EXHIBIT_1-1_-_SNEMT_PROGRAM_GUIDE_-_revised_10.6.2026.pdf

Senior Non-Emergency Medical Transportation Program

Program Guide July 2026

Table of Contents

I. Purpose and Authority…………...…………………………………………………3

II. Program Overview………………………………………………………………….3

III. Service Area Definition……………………………………………………………4

IV. Eligibility, Enrollment, and Recertification……………………………………….5

V. Trip Limits, Geographic Restrictions, and Exceptions…………………………….5

VI. Capacity Management and Trip Prioritization…………………………………….7

VII. Service Delivery Standards………………………………………………...………8

VIII. Forms, Applications, and Client Documentation………………………………….10

IX. User Fees…………………………………………………………………………...10

X. Client Rights, Responsibilities, Complaints, and Appeals…………………………10

XI. Safety Incident, and Emergency Response……………………………………….11

XII. Vehicle Standards and Fleet Management…………………………………………11

XIII. Staffing, Training, and Personnel Requirements………………………………….12

XIV. Monitoring, Quality Assurance, and Customer Satisfaction…………………….14

XV. Data Collection, Records Retention, and Reporting…………………………………14

XVI. Program Guide Updates……………………………………………………………...15

I. Purpose and Authority

This Program Guide establishes comprehensive operational, procedural, and administrative requirements for the Senior Non-Emergency Medical Transportation (SNEMT) Program.

This Program Guide is incorporated by reference into the SNEMT Contract and Scope of Work and constitutes a mandatory component of Contractor compliance requirements.

The purpose of this Guide is to define the detailed operational standards and procedures required for the administration and delivery of SNEMT services, including eligibility determination, enrollment, trip scheduling, service delivery, staffing, fleet management, documentation, reporting, and compliance monitoring.

The Scope of Work defines the Contractor’s binding service obligations. This Program Guide establishes the operational standards and procedures necessary to fulfill those obligations.

In the event of any conflict or inconsistency among governing documents, the following order of precedence shall apply:

SNEMT Contract Scope of Work SNEMT Program Guide

The County may issue written administrative directives, clarifications, technical guidance, or updates to this Program Guide at its sole discretion and upon written notice. Contractors shall implement all such directives within the timeframe specified by the County.

II. Program Overview

The SNEMT Program provides demand-responsive, non-emergency medical transportation services for eligible older adults age sixty (60) and older who lack other reasonable transportation alternatives.

The Program goals include:

Providing safe and reliable transportation;

Ensuring timely access to medically necessary trips;

Promoting equitable distribution of available resources;

Supporting independent living and aging in place; and Maintaining compliance with all applicable requirements.

III. Service Area Definitions

The County has established Service Areas for purposes of Contractor service assignments, enrollment administration, geographic distribution of services, and efficient utilization of available program funding.

To be eligible for enrollment, a Client must reside within the Contractor's designated Service Area.

Clients shall receive services from the Contractor responsible for the Service Area in which the Client resides unless otherwise authorized in writing by the County.

Service Area boundaries determine enrollment eligibility and Contractor responsibility. Service Area boundaries do not restrict eligible trip destinations.

Eligible Clients may travel outside their assigned Service Area provided the trip complies with all mileage, destination, funding availability, and program requirements established in this Program Guide.

Area 1 – North County

Anaheim, Brea, Buena Park, Fullerton, La Habra, La Palma, Placentia, Villa Park, Yorba Linda, Orange (including El Modena, Orange Hills, Orange Park Acres, Olive, Olinda).

Area 2 – South County Aliso Viejo, Coto de Caza, Dana Point, Irvine, Ladera Ranch, Laguna Beach, Laguna Hills, Laguna Niguel, Laguna Woods, Lake Forest, Mission Viejo, Newport Beach, Rancho Santa Margarita, San Clemente, San Juan Capistrano, Trabuco Canyon, Dove Canyon, Silverado Canyon, Modjeska Canyon, Los Flores, Santa Ana Heights, Santiago Canyon.

Area 3 – Central/West County Costa Mesa, Cypress, Fountain Valley, Garden Grove, Huntington Beach, Los Alamitos, Midway City, North Tustin, Rossmoor, Santa Ana, Seal Beach, Stanton, Sunset Beach, Surfside, Tustin, Westminster, Cowan Heights, Lemon Heights.

The Contractor shall:

Verify that each enrolled Client resides within the Contractor's designated Service Area;

Maintain documentation supporting Client residency and enrollment eligibility;

Ensure trip scheduling and dispatch activities comply with applicable mileage and program requirements; and Provide transportation to eligible medical destinations regardless of Service Area boundaries when the trip otherwise complies with Program requirements.

Service Areas may only be modified by written direction of the County.

IV. Eligibility, Enrollment and Recertification

To be eligible for SNEMT services, individuals must:

Be age 60 years or older;

Reside in Orange County, California within an approved Service Area;

Submit a completed County-approved application;

Require medically related transportation; and Lack other reasonable transportation options.

The Contractor shall:

Conduct eligibility intake and verification;

Maintain complete eligibility documentation;

Process applications using County-approved forms;

Notify applicants of approval or denial within five (5) business days of receiving a complete application; and Refer ineligible applicants to County Information and Assistance services.

Eligibility shall be recertified annually or as otherwise directed by the County.

Client Folders

All Client Folders must include the following information:

Application;

Mobility and functional status;

Verification of medical trip purpose;

Emergency contact information;

Signed Waiver and Release Form;

User Fee Waiver Form (if applicable); and Applicant Certification.

V. Trip Limits, Geographic Restrictions, and Exceptions

Standard Program Limits

SNEMT services are limited to the following parameters:

Trips shall be limited to destinations within Orange County including Long Beach VA;

Trips shall not exceed fifteen (15) miles one-way from the Client's residence to the destination or from the destination back to the Client's residence; and Clients shall be limited to sixteen (16) one-way trips per calendar month.

A Client's residence within the Contractor's Service Area establishes enrollment eligibility. Trip eligibility shall be determined by mileage, destination, medical purpose, and other applicable program requirements.

Mileage Verification

Contractors shall verify compliance with mileage limitations using actual vehicle odometer readings.

Mileage documentation shall be retained and made available for County review.

Contractor Responsibility

The Contractor is solely responsible for:

Verifying trip eligibility;

Verifying medical necessity;

Confirming destination eligibility;

Ensuring compliance with program requirements; and Maintaining supporting documentation.

Exceptions

Exceptions may be approved when medically necessary and properly documented.

Examples include:

Dialysis;

Chemotherapy;

Radiation therapy;

Organ transplant-related care;

Specialty care unavailable within standard service limits;

Veteran-specific medical services; and Other medically necessary services as determined by the Contractor.

Only the Contractor’s Transportation Manager or Executive Director, the County’s Program Manager or Director, or equivalent position with higher authority may authorize exceptions. Transportation exemptions involving more complex circumstances are subject to county pre-approval prior to authorization or implementation.

Dispatchers, drivers, reservation staff, and scheduling personnel shall not independently authorize exceptions.

Documentation Required for Exceptions:

Required documentation shall include:

Medical necessity justification;

Facility name and address;

Supporting medical documentation, when applicable;

Evidence that comparable services are unavailable within standard limits, when applicable;

Authorization date; and Name and title of approving staff.

VI. Capacity Management and Trip Prioritization

Contractors shall maintain written Capacity Management Policies and Procedures addressing enrollment controls, prioritization procedures, waitlist administration, reporting, and County notification procedures.

The County may implement prioritization measures when funding utilization, service demand, or operational conditions require allocation of limited resources.

Contractors shall not independently activate prioritization measures without written County authorization.

Client Priority Categories are:

Priority One

Individuals age 60 and over who:

Are at or below 50% of the Area Median Income (AMI);

Do not have access to specialized transportation services; and Requiring life-sustaining or urgent medical trips, including but not limited to:

Dialysis Chemotherapy Radiation treatment Multi-system failure or conditions requiring immediate medical supervision (e.g., diabetes, heart disease, Chronic Obstructive Pulmonary Disease (COPD)) Surgery or non-elective procedures requiring immediate care

Priority Two

Individuals age 60 and over requiring life-sustaining or urgent medical trips, including but not limited to:

Dialysis Chemotherapy Radiation treatment Multi-system failure or chronic conditions requiring immediate medical supervision (e.g., diabetes, heart disease, COPD) Surgery or non-elective procedures requiring immediate care

Priority Three

Individuals age 60 and over who:

Are at or below 50% of the Area Median Income (AMI);

Do not have access to specialized transportation services; and Require non-urgent medically related trips, including but not limited to:

Rehabilitation or physical therapy Dental services Elective procedures Vision services Other non-urgent medical appointments

Priority Four

Individuals aged 60 and over requiring non-urgent medically related trips, including but not limited to:

Rehabilitation or physical therapy Dental services Elective procedures Vision services Other non-urgent medical appointments

Priority Five

Individuals aged 60 and over requiring transportation to health education or disease management services.

VII. Service Delivery Standards

Trip Scheduling and Dispatch Standards

Contractors shall maintain written procedures governing:

Reservation systems;

Advance notice requirements;

Scheduling and dispatch;

Shared rides;

No-show and cancellations;

Personal Care Attendants (PCAs) transportation;

No Passenger Stranded;

Emergency response.

Contractors shall maintain accessible reservation systems that all Clients to request transportation within established advance notice requirements and support timely scheduling and dispatch operations.

Scheduling practices shall:

Promote on-time performance: within 15 mins before or after scheduled pick-up time;

Minimize passenger ride times;

Accommodate mobility and accessibility needs; and Optimize vehicle capacity and utilization.

Eligible and Ineligible Trips

Non-emergency medical transportation is limited to medically related purposes, including but not limited to:

Appointments with physicians or medical practitioners;

Dentist services;

Vision services;

Outpatient medical services;

Laboratory testing;

Radiation therapy;

Chemotherapy;

Dialysis;

Rehabilitation or physical therapy provided by a licensed physical therapist;

Mental health counseling;

Health education services;

Disease management services;

Elective medical procedures; and Securing prescription medications or medically necessary devices.

Ineligible trips include transportation for non-medical purposes.

No-Shows and Cancellations

A No-Show is defined as:

Failure of the Client to appear within ten (10) minutes of the scheduled pick-up time after vehicle arrival and dispatch notification; or Cancellation received less than two (2) hours prior to the scheduled pick-up time.

Contractors shall monitor no-show patterns and may implement corrective actions consistent with their Client Suspension and Termination Policy.

Shared Ride Time Limit

Total ride time for any client shall not exceed forty-five (45) minutes from initial pick-up to final drop-off.

Exceptions may occur due to extraordinary circumstances, including but not limited to:

Traffic accidents Road closures Severe weather conditions Declared emergencies

Contractors shall monitor ride times and maintain documentation demonstrating compliance.

Repeated violations may require corrective action or service adjustments.

Personal Care Attendants (PCA)

One (1) PCA may accompany a client when medically necessary.

PCAs:

Shall not be charged a user fee; and Shall not be counted as passengers for performance reporting purposes.

No Passenger Stranded Standard

Under no circumstances shall a client be stranded.

Contractors shall maintain contingency procedures sufficient to ensure completion of all scheduled trips.

VIII. Forms, Applications, and Client Documentation Contractors shall develop and maintain County-approved:

SNEMT Applications;

Waiver and Release Forms;

User Fee Waiver Forms; and Other forms required by the County.

Forms shall contain all minimum required data elements established by the County.

IX. User Fees Contractors shall collect a $2.00 user fee per one-way trip unless waived due to documented financial hardship.

All waivers shall be documented using County-approved forms.

X. Client Rights, Responsibilities, Grievances, and Appeals Contractors shall maintain written policies addressing:

Client Rights and Responsibilities;

Grievance procedures;

Appeal procedures;

No-show policies;

Conduct standards;

Suspension procedures; and Termination procedures.

Clients shall receive written notice of Rights and Responsibilities prior to receiving services.

XI. Safety, Incidents, and Emergency Response

Contractors shall maintain written procedures governing:

Vehicle accidents;

Client injuries;

Medical emergencies;

Service disruptions;

Law enforcement involvement; and Incident reporting.

All reportable incidents shall be reported to the County within one (1) business day using County-approved forms.

XII. Vehicle Standards and Fleet Management

The Contractor shall maintain the vehicles used to provide SNEMT services within the Service Area or in a location reasonably in close proximity to the Service Area for which the Contractor is awarded a Contract.

The fleet location shall be strategically positioned to support efficient service delivery and ensure a more effective trip operations.

The fleet’s location shall be reasonably accessible to the County for purposes of program monitoring, vehicle inspections, operational observations, and contract oversight within 24 hours upon the County’s request.

The Contractor's corporate, administrative, or program office is not required to be located within the assigned Service Area or within Orange County. This requirement applies specifically to the physical location of the fleet used to provide SNEMT services.

The County reserves the right to select, modify, and approve the right to review and approve the proposed fleet location(s) and require reasonable modifications as necessary that support the best interest of the County.

All vehicles shall:

Be safe, clean, sanitary, and professionally maintained;

Maintain valid registration and insurance;

Meet ADA requirements, when applicable;

Pass daily pre-trip inspections; and Pass annual mechanical inspections.

Vehicles shall be retired at twelve (12) model years unless approved in writing by the County.

Vehicles exceeding ten (10) model years shall undergo enhanced annual inspections.

Taxi subcontractors shall maintain valid OCTAP permits and receive County approval prior to service delivery.

Contractor will update changes to their fleet via a County-approved format on a monthly basis.

Daily Pre-Trip Inspections

Drivers shall perform daily pre-trip vehicle inspections prior to entering service.

Pre-trip inspections shall include, at minimum:

Brakes, tires, lights, and signals;

Wheelchair securement systems and ramps or lifts; and

Interior cleanliness and potential safety hazards.

Drivers shall complete and sign a daily inspection checklist.

Any identified deficiencies must be corrected before the vehicle is placed into service.

Preventive Maintenance Program

Contractors shall maintain a preventive maintenance program consistent with manufacturer recommendations or more frequent intervals based on vehicle usage.

Preventive maintenance shall include inspection of servicing of:

Engine, transmission, brakes, and suspension systems;

Tires, battery, and fluid levels;

Wheelchair lifts, ramps, and securement systems; and Heating, ventilation, air conditioning (HVAC) and lighting systems.

All maintenance activities must be documented and signed by the mechanic or service provider and retained for County review.

Contractors shall maintain a vehicle maintenance log for each vehicle including:

Date of service Vehicle mileage Maintenance performed Parts replaced

Annual Safety Inspections

All vehicles shall undergo an annual mechanical and safety inspection conducted by an ASE-certified mechanic or equivalent qualified technician.

Inspection reports must include:

Vehicle Identification Number (VIN);

Date of inspection;

Detailed findings and corrective actions; and Certifying technician’s name, certification, and signature.

Vehicles that fail inspection shall be immediately removed from service until all deficiencies are corrected.

XIII. Staffing, Training, and Personnel Requirements

Contractors shall ensure all drivers:

Pass background checks;

Maintain valid driver's licenses;

Complete required training;

Receive defensive driving instruction;

Receive passenger assistance training;

Receive elder abuse awareness training;

Complete ADA and wheelchair securement training; and Comply with all applicable laws and regulations.

The County reserves the right to require removal of personnel deemed unsuitable for participation in the Program.

Personnel policies shall include:

Prohibition of weapons while performing program duties;

Maintenance of smoke-free service environment;

A Zero Tolerance Policy for misconduct; and Immediate reporting of allegations of misconduct or safety concerns.

Contractors shall ensure that drivers, staff, and volunteers maintain professional conduct, appearance, and demeanor appropriate for serving older adults.

Drivers, staff, and volunteers shall:

Treat all clients with dignity, respect, and patience;

Provide courteous assistance when boarding, riding, and existing vehicles;

Refrain from profanity or inappropriate language;

Maintain clean and professional attire; and Wear visible identification while providing services.

Driver Training Drivers shall receive initial and ongoing training in the following areas:

Defensive driving Passenger assistance techniques ADA mobility device securement procedures Customer service and older adult sensitivity training Emergency awareness and response procedures Confidentiality and privacy standards De-escalation techniques

The County reserves the right to require modifications or additional training requirements to address safety, compliance, or service quality concerns.

Removal of Drivers The County reserves the right to require removal of any driver deemed unsuitable for providing SNEMT services.

Reasons for removal may include, but not limited to:

Safety concerns Repeated client complaints/grievances Violations of program policies Unprofessional conduct Failure to meet training or licensing requirements

Upon County request for removal of a driver, the Contractor shall respond within ten (10) calendar days with a corrective plan or replacement driver.

XIV. Monitoring, Quality Assurance, and Customer Satisfaction

Contractors shall implement ongoing quality assurance activities to evaluate service delivery, safety, compliance, and customer experience.

The County reserves the right to conduct:

Site visits;

Vehicle inspections;

File reviews;

Ride-alongs;

Audits;

Service observations; and Performance evaluations.

Customer Satisfaction Surveys

The County may administer an annual Customer Satisfaction Survey as needed. Results of the survey will be distributed as necessary.

XV. Data Collection, Records Retention, and Reporting

Contractors shall:

Maintain complete trip records;

Maintain client eligibility documentation;

Maintain mileage records;

Maintain financial records;

Submit monthly reports and invoices; and Maintain documentation supporting reimbursement requests.

All program records shall be retained for a minimum of three (3) years, or longer if required by law, funding requirements, audit findings, litigation holds, or County direction.

Records shall be made available to the County upon request.

XVI. Program Guide Updates

The County may revise this Program Guide at its sole discretion to address operational needs, funding limitations, regulatory requirements, audit findings, safety concerns, program improvements, or service delivery requirements.

Contractors shall implement all revisions within the timeframe specified by the County and ensure all policies, procedures, forms, and operational practices remain consistent with the current version of this Program Guide.