Protecting Patients Transportation to Care Act

IIB 116TH CONGRESS 2D SESSION H. R. 3935 IN THE SENATE OF THE UNITED STATES SEPTEMBER 22, 2020 Received; read twice and referred to the Committee on Finance AN ACT To amend title XIX of the Social Security Act to provide for the continuing requirement of Medicaid coverage of nonemergency transportation to medically necessary serv- ices. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 03:54 Sep 23, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3935.RFS H3935 pamtmann on DSKBC07HB2PROD with BILLS 2 HR 3935 RFS SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Protecting Patients 2 Transportation to Care Act’’. 3 SEC. 2. MEDICAID COVERAGE OF CERTAIN MEDICAL 4 TRANSPORTATION. 5 (a) CONTINUING REQUIREMENT OF MEDICAID COV- 6 ERAGE OF NECESSARY TRANSPORTATION.— 7 (1) REQUIREMENT.—Section 1902(a)(4) of the 8 Social Security Act (42 U.S.C. 1396a(a)(4)) is 9 amended— 10 (A) by striking ‘‘and including provision 11 for utilization’’ and inserting ‘‘including provi- 12 sion for utilization’’; and 13 (B) by inserting after ‘‘supervision of ad- 14 ministration of the plan’’ the following: ‘‘, and, 15 subject to section 1903(i), including a specifica- 16 tion that the single State agency described in 17 paragraph (5) will ensure necessary transpor- 18 tation for beneficiaries under the State plan to 19 and from providers and a description of the 20 methods that such agency will use to ensure 21 such transportation’’. 22 (2) APPLICATION WITH RESPECT TO BENCH- 23 MARK BENEFIT PACKAGES AND BENCHMARK EQUIV- 24 ALENT COVERAGE.—Section 1937(a)(1) of the Social 25 VerDate Sep 11 2014 03:54 Sep 23, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3935.RFS H3935 pamtmann on DSKBC07HB2PROD with BILLS 3 HR 3935 RFS Security Act (42 U.S.C. 1396u–7(a)(1)) is amend- 1 ed— 2 (A) in subparagraph (A), by striking ‘‘sub- 3 section (E)’’ and inserting ‘‘subparagraphs (E) 4 and (F)’’; and 5 (B) by adding at the end the following new 6 subparagraph: 7 ‘‘(F) NECESSARY TRANSPORTATION.—Not- 8 withstanding the preceding provisions of this 9 paragraph, a State may not provide medical as- 10 sistance through the enrollment of an individual 11 with benchmark coverage or benchmark equiva- 12 lent coverage described in subparagraph (A)(i) 13 unless, subject to section 1903(i)(9) and in ac- 14 cordance with section 1902(a)(4), the bench- 15 mark benefit package or benchmark equivalent 16 coverage (or the State)— 17 ‘‘(i) ensures necessary transportation 18 for individuals enrolled under such package 19 or coverage to and from providers; and 20 ‘‘(ii) provides a description of the 21 methods that will be used to ensure such 22 transportation.’’. 23 (3) LIMITATION ON FEDERAL FINANCIAL PAR- 24 TICIPATION.—Section 1903(i) of the Social Security 25 VerDate Sep 11 2014 03:54 Sep 23, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3935.RFS H3935 pamtmann on DSKBC07HB2PROD with BILLS 4 HR 3935 RFS Act (42 U.S.C. 1396b(i)) is amended by inserting 1 after paragraph (8) the following new paragraph: 2 ‘‘(9) with respect to any amount expended for 3 non-emergency transportation authorized under sec- 4 tion 1902(a)(4), unless the State plan provides for 5 the methods and procedures required under section 6 1902(a)(30)(A); or’’. 7 (4) EFFECTIVE DATE.—The amendments made 8 by this subsection shall take effect on the date of the 9 enactment of this Act and shall apply to transpor- 10 tation furnished on or after such date. 11 (b) MEDICAID PROGRAM INTEGRITY MEASURES RE- 12 LATED TO COVERAGE OF NONEMERGENCY MEDICAL 13 TRANSPORTATION.— 14 (1) GAO STUDY.—Not later than two years 15 after the date of the enactment of this Act, the 16 Comptroller General of the United States shall con- 17 duct a study, and submit to Congress, a report on 18 coverage under the Medicaid program under title 19 XIX of the Social Security Act of nonemergency 20 transportation to medically necessary services. Such 21 study shall take into account the 2009 report of the 22 Office of the Inspector General of the Department of 23 Health and Human Services, titled ‘‘Fraud and 24 Abuse Safeguards for Medicaid Nonemergency Med- 25 VerDate Sep 11 2014 03:54 Sep 23, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3935.RFS H3935 pamtmann on DSKBC07HB2PROD with BILLS 5 HR 3935 RFS ical Transportation’’ (OEI–06–07–003200). Such 1 report shall include the following: 2 (A) An examination of the 50 States and 3 the District of Columbia to identify safeguards 4 to prevent and detect fraud and abuse with re- 5 spect to coverage under the Medicaid program 6 of nonemergency transportation to medically 7 necessary services. 8 (B) An examination of transportation bro- 9 kers to identify the range of safeguards against 10 such fraud and abuse to prevent improper pay- 11 ments for such transportation. 12 (C) Identification of the numbers, types, 13 and outcomes of instances of fraud and abuse, 14 with respect to coverage under the Medicaid 15 program of such transportation, that State 16 Medicaid Fraud Control Units have investigated 17 in recent years. 18 (D) Identification of commonalities or 19 trends in program integrity, with respect to 20 such coverage, to inform risk management 21 strategies of States and the Centers for Medi- 22 care & Medicaid Services. 23 (2) STAKEHOLDER WORKING GROUP.— 24 VerDate Sep 11 2014 03:54 Sep 23, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3935.RFS H3935 pamtmann on DSKBC07HB2PROD with BILLS 6 HR 3935 RFS (A) IN GENERAL.—Not later than one year 1 after the date of the enactment of this Act, the 2 Secretary of Health and Human Services, 3 through the Centers for Medicare & Medicaid 4 Services, shall convene a series of meetings to 5 obtain input from appropriate stakeholders to 6 facilitate discussion and shared learning about 7 the leading practices for improving Medicaid 8 program integrity, with respect to coverage of 9 nonemergency transportation to medically nec- 10 essary services. 11 (B) TOPICS.—The meetings convened 12 under subparagraph (A) shall— 13 (i) focus on ongoing challenges to 14 Medicaid program integrity as well as lead- 15 ing practices to address such challenges; 16 and 17 (ii) address specific challenges raised 18 by stakeholders involved in coverage under 19 the Medicaid program of nonemergency 20 transportation to medically necessary serv- 21 ices, including unique considerations for 22 specific groups of Medicaid beneficiaries 23 meriting particular attention, such as 24 American Indians and tribal land issues or 25 VerDate Sep 11 2014 03:54 Sep 23, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3935.RFS H3935 pamtmann on DSKBC07HB2PROD with BILLS 7 HR 3935 RFS accommodations for individuals with dis- 1 abilities. 2 (C) STAKEHOLDERS.—Stakeholders de- 3 scribed in subparagraph (A) shall include indi- 4 viduals from State Medicaid programs, brokers 5 for nonemergency transportation to medically 6 necessary services that meet the criteria de- 7 scribed in section 1902(a)(70)(B) of the Social 8 Security Act (42 U.S.C. 1396a(a)(70)(B)), pro- 9 viders (including transportation network compa- 10 nies), Medicaid patient advocates, and such 11 other individuals specified by the Secretary. 12 (3) GUIDANCE REVIEW.—Not later than 18 13 months after the date of the enactment of this Act, 14 the Secretary of Health and Human Services, 15 through the Centers for Medicare & Medicaid Serv- 16 ices, shall assess guidance issued to States by the 17 Centers for Medicare & Medicaid Services relating to 18 Federal requirements for nonemergency transpor- 19 tation to medically necessary services under the 20 Medicaid program under title XIX of the Social Se- 21 curity Act and update such guidance as necessary to 22 ensure States have appropriate and current guidance 23 in designing and administering coverage under the 24 VerDate Sep 11 2014 03:54 Sep 23, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3935.RFS H3935 pamtmann on DSKBC07HB2PROD with BILLS 8 HR 3935 RFS Medicaid program of nonemergency transportation 1 to medically necessary services. 2 (4) NEMT TRANSPORTATION PROVIDER AND 3 DRIVER REQUIREMENTS.— 4 (A) STATE PLAN REQUIREMENT.—Section 5 1902(a) of the Social Security Act (42 U.S.C. 6 1396a(a)) is amended— 7 (i) by striking ‘‘and’’ at the end of 8 paragraph (85); 9 (ii) by striking the period at the end 10 of paragraph (86) and inserting ‘‘; and’’; 11 and 12 (iii) by inserting after paragraph (86) 13 the following new paragraph: 14 ‘‘(87) provide for a mechanism, which may in- 15 clude attestation, that ensures that, with respect to 16 any provider (including a transportation network 17 company) or individual driver of nonemergency 18 transportation to medically necessary services receiv- 19 ing payments under such plan (but excluding any 20 public transit authority), at a minimum— 21 ‘‘(A) each such provider and individual 22 driver is not excluded from participation in any 23 Federal health care program (as defined in sec- 24 tion 1128B(f)) and is not listed on the exclu- 25 VerDate Sep 11 2014 03:54 Sep 23, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3935.RFS H3935 pamtmann on DSKBC07HB2PROD with BILLS 9 HR 3935 RFS sion list of the Inspector General of the Depart- 1 ment of Health and Human Services; 2 ‘‘(B) each such individual driver has a 3 valid driver’s license; 4 ‘‘(C) each such provider has in place a 5 process to address any violation of a State drug 6 law; and 7 ‘‘(D) each such provider has in place a 8 process to disclose to the State Medicaid pro- 9 gram the driving history, including any traffic 10 violations, of each such individual driver em- 11 ployed by such provider, including any traffic 12 violations.’’. 13 (B) EFFECTIVE DATE.— 14 (i) IN GENERAL.—Except as provided 15 in clause (ii), the amendments made by 16 subparagraph (A) shall take effect on the 17 date of the enactment of this Act and shall 18 apply to services furnished on or after the 19 date that is one year after the date of the 20 enactment of this Act. 21 (ii) EXCEPTION IF STATE LEGISLA- 22 TION REQUIRED.—In the case of a State 23 plan for medical assistance under title XIX 24 of the Social Security Act which the Sec- 25 VerDate Sep 11 2014 03:54 Sep 23, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3935.RFS H3935 pamtmann on DSKBC07HB2PROD with BILLS 10 HR 3935 RFS retary of Health and Human Services de- 1 termines requires State legislation (other 2 than legislation appropriating funds) in 3 order for the plan to meet the additional 4 requirement imposed by the amendments 5 made by subparagraph (A), the State plan 6 shall not be regarded as failing to comply 7 with the requirements of such title solely 8 on the basis of its failure to meet this ad- 9 ditional requirement before the first day of 10 the first calendar quarter beginning after 11 the close of the first regular session of the 12 State legislature that begins after the date 13 of the enactment of this Act. For purposes 14 of the previous sentence, in the case of a 15 State that has a 2-year legislative session, 16 each year of such session shall be deemed 17 to be a separate regular session of the 18 State legislature. 19 (5) ANALYSIS OF T–MSIS DATA.—Not later 20 than one year after the date of the enactment of this 21 Act, the Secretary of Health and Human Services, 22 through the Centers for Medicare & Medicaid Serv- 23 ices, shall analyze, and submit to Congress a report 24 on, the nation-wide data set under the Transformed 25 VerDate Sep 11 2014 03:54 Sep 23, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3935.RFS H3935 pamtmann on DSKBC07HB2PROD with BILLS 11 HR 3935 RFS Medicaid Statistical Information System to identify 1 recommendations relating to coverage under the 2 Medicaid program under title XIX of the Social Se- 3 curity Act of nonemergency transportation to medi- 4 cally necessary services. 5 Passed the House of Representatives September 21, 2020. Attest: CHERYL L. JOHNSON, Clerk. VerDate Sep 11 2014 03:54 Sep 23, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3935.RFS H3935 pamtmann on DSKBC07HB2PROD with BILLS