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H.R. 3935 — what changed

Protecting Patients Transportation to Care Act

From Introduced in House to Reported in House. 1 section amended between Introduced in House and Reported in House.

Sec. 2 Medicaid coverage of certain medical transportation

(a)
added Continuing requirement of medicaid coverage of necessary transportation—
(1)
added Requirement— Section 1902(a)(4) of the Social Security Act (42 U.S.C. 1396a(a)(4)) is amended—
(A)
added by striking “and including provision for utilization” and inserting “including provision for utilization”; and
(B)
added by inserting after “supervision of administration of the plan” the following: “, and, subject to section 1903(i), including a specification that the single State agency described in paragraph (5) will ensure necessary transportation for beneficiaries under the State plan to and from providers and a description of the methods that such agency will use to ensure such transportation”.
(a)
removed Requirement— Section 1902(a)(10) of the Social Security Act (42 U.S.C. 1396a(a)(10)) is amended—
(2)
changed Application with respect to benchmark benefit packages and benchmark equivalent coverage— in subparagraph (A), in Section 1937(a)(1) of the matter preceding clause (i), by striking “and (21)” and inserting “, (21), and (30)”; andSocial Security Act (42 U.S.C. 1396u–7(a)(1)) is amended—
(A)
added in subparagraph (A), by striking “subsection (E)” and inserting “subparagraphs (E) and (F)”; and
(B)
added by adding at the end the following new subparagraph:

added “(F) Necessary transportation—Notwithstanding the preceding provisions of this paragraph, a State may not provide medical assistance through the enrollment of an individual with benchmark coverage or benchmark equivalent coverage described in subparagraph (A)(i) unless, subject to section 1903(i)(9) and in accordance with section 1902(a)(4), the benchmark benefit package or benchmark equivalent coverage (or the State)—

added “(i) ensures necessary transportation for individuals enrolled under such package or coverage to and from providers; and

added “(ii) provides a description of the methods that will be used to ensure such transportation.”

(3)
changed Limitation on federal financial participation— in subparagraph (C)(iv), Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)) is amended by striking “and (17)” and inserting “, (17), and (30)”.after paragraph (8) the following new paragraph:

added “(9) with respect to any amount expended for non-emergency transportation authorized under section 1902(a)(4), unless the State plan provides for the methods and procedures required under section 1902(a)(30)(A); or”

(4)
added Effective date— The amendments made by this subsection shall take effect on the date of the enactment of this Act and shall apply to transportation furnished on or after such date.
(b)
added Medicaid program integrity measures related to coverage of nonemergency medical transportation—
(1)
added Gao study— Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a study, and submit to Congress, a report on coverage under the Medicaid program under title XIX of the Social Security Act of nonemergency transportation to medically necessary services. Such study shall take into account the 2009 report of the Office of the Inspector General of the Department of Health and Human Services, titled “Fraud and Abuse Safeguards for Medicaid Nonemergency Medical Transportation” (OEI–06–07–003200). Such report shall include the following:
(A)
added An examination of the 50 States and the District of Columbia to identify safeguards to prevent and detect fraud and abuse with respect to coverage under the Medicaid program of nonemergency transportation to medically necessary services.
(B)
added An examination of transportation brokers to identify the range of safeguards against such fraud and abuse to prevent improper payments for such transportation.
(C)
added Identification of the numbers, types, and outcomes of instances of fraud and abuse, with respect to coverage under the Medicaid program of such transportation, that State Medicaid Fraud Control Units have investigated in recent years.
(D)
added Identification of commonalities or trends in program integrity, with respect to such coverage, to inform risk management strategies of States and the Centers for Medicare & Medicaid Services.
(2)
added Stakeholder working group—
(b)
removed Description of Services— Section 1905 of such Act (42 U.S.C. 1396d) is amended—
(1)
removed in subsection (a)—
(A)
changed In general— in paragraph (29), by striking “and” at Not later than one year after the end;date of the enactment of this Act, the Secretary of Health and Human Services, through the Centers for Medicare & Medicaid Services, shall convene a series of meetings to obtain input from appropriate stakeholders to facilitate discussion and shared learning about the leading practices for improving Medicaid program integrity, with respect to coverage of nonemergency transportation to medically necessary services.
(B)
changed Topics— by redesignating paragraph (30) as paragraph (31) and by striking the comma at the end and inserting a semicolon; andThe meetings convened under subparagraph (A) shall—
(i)
added focus on ongoing challenges to Medicaid program integrity as well as leading practices to address such challenges; and
(ii)
added address specific challenges raised by stakeholders involved in coverage under the Medicaid program of nonemergency transportation to medically necessary services, including unique considerations for specific groups of Medicaid beneficiaries meriting particular attention, such as American Indians and tribal land issues or accommodations for individuals with disabilities.
(C)
changed Stakeholders— Stakeholders described in subparagraph (A) shall include individuals from State Medicaid programs, brokers for nonemergency transportation to medically necessary services that meet the criteria described in section 1902(a)(70)(B) of the Social Security Act (42 U.S.C. 1396a(a)(70)(B)), providers (including transportation network companies), Medicaid patient advocates, and such other individuals specified by inserting after paragraph (29) the following new paragraph:Secretary.

removed “(30) subject to subsection (ff), nonemergency transportation to medically necessary services, consistent with the requirement of section 431.53 of title 42, Code of Federal Regulations, as in effect as of June 1, 2019; and”

(3)
changed Guidance review— Not later than 18 months after the date of the enactment of this Act, the Secretary of Health and Human Services, through the Centers for Medicare & Medicaid Services, shall assess guidance issued to States by adding at the end Centers for Medicare & Medicaid Services relating to Federal requirements for nonemergency transportation to medically necessary services under the following new subsection:Medicaid program under title XIX of the Social Security Act and update such guidance as necessary to ensure States have appropriate and current guidance in designing and administering coverage under the Medicaid program of nonemergency transportation to medically necessary services.
(4)
added Nemt transportation provider and driver requirements—
(A)
added State plan requirement— Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is amended—
(i)
added by striking “and” at the end of paragraph (85);
(ii)
added by striking the period at the end of paragraph (86) and inserting “; and”; and
(iii)
added by inserting after paragraph (86) the following new paragraph:

added “(87) provide for a mechanism, which may include attestation, that ensures that, with respect to any provider (including a transportation network company) or individual driver of nonemergency transportation to medically necessary services receiving payments under such plan (but excluding any public transit authority), at a minimum—

added “(A) each such provider and individual driver is not excluded from participation in any Federal health care program (as defined in section 1128B(f)) and is not listed on the exclusion list of the Inspector General of the Department of Health and Human Services;

added “(B) each such individual driver has a valid driver’s license;

added “(C) each such provider has in place a process to address any violation of a State drug law; and

added “(D) each such provider has in place a process to disclose to the State Medicaid program the driving history, including any traffic violations, of each such individual driver employed by such provider, including any traffic violations.”

(B)
added Effective date—
(i)
added In general— Except as provided in clause (ii), the amendments made by subparagraph (A) shall take effect on the date of the enactment of this Act and shall apply to services furnished on or after the date that is one year after the date of the enactment of this Act.
(ii)
added Exception if state legislation required— In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by subparagraph (A), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.
(5)
added Analysis of t–msis data— Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services, through the Centers for Medicare & Medicaid Services, shall analyze, and submit to Congress a report on, the nation-wide data set under the Transformed Medicaid Statistical Information System to identify recommendations relating to coverage under the Medicaid program under title XIX of the Social Security Act of nonemergency transportation to medically necessary services.

removed “(ff) Nonemergency transportation to medically necessary services

removed “(1) Limitation on Federal financial participation—Notwithstanding any other provision of this title, to be eligible for federal financial participation under this title for expenses incurred as medical assistance or as an administrative expense for nonemergency transportation to medically necessary services described in subsection (a)(30), the State Medicaid agency of such State must have in place a prior authorization or utilization management requirement for such services.

removed “(2) Prior authorization defined—For purposes of paragraph (1), the term prior authorization means a process through which a request for provisional affirmation of coverage is submitted for review before the service involved is furnished and before a claim is submitted for payment for such service.”

(c)
removed Effective date— The amendments made by this section shall take effect on the date of the enactment of this Act and shall apply to transportation on or after such date.