with full public participation, including a public hearing. This would include decisions on the overall initial determination process that will be used, the structure of the appeal process, or a decision to establish or change the specifics of a no-show policy. It would also include major changes to the application/assessment form such as the addition or deletion of key questions regarding travel capabilities. Procedural changes such as the wording of notification letters or minor changes to the layout of forms and other materials can be made without full public participation. Obtaining less formal input is still, however, recommended. The ongoing mechanism for obtaining the input of persons with disabilities in the development and implementation of the paratransit service should be used throughout. Given the detail involved in developing all aspects of a determination process, consider establishing a small but representative working group to help in the development of draft materials and process recommendations. Make these draft materials and recommendations available to any advisory committee or distribute them to agencies and interested individuals for review and comment. Finally, present the recommended process and materials at a pubic hearing for broader comment and review. If eligibility materials are to be revised over time, consider combining the review and revision with the required annual ADA paratransit plan update process. Conversations with transit providers that have successfully implemented an eligibility determination process suggest that public involvement in the development and implementation of the process is vital. Individuals with disabilities and agency staff can assist with the preparation and testing of materials. They will provide a detailed knowledge about disabilities and travel capabilities and requirements that the transit provider staff do not necessarily have. Involving consumers and agencies will also allow for the development of options for outside assistance with initial reviews and appeals. For additional guidance on developing a public participation process, see the ADA Public Participation Handbook. This document, funded by FTA and prepared through Project ACTION, offers numerous suggestions and readily adapted material for strengthening local public participation. Public Information and Marketing In addition to a thorough public participation process, it is highly recommended that a public information/marketing program be developed to educate potential applicants and local disability organizations about ADA paratransit eligibility. The program should utilize a variety of media to reach persons with different types of disabilities, and program materials should be made available in accessible formats. It is likely that individuals and agencies may not fully understand the functional nature of ADA paratransit eligibility, the difference between individual and trip eligibility, the appeal process, or other key issues. Misunderstanding of the nature of eligibility for service can lead to incomplete and/or inappropriate applications, as well as political and customer relations problems. Communicating the trip-by-trip nature of ADA paratransit eligibility is particularly important. Several transit agencies have reported that individuals are hesitant to use fixed route services for fear this will make them ineligible for ADA paratransit. The public information program should emphasize that paratransit may still be appropriate even if fixed route service can be used some of the time. The eligibility determination process is intended to determine when each mode is appropriate rather than to make an absolute distinction between those who are to use fixed route and those who require paratransit. Another public perception issue raised by several transit agencies was that applicants often do not provide information about all of the difficulties they may have using the fixed route service. Applicants may think that, as long as the primary difficulty using transit is noted, they will qualify for paratransit and be able to request any trip. It is important that they understand that all difficulties be noted so that appropriate conditions/limitations of eligibility can be determined. While a public information campaign is recommended in all cases, it is particularly important in the following situations: If current paratransit customers are being required to reapply and be recertified as eligible for paratransit service. Differences between past eligibility policy and ADA paratransit eligibility will need to be explained; If a broader paratransit service will be provided with priority given to those determined ADA paratransit eligible. In this situation, it is important that the benefits of applying for and being determined ADA paratransit eligible be communicated to all riders. Some public information and marketing efforts to consider are listed below. (1) Develop a brochure that explains ADA paratransit eligibility. It could be displayed with other service materials and mailed to current riders. It could also be displayed at locations which are frequented by the general public and persons with disabilities such as public libraries, municipal buildings, senior centers, aggregate housing locations, social service agencies, and medical facilities. Appendix D contains copies of brochures developed by Seattle Metro, the Regional Transportation Authority of Chicago, and the Riverside Transit Agency of Riverside, California that explain the ADA, ADA paratransit, eligibility, and the appeals process. (2) As mentioned in Section 4 of this chapter, include a summary of ADA eligibility with certification materials that are sent to applicants. (3) Work with local human service agencies and disability organizations to include information about ADA paratransit eligibility in any publications that they may have. Organizations such as United Cerebral Palsy councils, local chapters of the National Easter Seal Society, commissions for the blind and visually-impaired, commissions for the deaf and hearing-impaired, area agencies on aging, mental health agencies, independent living programs, and state,regional, or local commissions on people with disabilities prepare newsletters which are sent to members and clients. (4) Request the opportunity to discuss eligibility issues with the governing boards of human service agencies and disability organizations and to make presentations at any workshops, conferences, or consumer meetings which they may sponsor. (5) Make a particular effort to explain the details of ADA paratransit eligibility to the staff of local agencies. Depending on the certification process employed, these individuals may be asked to supplement applicant information or may assist individuals in completing application materials. Even if not involved in the certification process, agency staff who are knowledgeable about eligibility issues will be able to better advise clients. (6) Sponsor a special public forum at which ADA paratransit issues, including eligibility, can be discussed. Invite current riders and other interested agencies and individuals as well as advertising it to the general public. A notice of such a forum, prepared by the Worcester Regional Transit Authority, is provided in Appendix D. (7) Work with local media to develop public interest stories that help to explain the service and eligibility. Feature a customer who uses the fixed route service for certain trips but has been certified for paratransit service for other trips. Additional Charges and Fees Section 37.5 of the regulations, which defines general requirements for nondiscrimination for all aspects of transportation services covered, states that: "An entity shall not impose special charges, not authorized by this part, on individuals with disabilities, including individuals who use wheelchairs, for providing services required by this part or otherwise necessary to accommodate them." [37.5(d)] For determinations of ADA paratransit eligibility, this means that there can be no charges associated with the process, including the filing and processing of applications, any in-person assessments that may be requested, the documentation of eligibility that is provided, or any other aspect of obtaining eligibility. In particular, if the process involves obtaining information from a professional or an in- person assessment, the transit provider or any third-party contractors acting on behalf of the transit provider cannot impose a fee for this service. If professional information is needed for the initial application to be considered complete, alternatives should be made available should the applicant not be able to obtain this information from a professional or not be willing to incur any costs that might be associated with obtaining this information. For example, the transit provider should make arrangements with local professionals to whom applicants can be referred and the transit agency should pay any fees associated with this service. Transportation to and from any in-person assessments or other appointment required by the process also should be made available to applicants. Similarly, a fee cannot be charged for the preparation of documentation of eligibility, including photo identification cards. A transit provider may, however, charge a nominal fee, meant to cover the cost of production, for replacement of lost I.D. cards. Local policy concerning such charges should be developed with full public participation, including the input of persons with disabilities. In addition to prohibiting obvious direct charges, the regulations note that the process may not impose "unreasonable administrative burdens" on applicants. Repetitive and superfluous documentation, questions, or tests must not be included. Section 2. Alternative Processes There are several ways that ADA paratransit eligibility determinations can be conducted. In general, the many approaches that have been developed can be characterized as one of the following: Self-certification with professional verification as needed; Self-certification and professional verification; In-person assessment; and Combined approaches. These alternative processes can be conducted either in-house by transit provider staff or can be contracted out and conducted by a third-party agency. It is also possible to conduct some determinations in-house and have third-party assistance available as needed. The best process and approach to conducting reviews depends on local circumstances. Some alternatives are better suited to smaller systems. Others are more appropriate for larger urban systems. Whether or not a paratransit service was provided prior to ADA complementary paratransit service is also an important consideration in the alternative selected. Each alternative also has its own benefits and issues that must be considered. Regardless of the approach selected, the goal of the determination process should be the same - to enable the public entity to accurately determine when and under what circumstances the fixed route service can and cannot be used by applicants. Information collected and reviewed must be sufficient to enable the reviewer to identify the relationship between a person's disability and their travel capabilities given factors such as: the accessibility of the fixed route service; the distance to and from stops/stations; environmental factors such as snow, ice, heat, cold; and natural and man-made architectural barriers such as steep terrain, lack of curb-cuts, and busy roads and/or intersections. Following is a description of each of the alternative processes listed above. For each, general recommendations are made concerning the applicability of the process to different types of systems. Major considerations associated with each alternative are also discussed. Self-certification with professional verification as needed This alternative involves the completion of a form by the applicant or a person assisting the applicant. The form which the applicant completes typically includes all of the information required for a determination of eligibility. As part of the form, applicants are requested to identify a professional who can be contacted if more information is needed, and are asked to sign a release authorizing the professional to provide the transit agency with pertinent information. While the applicant chooses the professional who can be contacted, the transit agency can request the identification of particular type(s) of professionals. Professional verification can be obtained under this model by phone, through the use of a second form which is mailed to the professional by the transit provider, or both. While it is theoretically possible to establish a determination process that only utilizes information provided by the applicant, it is highly likely that at least some determinations will require more detailed information. Verification of "hidden disabilities" such as cardiac conditions, pulmonary conditions, cognitive disabilities, and mental illness will be needed. It is therefore recommended that the ADA paratransit eligibility determination process allow for professional contact, at least as an option, in all cases. In addition to contacting the identified professional when additional information is needed, some transit providers will randomly contact named professionals to verify the information provided by applicants. Verification can also be done following certification if there is cause to believe that the information provided by the applicant is not correct. Applicability Self-certification with professional verification as needed is used extensively by smaller fixed route operators in small urban and rural areas. It is most appropriate in areas where the size of the system allows transit providers to be familiar with paratransit riders. It is also appropriate in cases where the transit agency offered paratransit services prior to the implementation of ADA service. In these instances, it is likely that the provider already has information about riders, possibly including professional verifications, on file. An ADA paratransit eligibility determination process which does not require professional verification can be used to reduce unnecessary duplication of existing eligibility information. Considerations This certification process is perhaps the least burdensome on applicants. Appointments with professionals to have forms completed or to have personal assessments conducted are not required. Greater burden is placed on reviewers, however, as follow-up may be needed if sufficiently detailed information is not provided in the initial application. If this alternative is selected, particular attention should be given to the 21 day timetable allowed by the regulations for reviewing applications and presumptive eligibility beyond this time. Applications must be considered complete if applicants complete all items on the form and name a professional contact as requested. Any follow-up by reviewers to obtain professional verification would be part of the 21 day review timetable. An initial review and decision whether or not professional information is needed should be made within the first few days after receipt of the application. Another important issue associated with this approach is getting information from the most appropriate professional. Depending on the nature of an applicant's disability, different types of professional verification are desirable. For example, for someone with a physical disability, information from a physical therapist or occupational therapist may be most helpful. For an applicant with a vision-impairment, information from an opthomologist which can provide the degree of sight which the applicant has may be helpful. It is not always possible, however, to control the type of professional named by the applicant. If allowed, many applicants may provide the name of a personal physician with a knowledge of the person's disability but with little understanding of their ability to travel on the fixed route service. If possible, applicants should be directed to identify professionals most appropriate to their disability or medical condition. Section 4 of Chapter 3 of this manual suggests wording that can be added to the application form to direct applicants to identify an appropriate professional. It is also possible under this approach to request that a different professional be identified if the person originally listed cannot provide adequate information. Finally, because this process relies on information provided by the applicant and/or a professional, it is important that they understand the nature of ADA paratransit eligibility. A major issue encountered by transit providers using this form of certification is that applicants/professionals will identify a primary disability or travel limitation but may not detail all problems that may be encountered using the fixed route service. This may be due to the fact that applicants feel they only need to qualify and that they will then receive service as needed. Professionals also may have a tendency to provide cryptic medical information. The introductory section of the form should describe ADA paratransit eligibility in detail. The notion of trip-by-trip eligibility also needs to be made clear so that the applicant and professional understands that detailed information is required in order to identify appropriate eligibility conditions/limitations. Self-certification and professional verification In this eligibility determination process, the initial application form contains two parts - one part completed by the applicant (or his/her representative) and the other part to be completed by a professional familiar with the applicant's condition. The information from the professional is requested as part of the initial submission and the application is not considered complete without it. As with the first alternative described above, each applicant selects the professional from which they request additional information. Transit providers can, however, specify the types of professionals that can provide this information. The professional verification portion of the application is typically designed in one of two ways. In some cases, the questions asked of both the applicant and the professional are very similar and the separate responses are compared for accuracy and consistency by the reviewer. In other cases, the applicant is asked only general information and more detailed information about travel capabilities and the nature of the person's disabilities is included in the professional verification section of the form. While information is requested from both applicants and professionals under this process, follow-up may still be required. Contact with the applicant may be needed if a different professional, with a better understanding of the person's functional abilities, is needed. Follow-up with professionals may be necessary if the information provided is not sufficiently detailed to allow a determination to be completed. Applicability This process is often used by larger transit providers who, because of the expected volume of certification requests, may find it administratively difficult to do the necessary professional follow-up within the required processing timetable. The inclusion of professional information as part of all applications received can help to facilitate the review process. It may also be applicable if past eligibility for paratransit service was not functionally based or if information that may be on file as part of past determinations needs to be updated. Considerations If this approach to certification is used, transit providers must allow for those instances when applicants are not able to easily obtain information from professionals. While systems report that most individuals are able to obtain the needed information from a professional, there will be some individuals who will not have an ongoing relationship with a professional or may have to pay for this information to be provided. In order for the process to be consistent with the regulatory prohibition against special charges and unreasonable administrative burdens, professional verification should be requested. Applicants should be instructed to contact the transit provider if professional verification cannot be obtained. A list of appropriate professionals to whom applicants can be referred should be maintained and the cost associated with any required appointments should be paid by the transit provider. As with "self-certification with professional verification as needed", it is important that an effort be made to obtain information from the most appropriate professional. Applicants can be instructed to provide verification from particular professionals or can be directed to contact a professional appropriate to their disability. Paratransit eligibility determination prior to the ADA often specified that this type of professional verification be provided by a personal physician. Under the ADA, the use of physicians may not be appropriate in many cases. While personal physicians may be the professionals most readily available to applicants, they may not understand the applicants functional capabilities as well as other professionals. The interpretive appendix to the regulation offers the following advice concerning the use of information from physicians: "The substantive eligibility process is not aimed at making a medical or diagnostic determination. While evaluation by a physician (or professionals in rehabilitation or other relevant fields) may be used as part of the process, a diagnosis of a disability is not dispositive. What is needed is a determination of whether, as a practical matter, the individual can use fixed route transit in his or her own circumstances. That is a transportation decision primarily, not a medical decision."[Appendix D to 49 CFR Part 37, Federal Register, September 6, 1991, page 45746] In certain instances, information from a physician will be appropriate. Verification of a cardiac condition or the degree of vision impairment may, for example, be needed. Transit providers should consider allowing applicants to obtain information from several different types of professionals, including physicians. Direction should also be provided encouraging applicants to obtain information from a professional most appropriate to their particular disability. It is also important that professionals understand that the verification which they provide is not considered a determination. Eligibility determinations are to be made by transit providers or contractors hired to conduct eligibility determinations. Professionals must understand that they are simply providing information to the reviewers and that they are not being asked to make the determination. This should be made clear on the forms provided. Avoid having professionals answer broad questions which ask them if they think that the person is ADA paratransit eligible. They should not be asked to make a final judgement. This will only cause problems and possible confrontations if the final determination differs from their professional opinion. Many systems also indicate that information provided by professionals is cryptic and general in nature. Transit providers should make questions concise and explain on the form that detailed information is needed. The concept of trip-by-trip eligibility should be explained and professionals should be informed that the information needs to be of sufficient detail to allow the reviewer to not only determine that paratransit service is needed but to decide when and under what circumstances paratransit service is needed. In some cases, transit providers will allow human service agencies to provide professional verification for their clients. Such agencies may have conducted assessments of clients to determine their eligibility for other programs. They often will have detailed functional information on file which can be of assistance in the process. Because of the obvious benefit to these agencies of having clients certified for paratransit service, it is recommended that consideration be given to the extent of this type of agency involvement in the process. If the staff of human service agencies are to be used for professional information and verification, transit providers may want to consider limiting the types of agency verifications accepted to those agencies that promote independent living. It is important that agencies authorized to provide verifying information be concerned not just with obtaining a convenient service for their clients but with mainstreaming them. Independent living centers, certain agencies for persons with vision-impairments, and rehabilitation centers are examples of such agencies. As with other types of professional verification, it is important that information provided by these agencies be one factor in the determination rather than being used as a final eligibility decision. If reviewers used by the transit provider are skilled in interpreting standard human service assessments, another option available under this model would be to request copies of any functional tests which these agencies may have on file. In-Person Assessments Under this model, all applicants are required to meet with a reviewer selected by the transit provider. At this assessment meeting, the reviewer will typically ask the applicant a series of questions, similar to those contained in an application form, meant to determine the person's disability and ability to use fixed route service. Often, the reviewer will also elaborate on standard questions to get more detailed information as appropriate. In addition to a face-to-face interview, in-person assessments may also involve the administration of functional tests. These may include physical tests such as the ability to board and disembark from an inaccessible bus, use a wheelchair-lift, or see and read signs or other visual information. It may also involve administering standard cognitive tests to determine the applicants ability to perform tasks such as asking for and following directions. Because of the skill required to administer and interpret detailed tests and draw immediate conclusions from such assessments, determinations under this process are typically performed by third-party agencies under contract to the transit provider. Transit providers may also work with contractors to develop testing centers containing equipment needed to simulate travel on the fixed route system. The Transit Authority of River City (TARC) in Louisville, Kentucky, for example, has created a testing center at a local rehabilitation center that is equipped with a specially constructed bus stop and a spare bus. The site also contains sidewalks with varying terrain and varying surfaces. For applicants with visual impairments, the site includes typical transit signage and symbols and can simulate varying degrees of light and darkness. For applicants with mental disabilities, a cognitive and orientation assessment is conducted by a clinical psychologist. In addition to information collected by the reviewer, the process may require applicants to complete a general information form and sign necessary releases/certifications. Applicability In-person assessments may be particularly applicable in larger urban systems with complex fixed route services. The in-person process is able, in these circumstances, to obtain detailed information about using various parts of the system that may be difficult or complex to collect on standard application forms. This approach may also be more appropriate in areas that did not provide paratransit service prior to the ADA. While transit providers with established paratransit services and longstanding customers may not deem it necessary to require all riders to undergo an in- person assessment, new systems will have no past record of riders to rely on. New riders may also be more amenable to an in-person assessment process. Considerations The use of in-person assessments has many advantages. It allows eligibility determination to be done by a limited number of professional who can be trained by the transit provider. Obtaining information from an appropriate professional, which is a major concern in self- certification/professional verification models, is eliminated. In-person assessments also are not bound by standard application questions. The process can be more personalized to the person's particular disability. Even though standard questionnaires are used to guide the process, reviewers can ask follow-up questions as needed. This process also allows reviewers to explain ADA paratransit eligibility in-person and to answer questions about eligibility which the applicant may have. The applicant also has an opportunity to request clarification of questions before providing an answer. The information received is therefore more likely to be complete and accurate. Because of the degree of flexibility which reviewers may have, it is important that efforts be made to maintain consistency in the process. Transit providers should consider establishing standards for the types of professionals who are used as reviewers. Detailed training of reviewers is also vital. Perhaps the greatest drawback to requiring in-person reviews in all cases is that many applicants may have disabilities which do not require such elaborate assessments. To many applicants, such a required process may seem an unnecessary and burdensome procedure. Another issue with this type of process is assessing disabilities that are intermittent or episodic. A single visit and review may not generate the same level of information about a person's capabilities that may be available to a professional who has worked with the individual for years. Consideration should be given, in such cases, to obtaining supplemental information from a professional identified by the applicant. Similarly, an assessment of cognitive ability based on a single visit or series of tests may not be as complete as information which can be obtained from the person's social worker or mental health counselor. Finally, it may be difficult to simulate all environmental conditions which may affect a person's ability to use fixed route service. The limitations of certain physical tests need to be considered and the applicability of these tests to the process carefully weighed against the cost of their administration and inconvenience to the applicant. Regardless of the sophistication of the tests administered, information obtained in the personal interview is likely to still be an important part of the determination. Combined Approaches In addition to the basic approaches described above, eligibility determination can also be conducted by combining the features of each of these processes. Table 2, presented at the end of this section, includes information about the processes used by several selected transit providers across the country. As can be seen, many different combined models are possible. Perhaps the combined model that is most widely used combines self-certification/professional verification with in-person assessments as needed. For example, the Madison Metro Transit System in Madison, Wisconsin relies primarily on a self-certification process which asks applicants to identify a professional that can be contacted for verification and additional information. Metro's in-house reviewers will seek verification as needed. Metro also reserves the right to ask applicants to appear in-person for an assessment by a local rehabilitation center. Several providers, including Lane Transit District, Baltimore's MTA, Seattle METRO, and the Utah Transit Authority obtain information from both the applicant and a professional ("self-certification and professional verification"). In addition, they will refer applicants for an in-person assessment if a final determination is still not possible. The Riverside Transit Agency (RTA) requires an in-person assessment in most cases. They will, however, accept professional verification from applicants with severe mental retardation. An in-person assessment is not required if a psychological evaluation is provided which indicates severe mental retardation and has been signed by 4 or more professionals of the regional mental health program. It is also interesting to note that the RTA has arranged for in-person assessments to be conducted either at the local clinic or at the applicant's home. The Regional Transportation Authority of Chicago, which will be administering eligibility determinations for CTA and PACE, combines self-certification with in-person assessments as needed. A similar process is being established by the New York City Transit Authority. It is interesting to note that in systems that employ "combined" processes using both self- certification/professional verification and in-person assessments, relatively few in-person reviews are necessary. As shown in Table 2, 90 percent of all determinations can typically be completed based on the information supplied by the applicant and/or the named professional. Seattle Metro, for example, has found it necessary to refer only 5 percent of all applicants for an in-person assessment. The Utah Transit Authority relies on in-person reviews in 7 percent of all cases. The Lane Transit District, located in a medium sized urban area, finds in-person assessments necessary in only 1 percent of all determinations. As transit providers complete recertification efforts and begin doing determinations of new riders, in-person assessments may become more important. Madison Metro reports, for example, that during the process of recertifying existing riders, only 10 percent of all determinations of existing riders required in-person reviews. Following the recertification of existing riders, in-person assessments have been deemed necessary in 25-30 percent of all determinations. Another model developed by the Port Authority of Allegheny County's ACCESS Program in Pittsburgh combines in-person assessment with professional verification. An in-person assessment is required in all determinations. In addition, applicants who receive services from a local human service agency are also encouraged to bring verification information from that agency to the assessment. PAT provides a "Professional Verification" form to applicants for this purpose. Finally, the Oshkosh Transit System in Oshkosh, Wisconsin uses a self-certification with professional verification as needed process but also relies heavily on two local human service agencies for verification of eligibility. The Oshkosh Transit System recently consolidated local paratransit services and assumed operating responsibility from the local Red Cross and the County Committee on Aging. As the past operators of service, these two agencies were familiar with existing riders. The Oshkosh Transit System therefore accepts professional verification from these two agencies for all existing riders seeking ADA paratransit eligibility. Applicability and Considerations Combined models may be appropriate in any number of situations. The use of in-person assessments as needed or professional verification to supplement an in-person review process may be needed to strengthen the original process. As experience is gained with the eligibility determination process, transit providers and their reviewers may discover that these additional steps are needed to ensure the accuracy and consistency of determinations. Depending on the features combined, the issues noted above for each of the basic processes would apply. Considerations for Future Recertification of Riders As noted in Chapter 2 of this manual, the regulations permit transit providers to require periodic recertification of riders. It is possible that the process used for this recertification will be different from that used in the initial determination or to certify new riders. For example, if a self-certification/professional verification process was used for initial determinations, it may be possible to forward the information that was originally provided by the applicant and request that they indicate whether this information is still current and correct. Updating of the original form may also be supplemented by a limited number of new questions. Applicants could be asked if the professional who provided the initial verification is still the appropriate person to contact and new verification could be sought only in those cases where significant changes in capabilities are noted. Transit providers using an in-person assessment process for all initial determinations could opt to not require another detailed review but instead could use a self-certification type of form that asks if the persons disability or ability to use the fixed route service has changed. In-person assessments may be limited to those recertifications where significant changes are noted. Table 2. Eligibility Determination Processes Used by Selected Transit Providers Name of Transit Provider Type of Determination Process Determination Performed by % Determination Referred to Outside Contractor(s) Cost per Contract Review (in-house costs are not included) Ann Arbor Transportation Authority Ann Arbor, MI Self-certification and professional verification. In-house N/A N/A Ben Franklin Transit Richland, WA Self-certification with professional verification as needed In-house N/A N/A City of Charlotte Charlotte, NC Self-certification and professional verification. In-house N/A N/A Delaware Administration for Specialized Transportation (DAST) Dover, DE Self-certification and professional verification In-house N/A N/A Greater Bridgeport Transit District Bridgeport, CT Self-certification with professional verification as needed. In-house N/A N/A Greeley, CO Self-certification with professional verification as needed. In-house N/A N/A Lane Transit District Eugene, OR Combined: Self-certifica- tion and professional verification with in- person assessment as needed. Initially by paratransit contractor. Referred as needed to one of two OT's under contract. 1% $30-$50 per hour (one hour review medical) Los Angeles County Metropolitan Transportation Authority Los Angeles, CA In-person assessment "Certification Analysts" selected by LACMTA - either registered nurse with at least two years experience; physical therapist; occupational therapist; or clinical social worker. 100% Initial review: $27.60 Madison Metro Transit System Madison, WI Combined: Self-certifica- tion with professional verification and/or in- person assessment as needed. Initially in-house. Referred to Rehabilitation Center as needed 10% during re- certification, 25-30% ongoing $120 per in-person assessment Mass Transit Administration (MTA) Baltimore, MD Combined: Self-certifica- tion and professional verification with in- person assessment as needed. In-house N/A N/A Municipality of Metropolitan Seattle (METRO) Seattle, WA Combined: Self-certifica- tion and professional verification with in- person assessment as needed Initially in-house, referred to Evergreen Medical Center as needed. 5% Cognitive Test: $82 Physical Test:$82 Both: $164 New York City Transit Authority New York, NY Self-certification with in- person assessment as needed In-house review of self-certification information. Assessments by third- party contractors to be determined. N/A (process only recently implemented) N/A OMNITRANS San Bernardino, CA Self-certification with professional verification as needed. Also, doing random verifications to check accuracy of self- certifications. In-house N/A N/A Oshkosh Transit System Oshkosh, WI Self-certification and professional verification. Work closely with previous operators - the Red Cross and County Committee on Aging for professional verification. In-house N/A N/A Port Authority of Allegheny County (PAT); ACCESS Program Pittsburgh, PA In-person assessment and professional verification Local Chapter of the Easter Seal Society; Behavior Neuropsychology Associates, Inc; and a network of orientation and mobility specialist for persons with vision impairments 100% $20 Regional Transportation Authority (for CTA/PACE) Chicago, IL Self-certification with in- person assessment as needed In-house review of self-certification information. Assessments by local non-profit organizations with occupational and physical therapists on staff who are often involved in administering eligibility screening for human service programs. N/A (process only recently implemented) $150 Riverside Transit Agency Riverside, CA In-person assessment or professional verification (for persons with severe mental retardation). Local medical clinic. 100% $62 for reviewat clinic; $85 for assessment at home. SAMTRANS San Mateo County, CA Self-certification with professional verification as needed In-house N/A N/A Southeastern Pennsylvania Transportation Authority Philadelphia, PA Self-certification and professional verification In-house N/A N/A Transit Authority of River City (TARC) Louisville, Kentucky Self-certification with in- person assessment as needed Initial review is in-house. Assessments conducted by local rehabilitation center 10% $105 Utah Transit Authority Salt Lake City, UT Combined: Self-certifica- tion with in-person assessment as needed. In-house initially. Referral as needed to either: State Services for the Visually-Impaired; University Spine Rehabilitation Center; or local mental health agencies and associations for retarded citizens. 7% State Services for the Visually- Impaired: $0 Others: $25 Washington Metropolitan Area Transportation Authority (WMATA) Washington, DC Self-certification and professional verification. Will be third party contractor. 100% N/A Waukesha Transit System Waukesha, WI Self-certification with professional verification as needed. In-house N/A N/A Worcester Regional Transit Authority Worcester, MA Self-certification and professional verification. Three independent rehabilitation specialists under contract to the authority review forms. 100% $35/hour (initially 2/hour; recently 5- 10/hour). Section 3. Deciding Who Will Do Initial Determinations A second major decision that must be made when designing an eligibility determination process is who will actually review application materials or conduct in-person screenings. The basic choice is to either conduct initial determinations in-house, using staff of the public entity, or to contract with a third-party to perform this service. It is also possible to involve staff in part of the process and utilize outside help for specific functions as needed. Issues related to each of these options are discussed below. The approach taken by selected transit providers is also presented in Table 2 in the previous section. In-House Determinations If eligibility decisions are to be made by in-house staff, it is important to be sure that this staff has the capabilities and qualifications to make accurate and consistent determinations. While ADA paratransit eligibility is a functional transportation-related decision, it also involves relating specific types of disabilities to reported functional capabilities. A knowledge of various types of disabilities and the likely functional capabilities of persons with such disabilities is, therefore, important. Public entities which operated paratransit services prior to the ADA and have been conducting eligibility determinations may already have staff with such capabilities. Others may elect to hire new staff or train existing staff to handle this job. Consideration should also be given to combining the task of doing ADA paratransit eligibility determinations with other similar in-house tasks. For example, it may be possible to combine the job of ADA eligibility determinations with the review of applications for reduced fare cards. If an in- house travel training program is developed, staff in this program could also assist with determinations of eligibility. A medical officer hired to work on drug and alcohol testing might also be a good person to involve in the eligibility determination process. In-house determinations are more common among providers that have elected to use either a self-certification with professional verification as needed or a self-certification with required professional verification system. It is also common among smaller providers and providers which offered paratransit services to persons with disabilities prior to the ADA. Utilizing Contract Reviewers It is likely that there are a variety of local organizations in the area that could be hired to either do or assist in initial eligibility determinations. This might include a clinic that employs occupational or physical therapists, a rehabilitation center, an independent living center or program, a rehabilitation center, or a visiting nurses program. If it is determined that in-house staff capabilities are not adequate, or if the impartiality of having