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14 areas, respectively. Wheels of Wellness, a not-for-profit orga- vehicles available to communities and RTAs. An interagency nization, was established in 1959 to provide nonemergency advisory committee, composed of state and local transporta- medical transportation free of charge to low-income residents tion and human services representatives, was established to of the Philadelphia area. Since 1981, Wheels has been offer- review applications for both programs and make award deci- ing service through a transportation brokerage that includes sions. Over time, applicants within an RTA service area were fixed-route transit services (operated by the Southeastern required to explore options for service with the transit agency Pennsylvania Transportation Agency [SEPTA]), paratransit before requesting their own vehicles. Building on the rela- service provided by local profit and nonprofit operators, and tionships developed through the interagency advisory com- a volunteer driver program. One of Wheels' major programs, mittee, state-level human services agencies began to contract the Medical Assistance Transportation Program began in with more RTAs for the provision of client transportation ser- 1981 with a contract between the Pennsylvania Department vices. Today, state-level human services agencies in Massa- of Public Welfare and Wheels for provision of service to chusetts have joined together in a new consolidated human ser- Medicaid recipients in the City and County of Philadelphia. vices transportation office and contract with RTAs to broker In the other most urbanized part of Pennsylvania, ACCESS services for all participating agencies within defined regions. Transportation Systems has been managing a brokerage under The earliest coordination efforts offer several important contract to the Port Authority of Allegheny County (PAT), the lessons for current practitioners: Pittsburgh area's public transit provider, since 1979. Develop- ment of the ACCESS brokerage was made possible by FTA Support of a local champion is critical. funding for a brokerage demonstration program, which PAT Encouragement or incentives provided at higher policy received in 1978. levels is helpful, as described in more detail below. Another state-level action that has benefited the ACCESS Local successes can move statewide efforts forward. program and assisted with coordination efforts in other parts of Pennsylvania was the creation of the State Lottery by the SUPPORT FOR COORDINATION AT Pennsylvania legislature in 1971. A unique aspect of the lot- THE FEDERAL LEVEL tery program is that all net proceeds are used to fund pro- grams and services for older Pennsylvanians. The Shared Ride On the transportation side, addressing issues of inefficiency and Free Transit Programs subsidize, respectively, door-to- and unmet need through coordination of the resources used door, specialized transportation and use of off-peak public to provide transportation services for the transportation dis- transit services for individuals age 65 and over. These two advantaged has been a federal priority for several decades. programs generate approximately $188 million per year for Beginning with the U.S.DOT regulations that implemented providers such as ACCESS and encourage coordination by the requirements of Section 504 of the Rehabilitation Act of promoting the use of multiple modes to meet the transporta- 1973, continuing with the passage of the Transportation tion needs of older adults in the state. Equity Act for the 21st Century (TEA 21) in 1998, and includ- In other areas, local successes helped lead to statewide ini- ing recent proposals for the reauthorization of the federal tran- tiatives. In Massachusetts, for example, some of the earliest sit programs, coordination in the planning and delivery of coordinated services were operated by the following: transportation services has been encouraged, if not required, at the federal level. Call-A-Ride, a nonprofit transportation provider on The federal DHHS has been involved for nearly as long, Cape Cod since the formation of the Joint DHHS/DOT Coordinating Brockton Area Transit Authority (BAT), one of the first Council on Human Services Transportation (now the Coor- transit agencies to contract with a variety of human ser- dinating Council for Access and Mobility) in 1986. Formed vices agencies to provide client transportation to support coordination efforts by facilitating the discussion Share-A-Ride, a nonprofit human services transporta- and resolution of issues between U.S.DOT and DHHS and tion provider in the northwestern section of the Boston by providing technical assistance to transportation providers metropolitan area and human services agencies, the Coordinating Council has SCM Elderbus, a nonprofit operator originally estab- conducted outreach efforts, identified barriers to coordina- lished to provide medical transportation to seniors that tion, disseminated useful information, and developed plan- expanded to serve seniors and people with disabilities in ning guidelines and other aids for organizations engaged in 21 communities in south central Massachusetts coordination activities. Federal support for the coordination of transportation ser- Several of these systems were among the state's first vices was reinforced once more by the funding programs and recipients of vehicles under the former Section 16(b)(2) pro- guidance, for both transportation providers and human services gram. At least in part because of the success of these sys- agencies, that resulted from federal welfare reform. Following tems, a parallel program using state transportation bond funds passage of the Personal Responsibility and Work Opportunity was created to make the same types of specialized transit Reconciliation Act of 1996, several separate federal welfare