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Suggested Citation:"Chapter 2 - Coordination History." National Academies of Sciences, Engineering, and Medicine. 2004. Strategies to Increase Coordination of Transportation Services for the Transportation Disadvantaged. Washington, DC: The National Academies Press. doi: 10.17226/13784.
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Suggested Citation:"Chapter 2 - Coordination History." National Academies of Sciences, Engineering, and Medicine. 2004. Strategies to Increase Coordination of Transportation Services for the Transportation Disadvantaged. Washington, DC: The National Academies Press. doi: 10.17226/13784.
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Suggested Citation:"Chapter 2 - Coordination History." National Academies of Sciences, Engineering, and Medicine. 2004. Strategies to Increase Coordination of Transportation Services for the Transportation Disadvantaged. Washington, DC: The National Academies Press. doi: 10.17226/13784.
×
Page 15
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Suggested Citation:"Chapter 2 - Coordination History." National Academies of Sciences, Engineering, and Medicine. 2004. Strategies to Increase Coordination of Transportation Services for the Transportation Disadvantaged. Washington, DC: The National Academies Press. doi: 10.17226/13784.
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13 CHAPTER 2 COORDINATION HISTORY Public transportation providers and human services agencies have a long history of delivering transportation services for individuals who are considered to be transportation disad- vantaged. For transit operators, this group typically includes seniors and people with disabilities, although in small urban or rural areas, the general public also may use the services. Human services agencies frequently supply transportation to enable clients to participate in the programs and services they offer. Client groups often include seniors, people with dis- abilities, children, and low-income individuals. Yet, although transit providers and human services agen- cies operate similar services for similar types of riders, trans- portation is often provided through separate, parallel deliv- ery systems. Reasons for this separation include differences in funding sources, administrative and regulatory require- ments, and the importance of transportation to the missions of different types of agencies. The results of this separation are often duplication of services or of administrative efforts, inefficient use of vehicles and other resources, poor service quality, and unmet transportation needs. A common example of uncoordinated services is the arrival of two vehicles at a medical facility: a public transit vehicle carrying customers of its paratransit program and a private vehicle transporting Medicaid recipients to their medical appointments—with both vehicles being utilized at less than their full capacity. Planning, designing, funding, and delivering transportation services for the transportation disadvantaged in a coordinated manner can help to address such problems. At the regional or local level, coordination efforts can involve any combi- nation of partners: public providers of fixed-route transit and paratransit service, nonprofit transportation providers, private transportation companies, and public or nonprofit human ser- vices agencies. Often the aim of coordination is increased efficiency and a lower cost per passenger trip for participating agencies. In some cases, coordination has been shown to result in signifi- cant reductions in cost per vehicle hour or passenger trip, which may lead to lower transportation expenditures. A Med- icaid agency, for example, that pays a very high cost per trip when purchasing service on its own, may be able to reduce its overall transportation expense by purchasing service from a coordinated system, particularly one that takes full advan- tage of existing fixed-route transit services. For many partic- ipants, however, the result of increased coordination may lead to benefits other than cost savings. For human services agen- cies or transit providers that may be serving only a portion of the demand for their transportation services or whose unit costs are already relatively low, coordination is likely to enable them to serve more customers or offer a higher level or qual- ity of service for the same expenditure. Today, partly due to encouragement and support at the federal and state levels, coordinated systems typically pro- vide some or all of the following transportation services: • ADA-complementary paratransit services and other ser- vices for people with disabilities • Medical transportation • Job access transportation • Services for seniors • Transportation to human services program sites • Student transportation In rural areas, coordinated systems may provide the only available public transportation option. EARLY COORDINATION EFFORTS: INITIATIVES AT THE LOCAL LEVEL Throughout the late 1970s and 1980s, a number of coordi- nation efforts were undertaken by local transit providers and human services agencies. A critical ingredient in many of the early initiatives was the leadership of a particular indi- vidual who believed in the value of coordinated services and worked to make them a reality. State- or federal-level actions to encourage coordination also played a role in some of the first efforts. In other cases, early local successes proved dif- ficult to replicate until the development of state legislation or programs to encourage coordination made the task easier for other organizations. Beyond the efforts of a local champion, a grant or contract from a federal or state agency was a factor in either the ini- tial implementation or the success of some early coordination initiatives. For example, two well-known, long-standing coordinated systems are Wheels of Wellness and ACCESS Transporta- tion Systems, operating in the Philadelphia and Pittsburgh

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

15 programs administered by DHHS were combined into a sin- gle new block grant to states called Temporary Assistance for Needy Families (TANF). A new welfare-to-work grant pro- gram, offering formula grants to states and competitive grants to local communities, was established by the U.S. DOL. The new programs recognized transportation as an important ele- ment of a successful transition from public assistance to inde- pendent employment by the new programs and included it among eligible project expenses. In addition, FTA created the JARC grant program, which required that projects be the result of a coordinated human services/public transit plan- ning process in order to be eligible for funding. Joint guid- ance to grant recipients from federal agencies outlined the ways in which TANF and welfare-to-work funds could be used to provide transportation services. Two recent events highlight the prominence of human ser- vices transportation coordination on the federal transportation policy agenda. In late 2003, the U.S.DOT, DHHS, DOL, and Department of Education introduced a new human services transportation coordination initiative, United We Ride. It has five components—including state leadership awards and coordination grants, as well as technical assistance tools and activities—designed to make coordination of human services transportation easier and more rewarding for states and local communities to pursue. In February 2004, President Bush issued an Executive Order on Human Services Transportation Coordination, reasserting the federal government’s commitment to improved mobility for transportation-disadvantaged citizens and more efficient use of transportation resources. The Executive Order estab- lished a new Interagency Transportation Coordinating Coun- cil on Access and Mobility, composed of representatives of 10 departments. It charged the council with identifying laws, regulations and procedures that facilitate coordination as well as those that hinder it, recommending changes that will streamline and coordinate federal requirements, and assess- ing agency and program efforts to reduce duplication and provide the most appropriate, cost-effective transportation services. STATE AND REGIONAL COORDINATION EFFORTS Coordination has also been an ongoing subject of interest among both transportation providers and human services agen- cies at the state level. State DOTs and human services are concerned with making maximum use of limited resources and serving as many transportation needs as possible, as are local transit operators, nonprofit agencies, and human ser- vices providers. Coordination at the regional level is becoming an increas- ingly important issue as populations continue to disperse. The closest or most convenient employment opportunities, shop- ping centers, or medical facilities to many residential areas may be located in a neighboring city, county, or state. At the same time, local transportation providers, which usually have distinct service area boundaries, may not have the operating authority to offer services in those neighboring areas. This cre- ates a particular problem for people needing the mobility that transportation services for the transportation disadvantaged can provide. However, regional coordination of services has been specifically addressed in only a few states to date. Coordination at the State Level Most states encourage at least informal coordination among transportation providers. In 1994, CTAA published a report that summarized coordination efforts in each of the 50 states (1). By 1994, the following accomplishments had been made: • Thirty-eight states had established state-level interagency advisory committees/coordinating councils to promote information sharing or assist in decision making about the distribution of available transportation funding. • Thirteen states had Memorandums of Understanding (MOUs) between their DOTs and human services agencies. These MOUs often establish the above cited committees/councils and define general policy regard- ing the desire for improved coordination. • Twelve states had informal agreements between DOTs and human services agencies. • Nineteen states had passed legislation requiring some level of coordination. In some cases, this legislation is general and formally establishes the interagency processes noted above. • In three states (New Jersey, Delaware, and Rhode Island) a single, statewide transit agency had worked to some degree with state human services agencies to coordinate public and human services transportation. • Legislation requiring coordination and specifically defin- ing processes for achieving coordination had been enacted in Arizona, California, Florida, Iowa, Kansas, Maine, North Carolina, and Vermont. An updated survey of states, prepared in 2000, showed substantially the same results (2). A number of states are generally regarded as having devel- oped successful coordination programs that serve as models for other areas. They include, among others, Florida, Iowa, Kansas, Kentucky, Maine, North Carolina, Ohio, Pennsylva- nia, and Washington. Coordination at the Regional Level A great deal of research has been conducted over the past 20 years on the development of coordinated transportation systems, but that effort has typically focused on coordina- tion activities within a single county. Recent experience has demonstrated that many trip destinations lie beyond the county

16 of trip origin and that there is a need to better coordinate trips on a regional level. Examples of regional trips involve non- emergency medical transportation to regional medical centers (often funded by Medicaid) and employment transportation to regional work centers. The need to develop public transpor- tation services that respond to living patterns that are becom- ing oriented to increasingly larger geographic areas is also a regional issue. While many public transportation systems have achieved some local coordination in transporting clients of human ser- vices programs as well as the general public, there is a lack of coordination for regional trips. For example, each county typ- ically transports patients in its own vehicles to regional med- ical centers instead of providing feeder service to regional routes. A similar situation exists with employment trans- portation. Major employment centers are no longer located exclusively in downtown areas of major cities but are dis- persed throughout many regions. There is typically a lack of coordinated transportation service provided to employees in such regions.

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TRB’s Transit Cooperative Research Program (TCRP) Report 105: Strategies to Increase Coordination of Transportation Services for the Transportation Disadvantaged examines strategies for initiating or improving coordination of local and regional publicly funded transportation services for the transportation disadvantaged.

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