Dialysis Transportation: The Intersection of Transportation and Healthcare (2019) / Chapter Skim
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Pages 27-50
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From page 27... ...
Photo courtesy of KFH Group. Introduction Individuals with ESRD who dialyze at a facility face a signi�icant transportation burden with multiple weekly trips required -- trips to and from the facility 3 days every week: Monday, Wednesday, Friday or Tuesday, Thursday, Saturday -- every month, 12 months a year.
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From page 28... ...
"How Do Your Patients Travel To Your Facility? " Results of Research Project's Survey of Dialysis Facilities, March 2017 The remaining patients -- about 20% -- use a mixture of various van providers, including Medicaid nonemergency medical transportation (NEMT)
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From page 29... ...
Photo courtesy of KFH Group. Transportation to Dialysis Data from this research project and from the other studies cited collectively indicate that approximately half of dialysis patients either drive themselves or get rides from family or friends.
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From page 30... ...
"Sometimes I have to sit and wait at least an hour and I have to call and say my ride is not here yet, which makes me late getting there, which makes me late getting on the machine, which makes me late getting off the machine. And then ...
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From page 31... ...
Results of Research Project's Survey of 262 Nephrology Social Workers, March 2017 Perspectives of the Dialysis Facilities The unreliability of transportation and resulting stress on patients are also complaints expressed in the research project's survey of nephrology social workers. Signi�icantly, almost 90% of the surveyed social workers reported that the transportation problems for their patients who rely on public transportation negatively impact the patients' treatment.
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From page 32... ...
• Public paratransit has problems: days and hours of service are limited; service area is limited; and dialysis trips on ADA paratransit cannot be prioritized. • Transportation options are limited in rural areas for patients without their own transportation.
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From page 33... ...
Photo courtesy of KFH Group. This study also queried patients about their reasons for skipping or shortening their dialysis treatment.
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From page 34... ...
Perhaps most telling, one-fourth of these agencies reporting impacts indicated that during peak periods for dialysis trips, they cannot serve other trip purposes given the dialysis trip demand. What Are Transit Agencies Doing to Meet Dialysis Trip Demand?
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From page 35... ...
• The extra care and support needed by dialysis patients, particularly after treatment, with several transit agencies stating that such special assistance is beyond what a transit driver can provide. • Changing treatment days and times for patients, which then causes scheduling complications for transit agencies.
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From page 36... ...
Funding becomes a struggle particularly as transit agencies see growing demand for their specialized services that support healthcare trips, including those for dialysis. The federal government also supports transportation for medical trips, including for dialysis, through the Centers for Medicare and Medicaid Services (CMS)
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From page 37... ...
The City of Phoenix funds a number of specialized transportation programs with local funds, and one specialized transportation program is designed speci�ically for dialysis patients. This program, initiated in 1999 for city residents undergoing dialysis treatment and certi�ied as ADA eligible, subsidizes taxi trips to and from the patients' dialysis facility.
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From page 38... ...
R2W Pilot in Flint, Michigan The Flint, Michigan, Mass Transportation Authority (MTA) received a grant of $310,040 in FY 2016 for a Rides to Wellness project that provides nonemergency medical transportation, including dialysis trips, using public transit and mobility management.
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From page 39... ...
The original Transit & Health Access Initiative (R2W) grew out of FTA's desire to increase partnerships between health and transportation providers, recognizing that lack of transportation can be a barrier for individuals to get medical treatment particularly for chronic diseases such as ESRD.
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From page 40... ...
"Most of our patients are on Medicare[,] which does not cover transportation and they cannot afford the private wheelchair van service that can cost up to $40 per pick-up plus $3 per mile." Quote from a nephrology social worker responding to the research project's survey of dialysis facilities, March 2017.
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From page 41... ...
... the safe harbor for local transportation will save federal healthcare dollars for ESRD patients, as "dialysis patients are a population that has been identi�ied as contributing to the increasing costs of non-emergency ambulance transportation and would bene�it from local transportation furnished by providers." Medicaid Medicaid is an entitlement program funded jointly by the federal and state governments, which covers a broad range of medical services and supports for individuals and families with low incomes.
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From page 42... ...
The requirement for transportation was �irst articulated in Medicaid guidance in 1966, stating that access to care and services is determined by "provision of necessary transportation" to suppliers of medical and remedial care. The transportation requirement was then included in rulemaking issued in 1968 and, in 1978, the transportation requirement was of�icially added to Title 42, Chapter IV, Subchapter C, Part 431 of the Social Security Act as §431.53 assurance of transportation.
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From page 43... ...
Public trans Excerpts from Instructions to County Medicaid NEMT Administrators: [Administrators] are expected to consider alternatives, both of transportation resources and provider resources [when ensuring access to medically necessary care]
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From page 44... ...
For a public entity managing Medicaid NEMT, the availability of ADA paratransit may be interpreted as a transportation resource that is available free of charge, following Medicaid regulations for NEMT. The State of Maryland, for example, directs its county-based NEMT administrators to consider ADA paratransit as such a resource.
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From page 45... ...
CMS Ruling in 2008 Implementing the 2005 Deficit Reduction Act Permits Brokers and a Negotiated Rate for NEMT Trips on ADA Paratransit While the Medicaid guidebook is no longer in print, the suggestion that states negotiate rates with public transit agencies for Medicaid NEMT trips on ADA paratransit remains a viable option, as provided through CMS's 2008 Final Rule implementing Section 6083 of the De�icit Reduction Act of 2005. This ruling allowed states to amend their Medicaid state plans to establish a nonemergency medical transportation brokerage program, and it speci�ically addressed payment for trips on ADA paratransit.
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From page 46... ...
There are at least a few examples of state Medicaid agencies that coordinate with public transit. One is from Nevada: the public transit agency in Las Vegas has had an agreement with the Nevada State Medicaid agency that provides for partial reimbursement of Medicaid-eligible trips on the agency's ADA paratransit service.
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From page 47... ...
What the Research Project's Survey Results Contribute to the Discussion Findings from the research project's surveys provide additional insights on the relationship between Medicaid NEMT and public transit, with a number of transit agency respondents to the survey commenting about Medicaid NEMT. One large transit agency reported that once the state brought in a private statewide broker, trip and cost shifting to ADA paratransit accelerated.
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From page 48... ...
Photo courtesy of KFH Group.
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From page 49... ...
Photo courtesy of KFH Group. A small urban transit agency on Maryland's Eastern Shore had to reduce service frequency on its popular summer route due to funding constraints caused by increasing demand and cost for ADA paratransit.
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From page 50... ...
"There is a great need for [dialysis trips] in our county.
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