Department  of  Health and Human  Services 
OFFICE  OF 
INSPECTOR  GENERAL 
NON-EMERGENCY  TRANSPORTATION 
FOR  DIALYSIS  PATIENTS 
,atSiXM7C2S 
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*  JUNE  GIBBS  BROWN 
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: Inspector  General 
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AUGUST  1994 
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OEI-03-90-02132  OFFICE  OF INSPECTOR  GENERAL 
The  mission  of the  Office of Inspector  General  (OIG),  as mandated  by Public  Law 95-452, as 
amended,  is to protect  the  integrity  of the Department  of Health  and Human  Services (HHS) 
programs  as well as the  health  and welfare  of beneficiaries  served  by those  programs.  This 
statutory  mission is carried  out  through  a nationwide  network  of audits,  investigations,  and 
inspections  conducted  by three  OIG  operating  components:  the  Office of Audit  Services,  the 
Office of Investigations,  and the  Office of Evaluation  and Inspections.  The  OIG  also informs 
the Secretary  of HHS  of program  and management  problems  and recommends  courses  to 
correct  them. 
OFFICE  OF AUDIT  SERVICES 
The  OIGS  Office of Audit  Services  (OAS)  provides  all auditing  services for HHS,  either  by 
conducting  audits with its own audit  resources  or by overseeing  audit work done  by others. 
Audits  examine  the  performance  of HHS  programs  and/or  its grantees  and contractors  in 
carrying out  their  respective  responsibilities  and are intended  to provide  independent 
assessments  of HHS  programs  and operations  in order  to reduce  waste,  abuse,  and 
mismanagement  and to promote  economy  and efficiency throughout  the  Department. 
OFFICE  OF INVESTIGATIONS 
The  OIGS  Office of Investigations  (01)  conducts  criminal,  civil, and administrative 
investigations  of allegations  of wrongdoing  in HHS  programs  or to HHS  beneficiaries  and of 
unjust  enrichment  by providers.  The  investigative  efforts  of 01  lead to criminal  convictions, 
administrative  sanctions,  or civil money  penalties.  The  01  also oversees  State  Medicaid  fraud 
control  units which investigate  and prosecute  fraud  and patient  abuse  in the  Medicaid  program. 
OFFICE  OF EVALUATION  AND  INSPECITONS 
The  OIGS  Office of Evaluation  and Inspections  (OEI)  conducts  short-term  management  and 
program  evaluations  (called inspections)  that  focus on issues of concern  to the  Department, 
the  Congress,  and the  public.  The  findings and recommendations  contained  in these  inspection 
reports  generate  rapid,  accurate,  and up-to-date  information  on the  efficiency, vulnerability, 
and effectiveness  of departmental  programs. 
This report  was prepared  in the  Philadelphia  regional  office under  the  direction  of Joy Quill, 
Regional  Inspector  General  and Robert  A. Vito,  Deputy  Regional  Inspector  General.  Project 
staf~ 
REGION  13EADOUARTERS 
Nancy J. Molyneaux,  Project  Leader  Hugh  Hetzer,  Program  Analyst

Laura  M. Shafron,  Intern

Myra Reichel,  Intern

For additional copies of this repo~  please contact the Philadelphia Regional  Office at 
(800) 531-9562  EXECUTIVE  SUMMARY 
PURPOSE 
To identify  non-emergency  transportation  services  and  sources  of financial  assistance  to 
cover  transportation  expenses  for  patients  going  to  kidney  dialysis  in  a sample  of eight 
cities. 
BACKGROUND 
In previous  work, we found  that  many  dialysis patients  do not  meet  Medicare  coverage 
guidelines  for ambulance  transportation.  As part  of its response  to our  findings,  the 
Health  Care  Financing  Administration  (HCFA)  has  planned  research  on alternative 
forms  of transportation  for  dialysis patients.  The  information  in this report  is provided  to 
assist  HCFA  as it pursues  that  research  and  formulates  policy in this area. 
The  HCFA  explains  in the  Medicare  Carriers  Manual  that  no payment  for  ambulance 
transportation  may be  made  in any case  in which  some  means  of transportation  other 
than  an ambulance  could  be  utilized  without  endangering  the  individuals  health,  whether 
or not  such other  transportation  is actually  available  (section  2120.2.A.).  The  Manual 
also states  that  a person  receiving  outpatient  dialysis is not  ordinarily  ill enough  to 
require  an ambulance  (section  2120.3 .J.).  While  Medicare  does  cover  transportation 
services  in limited  circumstances,  transport  in a vehicle  other  than  an  ambulance  is not 
covered. 
Most  persons  with kidney  failure  go to dialysis facilities  for treatment  rather  than 
dialyzing  at home.  These  patients  must  travel  to the  facilities  an  average  of three  times 
per  week.  A small number  of these  patients  use ambulances  to go to and  from  dialysis 
at a very high cost. 
A recent  Office  of Inspector  General  report  (Ambulance  Transpotiahon  for ESRD 
Beneficiaries:  Medical  Necessi~  OEI-03-90-02130)  found  that  many  ambulance  transports 
to dialysis did not  meet  Medicares  medical  necessity  guidelines.  The  study  found  many 
of these  patients  could  have  been  transported  safely by other  means.  However,  it was 
not  clear  what  types  of non-emergency  transportation  were  available  or whether  non-
emergency  transportation  was physically  and  financially  accessible  to patients  going to 
dialysis.  The  HCFA  staff  asked  us to find out what  we could  about  transportation 
semices  for dialysis patients. 
We  obtained  information  from  transportation  coordinators  in  18 dialysis  facilities  in eight 
cities.  These  respondents  identified  37 non-emergency  transportation  providers  and  16 
organizations  which  provide  financial  assistance  for transportation  expenses  from  whom 
we gathered  further  information. 
i  FINDINGS 
~ampotiation  appeam to be avaikble  in most of the sampled cities. 
Patients  use  a number  of different  types  of vehicles  to travel  to dialysis.  These  include 
cars,  taxis, wheelchair  vans,  passenger  vans,  and  buses.  According  to  dialysis facility 
respondents,  approximately  one-quarter  of their  patients  come  to dialysis in privately 
owned  cars. 
Transportation  seems  generally  available  in most  of the  sampled  cities.  Dialysis  facility 
respondents  in five of the  sampled  cities  thought  that  there  was enough  transportation 
available  for people  going to dialysis.  Only an  estimated  20-22 of the  nearly  2000 
patients  treated  at  the  facilities  in our  sample  occasionally  missed  treatments  due  to lack 
of affordable  transportation.  Thirty-four  out  of 37 transportation  providers  did not  have 
waiting  lists for patients  who  needed  transport  to dialysis. 
Financial &tance  for tran.yxntation expenses was aiko generally available. 
Financial  assistance  for transportation  expenses  comes  from  a variety  of sources.  These 
include  Medicaid  in all States,  and  in some  places  State  kidney  programs,  the  American 
Kidney  Fund,  Area  Agencies  on Aging, the  American  Red  Cross,  and  the  National 
Kidney  Foundation. 
Howeve.q reqxmdknts did ident@ probkms  in some  locations for some patients. 
In one  of the  eight  cities  in our  sample  dialysis facility respondents  felt  there  were  not 
enough  transportation  services  at all for people  going to dialysis.  In two  other  cities 
respondents  did not  think  there  were  enough  transportation  services  for  certain  people  or 
in certain  areas. 
Respondents  from  all sampled  cities  also identified  other  barriers  to access.  Three 
problems  were  frequently  mentioned:  long waiting  times,  costs for patients  not  eligible 
for financial  assistance,  and  lack of physical  assistance  to patients  using the  services. 
CONCLUSION 
Based  on this limited  review,  we draw  several  preliminary  conclusions  about  non-
emergency  transportation  for dialysis patients.  We  offer  these  to HCFA  as it conducts  a 
more  substantive  effort  to examine  access  to transportation  for dialysis patients. 
First,  it does  not  appear  that  lack of access  to alternative  forms  of transportation  is a 
central  explanation  of our  data  indicating  inappropriate  use of emergency  transportation. 
In most  of the  sampled  cities,  alternative  forms  of transportation  seem  generally 
available. 
ii  Second,  successful  approaches  to developing  a network  of transportation  options  seem  to 
exist.  More  in-depth  review  of the  five cities where  respondents  reported  quite  favorably 
about  the  availability  of transportation  might  provide  good  lessons  for other  localities. 
How  did such  networks  come  to exist?  How  are  the  problems  which  were  identified  in 
other  cities  addressed? 
Third,  some  problems  might  merit  further  examination:  locations  where  access  problems 
might  exist, special  access  problems  for certain  populations,  and  problems  of long waiting 
times  and  lack  of physical  assistance  that  might  apply  more  generally  to all dialysis 
patients.  These  are  areas  that  HCFA  may wish to  pursue  further  in its research  planned 
on this subject.  In addition,  non-urban  populations  (who we did not  examine)  may also 
merit  further  examination,  since  such areas  may pose  different  challenges  or represent 
unique  issues. 
... 
111  TABLE  OF  CONTENTS 
PAGE 
EXECUTIVE  SUMMARY 
INTRODUCHON  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1 
FINDINGS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3 
Availability  oftransportation  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3 
Financial  assistance  for transportation  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3 
Problems  with  transportation  services  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5 
CONCLUSION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7 
APPENDICES 
f%  Sample  ofcities  . . . . . . . ..o.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A4-1 
B:  which  provide  assistance  . . . . . . . . . . . . . . . . . . . . . .  B-1  INTRODUCTION 
PURPOSE

To  identify  non-emergency  transportation  services  and  sources  of financial  assistance  to

cover  transportation  expenses  for patients  going to kidney  dialysis in a sample  of eight

cities.

BACKGROUND

In previous  work,  we found  that  many  dialysis patients  do not  meet  Medicare  coverage

guidelines  for  ambulance  transportation.  As part  of its response  to our  findings,  the

Health  Care  Financing  Administration  (HCFA)  has planned  research  on alternative

forms  of transportation  for dialysis patients.  The  information  in this  report  is provided  to

assist  HCFA  as it pursues  that  research  and  formulates  policy in this  area.

The  Health  Care  Financing  Administration  (HCFA)  explains  in the  Medicare  Carriers

Manual  that  no payment  for ambulance  transportation  may be  made  in any case  in which

some  means  of transportation  other  than  an ambulance  could  be  utilized  without

endangering  the  individuals  health,  whether  or not  such other  transportation  is actually

available  (section  2120.2.A.).  The  Manual  also states  that  a person  receiving  outpatient

dialysis is not  ordinarily  ill enough  to require  an ambulance  (section  2120.3 .J.).  While

Medicare  does  cover  ambulance  transportation  services  in limited  circumstances,

transport  in a vehicle  other  than  an  ambulance  is not  covered.

Most  persons  with  kidney  failure  go to dialysis facilities  for treatment  rather  than

dialyzing  at  home.  These  patients  must  travel  to the  facilities  an  average  of three  times

per  week.  A small  number  of these  patients  use ambulances  to go to  and  from  dialysis.

A recent  Office  of Inspector  General  (OIG)  report  (Ambulance  Transpofiation  for  ESRD

Beneficiaries:  Medka/  Necessizy OEI-03-90-02130)  found  that  many  ambulance  transports

to dialysis did not  meet  Medicares  medical  necessity  guidelines.  The  study  found  that

many  of these  patients  could  have  been  transported  safely by other  means.  However,  it

was not  clear  what  types  of non-emergency  transportation  were  available  or whether  non-

emergency  transportation  was physically  and  financially  accessible  to  patients  going  to

dialysis.  HCFA  staff  asked  us to find out what  we could  about  transportation  services  for

dialysis patients.

SCOPE  AND  METHODOLOGY

This  report  focuses  on transportation  of patients  to and  from  dialysis  treatments  in

vehicles  other  than  ambulances  in a sample  of eight  cities.

Respondents  were  selected  from  the  sample  of eight  carriers  and  277 end  stage  renal

disease  beneficiaries  used  for two previous  OIG  studies  (Ambulance  Transpotialion  for

1  ESRD  Beneficiaries:  Medical  Necessily  OEI-03-90-02130  and Ambulance  Transpotiation  for 
ESRD13eneficiaries:  Payment  Practices 0EI-03-90-02131).  We  chose  one  city in eachof 
the  eight  carrier  areas  where  the  most  sample  beneficiaries  were  dialyzed  in1991.  A 
total  of 70 beneficiaries  of the  180 who were  transportedto  dialysis by ambulance  were 
dialyzed  inthese  cities  (See  Appendix  A).  Sixofthe  sites  selected  were  large 
metropolitan  areas  and  two were  small  cities.  We  did not  examine  rural  areas. 
Since  transportation  arrangements  are  often  coordinated  by dialysis facility  social 
workers,  we contacted  a total  of 18 dialysis facilities  in the  selected  cities.  We 
interviewed  them  to determine  what  types  of non-emergency  vehicles  were  used  to 
transport  patients  to their  facility, the  names  and  addresses  of non-emergency 
transportation  providers,  and whether  financial  assistance  was available  for transportation 
expenses. 
We  then  contacted  37 non-emergency  transport  providers  identified  by dialysis facility 
respondents  to determine  what  types  of non-emergency  transportation  they  offer,  what 
physical  assistance  they  provide  to non-emergency  patients,  and  the  cost  to patients  for 
transportation. 
Finally,  we contacted  16 organizations  and  agencies  which  provide  financial  assistance  for 
dialysis patients  transportation  expenses.  Respondents  included  representatives  from 
private  kidney  organizations,  Area  Agencies  on Aging,  State  Medicaid  agencies,  and  State 
kidney  programs. 
2
 FINDINGS

TRANSPORTATION  APPEARS  TO  BE  AVAILABLE  IN MOST  OF  THE  SAMPLED 
CITIES. 
Patients  use  a number  of different  types  of vehicles  to travel  to dialysis.  These  include

cars,  taxis, wheelchair  vans,  passenger  vans,  and  buses.  According  to dialysis facility

respondents,  approximately  one-quarter  of their  patients  come  to dialysis in privately

owned  cars.  Another  30 percent  come  in wheelchair  vans.  Most  of the  remainder  come

by taxis, public  buses,  or buses  with wheelchair  lifts.  Only a very small percentage  come

to dialysis in ambulances.

Based  on responses  from  dialysis facility staff,  availability  of transportation  services  does

not  appear  to be  a problem  in most  of the  cities  covered  by our  review.  Dialysis  facility

respondents  in five of the  sampled  cities  (Detroit,  MI, Fremont,  CA  Miami  Beach,  ~

New York  City, NY,  and  Pittsburgh,  PA)  thought  that  there  was enough  transportation

available  for people  going  to dialysis.  Limited  problems  were  reported  in two

communities  (Elizabethtown,  KY and  Brighton,  MA),  and  a general  unavailability  was

reported  in one  city (Houston,  TX).

Only an estimated  20-22 of the  nearly  2000 patients  treated  at the  facilities  in our  sample

occasionally  missed  treatments  due  to lack of affordable  transportation.  Thirty-four  out

of 37 transportation  providers  did not  have  waiting  lists for patients  who  needed

transport  to  dialysis.

FINANCIAL  ASSISTANCE  WAS  ALSO  GENERALLY  AVAILABLE  TO  PATIENTS 
GOING  TO  DIALYSIS. 
Financial  assistance  for  transportation  expenses  comes  from  a variety  of sources  such  as 
Medicaid,  Area  Agencies  on Aging, State  Kidney  Programs,  the  American  Kidney  Fund, 
the  National  Kidney  Fund,  and  the  American  Red  Cross.  A range  of organizations  or 
agencies  offers  financial  assistancelfor  transportation  expenses  in each  city in our 
sample.  See  Appendix  B for a breakdown  of resources  by city. 
Medicaid 
Transportation  services  are  covered  for Medicaid-eligible  dialysis patients.  Medicaid 
regulations  state  that  all Medicaid  agencies  will ensure  necessary  transportation  for 
recipients  to and  from  providers  (42 CFR  431.53).  Medicaid  rarely  pays for  ambulance 
service  but  will cover  other  vehicles  such as wheelchair  vans,  taxis, and  in some  cases 
privately  owned  cars.  Medicaid  was cited  by 25 of 37 transportation  providers  as the 
*We included  the  provision  of free  or discounted  services  as a form  of financial 
assistance  in describing  some  organizations. 
3  primary  source  of financial  assistance.  All of the  dialysis facility  respondents  also 
indicated  Medicaid  as a source  of financial  assistance  for transportation  expenses. 
Americans  with Dkabilitia  Act 
Some  dialysis patients  who  qualify  as transportation  disabled  would  be  eligible  for 
transportation  services  under  the  Americans  with Disabilities  Act  of 1990 (42 U.S.C. 
12101-12213).  Regulations  implementing  the  Americans  with  Disabilities  Act  (ADA) 
require  that  each  public  entity  operating  a fixed route  system  shall  provide  paratransit  or 
other  special  service  to individuals  with  disabilities  that  is comparable  to the  level  of 
service  provided  to individuals  without  disabilities  who  use  the  fixed route  system  (49 
CFR  37.121). 
While  the  ADA  does  not  directly  provide  financial  assistance  to  disabled  patients  going 
to dialysis, it does  stipulate  that  fares  for paratransit  sefice  shall not  exceed  twice  the 
fare  that  would  be  charged  to an individual  paying full fare...on  the  entitys  fixed route 
system  (49 CFR  37.131).  This would  limit costs for disabled  dialysis patients  to no 
more  than  a few dollars  each  way. 
Area Agencies  on Aging 
Area  Agencies  on Aging  can be  another  source  of financial  assistance.  In half  the  cities 
we selected  there  were  transportation  services  specifically  for  the  elderly.  Two  of these 
providers  serve  persons  who  are  60 or older.  One  provides  services  to those  who  are  62 
or older  and  handicapped.  The  fourth  only serves  persons  65 or older.
State Kidkey RT2grams 
Two  State  kidney  programs  cover  some  transportation  expenses  for  dialysis  patients  in 
the  sampled  cities.  One  program  will provide  up to $350 per  month  to  cover  both 
transportation  and  drug  expenses.  Another  State  program  contracts  with  other 
organizations  to coordinate  transportation  services.  These  organizations  must  also 
provide  matching  funds  for transportation.  Both  State  kidney  programs  require  co
payments  which are  determined  by the  patients  income.  In one  program,  nearly  84 
percent  of dialysis patients  had  incomes  below  the  level  required  for  co-payments  in 
1993. 
American  Kidnqy Fund 
The  American  Kidney  Fund  will provide  up to three  $200 grants  per  year  to cover 
expenses  related  to a patients  kidney  condition  including  transportation  costs.  However, 
they  do not  provide  financial  assistance  for transportation  services  on a routine  basis. 
Patients  must  apply  for  a grant  each  time  they need  assistance.  Patients  needs  for 
financial  assistance  is determined  on a case  by case  basis. 
National Kidney Foundation 
4  Local  chapters  of the  National  Kidney  Foundation  (NKF)  are  another  source  of financial 
assistance  in some  areas.  Branches  of the  NKF  in three  of the  eight  cities  selected 
provide  financial  assistance  for transportation  expenses.  The  NKF  reimburses  for taxis, 
paratransit  (wheelchair  van),  mileage  for personal  auto  use,  and  gives emergency  funds 
for  special  one-time  situations. 
Patients  must  not  be  eligible  for funding  from  any other  source,  such  as Medicaid,  in 
order  to receive  financial  assistance  from  NKF.  The  level  of funding  varies  in each  area. 
For  example,  the  NKF  in one  area  will provide  a patient  who  is not  eligible  for Medicaid 
with  $50 a month  for transportation  expenses.  Other  NKF  offices  do not  set limits  on 
monthly  funding. 
American  Red Cress 
In two cities,  the  American  Red  Cross  provides  not  money  but  free  transportation  to 
dialysis patients.  In one  city, however,  sefices  are  limited  to patients  referred  by a social 
worker  at a facility the  Red  Cross  serves.  In both  cities,  the  patient  had  to be  unable  to 
afford  any other  means  of transportation  in order  to qualify  for  Red  Cross  services. 
DiaZysisFacilities 
In some  cases,  dialysis facilities  will pay for a patients  transportation.  However,  this is 
only on a sporadic,  emergency  basis.  None  of the  dialysis facilities  we contacted  provided 
financial  assistance  for transportation  expenses  on a regular  basis.  Even  the  emergency 
financial  assistance  facilities  give may  come  from  another  source  such  as the  American 
Kidney  Fund. 
HOWE- RESPONDENTS  DID  IDENTIFY  PROBLEMS  IN  SOME  LOCATIONS 
FOR  SOME  PATIENTS. 
As mentioned  earlier,  dialysis facility  staff  in three  cities  said  there  were  not  enough 
transportation  services  for  dialysis patients.  In two cities,  the  problems  reported  were 
limited:  one  said there  needed  to be  more  transportation  for  those  not  eligible  for 
Medicaid  or elderly  sexvices and  another  said  only particular  counties  were  affected.  In 
one  city, dialysis facility respondents  said  there  were  not  enough  transportation  services 
at all for people  going to dialysis. 
Respondents  from  all sampled  cities  did identify  other  barriers  to access.  Three 
problems  were  frequently  mentioned:  long waiting  times,  costs for patients  not  eligible 
for financial  assistance,  and  lack  of physical  assistance  to patients  using  the  services. 
Long  waiting  times  was the  problem  mentioned  most  often.  According  to dialysis facility 
social workers,  patients  often  must  wait  a long time  to be  dropped  off at the  facility and 
then  again  later  to be  picked  up  after  treatment.  If a patient  is late  for her  or his 
scheduled  dialysis treatment  it sometimes  means  that  treatment  will be  shortened.  This 
can  lead  to other  medical  complications. 
5  Cost  was the  second  most  common  problem  mentioned  by dialysis facility  social  workers. 
Patients  outofpocket  costs for transportation  vary.  Inmanycases,  aperson  eligible  for 
Medicaid  pays nothing.  Inother  cases,  dialysis patients  pay bemeen.75-$30  each  way. 
For  patients  traveling  to dialysis three  times  a week,  these  costs can become  prohibitive. 
Among  dialysis facility  respondents,  most  concern  was focused  on those  not  eligible  for 
Medicaid  but  not  ill enough  to require  a Medicare  reimbursed  ambulance.  Over  one-
third  of the  transportation  providers  we contacted  require  that  a patient  be  Medicaid 
eligible  in order  to  receive  transportation  services. 
According  to  some  dialysis facility respondents  lack of physical  assistance  on the  part  of 
transportation  providers  was a problem  for some  patients.  Twenty-one  of the  37 
providers  we contacted  said they  did provide  physical  assistance  on stairs.  While  some 
providers  would  only assist patients  on one  to seven  steps,  in New York  City some 
providers  will carry  patients  up and  down  as many  as six flights of stairs.  Six providers 
said  they  provided  curb-to-curb  service  only. 
6
 CONCLUSION

Based  on this  limited  review, we draw  several  preliminary  conclusions  about  non-
emergency  transportation  for dialysis patients.  We  offer  these  to HCFA  as it conducts  a 
more  substantive  effort  to examine  access  to transportation  for  dialysis patients. 
First,  it does  not  appear  that  lack of access  to  alternative  forms  of transportation  is a 
central  explanation  of our  data  indicating  inappropriate  use  of emergency  transportation. 
In most  of the  sampled  cities,  alternative  forms  of transportation  seem  generally 
available. 
Second,  successful  approaches  to developing  a network  of transportation  options  seem  to 
exist.  More  in-depth  review  of the  five cities where  respondents  reported  quite  favorably 
about  the  availability  of transportation  might  provide  good  lessons  for other  localities. 
How  did such  networks  come  to exist?  How  are  the  problems  which were  identified  in 
other  cities  addressed? 
Third,  some  problems  might  merit  further  examination:  locations  where  access  problems 
might  exist, special  access  problems  for certain  populations,  and  problems  of long waiting 
times  and  lack  of physical  assistance  that  might  apply  more  generally  to all dialysis 
patients.  These  are  areas  that  HCFA  may wish to pursue  further  in its research  planned 
on this subject.  In addition,  non-urban  populations  (whom  we did not  examine)  may also 
merit  further  examination,  since such areas  may  pose  different  challenges  or represent 
unique  issues. 
7
 APPENDIX  A

SAMPLE  OF  CITIES 
Listed  below  are  the  number  of beneficiaries,  from  the  sample  of 277 used  for two 
pretious  studies,  whowere  dialyzed  ineachof  the  sampled  cities.  The  sites  chosen 
represent  the  city within  each  carrier  where  the  most  sample  beneficiaries  were  dialyzed. 
After  choosing  these  cities  we then  contacted  the  dialysis facilities  in each  city where 
these  beneficiaries  were  dialyzed  to find out  about  non-emergency  transportation  services 
used  by patients  at  that  facility.  We  obtained  information  about  transportation  from 
dialysis facility  social  workers  who  coordinate  transportation  arrangements  for dialysis 
patients  and  from  non-emergency  transportation  providers  serving  these  facilities. 
Detroit,  MI -16  beneficiaries 
Elizabethtown,  KY  -12  beneficiaries 
Houston,  TX  -11  beneficiaries 
Brighton,  MA  -9  beneficiaries 
New York,  NY -9  beneficiaries 
Miami  Beach,  FL  -6  beneficiaries 
Pittsburgh,  PA -4  beneficiaries 
Fremont,  CA -3  beneficiaries 
A-1
 APPENDIX  B

ORGANIZATIONS  WHICH  PROVIDE  FINANCIAL  ASSISTANCE 
Organizations  Which  Provide  Financial  Assistance  For 
Transportation  Expenses  in Eight  Cities 
Medic- AKF1  Nl@  ,40A3  Red 
aid  Cross 
x  x 
Fremont,  CA 
1 
x  x  x  x 
Miami  Beach, 
FL 
I 
Elizabeth-
x  x  x 
town,  KY 
Boston,  MA  x  x  x  xl 
x  x  x  x 
Detroit,  MI  xl 
x  x 
New  Yorlq  NY  xl 
1 
x  x  x  x  X1X 
Pittsburgh,  PA 
I 
x  x  x  x  X1X 
Houston,  TX 
TOTAL  8  8  3  4  2  7  12 
1 American  Kidney  Fund  - This  organization  is located  in Baltimore,  Maryland  but 
serves  patients  with  kidney  disease  nationwide. 
2 National  Kidney  Foundation 
3  Area  Agencies  on Aging 
4 Americans  with  Disabilities  Act 
B-1