IB 

Union Calendar No. 411 

116TH CONGRESS 

2D SESSION H. R. 3935 

[Report No. 116–511] 

To amend title XIX of the Social Security Act to provide for the continuing 

requirement of Medicaid coverage of nonemergency transportation to 

medically necessary services. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 24, 2019 

Mr. CARTER of Georgia (for himself, Mr. CA ́RDENAS, Mr. GRAVES of Georgia, 

and Mr. BISHOP of Georgia) introduced the following bill; which was referred to the Committee on Energy and Commerce 

SEPTEMBER 17, 2020 

Additional sponsors: Mr. LUETKEMEYER, Ms. KUSTER of New Hampshire, 

Mr. RUSH, Mr. NEGUSE, Mrs. RODGERS of Washington, Mr. KILMER, 

Mr. GRIFFITH, and Mr. SOTO

SEPTEMBER 17, 2020 

Reported with an amendment; committed to the Committee of the Whole 

House on the State of the Union and ordered to be printed 

[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on July 24, 2019] 


kjohnson on DSK79L0C42PROD with BILLS
2 

•HR 3935 RH

A BILL 

To amend title XIX of the Social Security Act to provide 

for the continuing requirement of Medicaid coverage of 

nonemergency transportation to medically necessary services. 


kjohnson on DSK79L0C42PROD with BILLS
3 

•HR 3935 RH

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Protecting Patients 

5 Transportation to Care Act’’. 

6 SEC. 2. MEDICAID COVERAGE OF CERTAIN MEDICAL TRANS7 PORTATION. 

8 (a) CONTINUING REQUIREMENT OF MEDICAID COV9 ERAGE OF NECESSARY TRANSPORTATION.— 

10 (1) REQUIREMENT.—Section 1902(a)(4) of the 

11 Social Security Act (42 U.S.C. 1396a(a)(4)) is 

12 amended— 

13 (A) by striking ‘‘and including provision 

14 for utilization’’ and inserting ‘‘including provi15 sion for utilization’’; and 

16 (B) by inserting after ‘‘supervision of ad17 ministration of the plan’’ the following: ‘‘, and, 

18 subject to section 1903(i), including a specifica19 tion that the single State agency described in 

20 paragraph (5) will ensure necessary transpor21 tation for beneficiaries under the State plan to 

22 and from providers and a description of the 

23 methods that such agency will use to ensure such 

24 transportation’’. 


kjohnson on DSK79L0C42PROD with BILLS
4 

•HR 3935 RH

1 (2) APPLICATION WITH RESPECT TO BENCHMARK

2 BENEFIT PACKAGES AND BENCHMARK EQUIVALENT

3 COVERAGE.—Section 1937(a)(1) of the Social Secu4 rity Act (42 U.S.C. 1396u–7(a)(1)) is amended— 

5 (A) in subparagraph (A), by striking ‘‘sub6 section (E)’’ and inserting ‘‘subparagraphs (E) 

7 and (F)’’; and 

8 (B) by adding at the end the following new 

9 subparagraph: 

10 ‘‘(F) NECESSARY TRANSPORTATION.—Not11 withstanding the preceding provisions of this 

12 paragraph, a State may not provide medical as13 sistance through the enrollment of an individual 

14 with benchmark coverage or benchmark equiva15 lent coverage described in subparagraph (A)(i) 

16 unless, subject to section 1903(i)(9) and in ac17 cordance with section 1902(a)(4), the benchmark 

18 benefit package or benchmark equivalent coverage 

19 (or the State)— 

20 ‘‘(i) ensures necessary transportation 

21 for individuals enrolled under such package 

22 or coverage to and from providers; and 

23 ‘‘(ii) provides a description of the 

24 methods that will be used to ensure such 

25 transportation.’’. 


kjohnson on DSK79L0C42PROD with BILLS
5 

•HR 3935 RH

1 (3) LIMITATION ON FEDERAL FINANCIAL PAR2 TICIPATION.—Section 1903(i) of the Social Security 

3 Act (42 U.S.C. 1396b(i)) is amended by inserting 

4 after paragraph (8) the following new paragraph: 

5 ‘‘(9) with respect to any amount expended for 

6 non-emergency transportation authorized under sec7 tion 1902(a)(4), unless the State plan provides for the 

8 methods and procedures required under section 

9 1902(a)(30)(A); or’’. 

10 (4) EFFECTIVE DATE.—The amendments made 

11 by this subsection shall take effect on the date of the 

12 enactment of this Act and shall apply to transpor13 tation furnished on or after such date. 

14 (b) MEDICAID PROGRAM INTEGRITY MEASURES RE15 LATED TO COVERAGE OF NONEMERGENCY MEDICAL TRANS16 PORTATION.— 

17 (1) GAO STUDY.—Not later than two years after 

18 the date of the enactment of this Act, the Comptroller 

19 General of the United States shall conduct a study, 

20 and submit to Congress, a report on coverage under 

21 the Medicaid program under title XIX of the Social 

22 Security Act of nonemergency transportation to medi23 cally necessary services. Such study shall take into ac24 count the 2009 report of the Office of the Inspector 

25 General of the Department of Health and Human 


kjohnson on DSK79L0C42PROD with BILLS
6 

•HR 3935 RH

1 Services, titled ‘‘Fraud and Abuse Safeguards for 

2 Medicaid Nonemergency Medical Transportation’’ 

3 (OEI–06–07–003200). Such report shall include the 

4 following: 

5 (A) An examination of the 50 States and 

6 the District of Columbia to identify safeguards to 

7 prevent and detect fraud and abuse with respect 

8 to coverage under the Medicaid program of non9 emergency transportation to medically necessary 

10 services. 

11 (B) An examination of transportation bro12 kers to identify the range of safeguards against 

13 such fraud and abuse to prevent improper pay14 ments for such transportation. 

15 (C) Identification of the numbers, types, 

16 and outcomes of instances of fraud and abuse, 

17 with respect to coverage under the Medicaid pro18 gram of such transportation, that State Medicaid 

19 Fraud Control Units have investigated in recent 

20 years. 

21 (D) Identification of commonalities or 

22 trends in program integrity, with respect to such 

23 coverage, to inform risk management strategies 

24 of States and the Centers for Medicare & Med25 icaid Services. 


kjohnson on DSK79L0C42PROD with BILLS
7 

•HR 3935 RH

1 (2) STAKEHOLDER WORKING GROUP.— 

2 (A) IN GENERAL.—Not later than one year 

3 after the date of the enactment of this Act, the 

4 Secretary of Health and Human Services, 

5 through the Centers for Medicare & Medicaid 

6 Services, shall convene a series of meetings to ob7 tain input from appropriate stakeholders to fa8 cilitate discussion and shared learning about the 

9 leading practices for improving Medicaid pro10 gram integrity, with respect to coverage of non11 emergency transportation to medically necessary 

12 services. 

13 (B) TOPICS.—The meetings convened under 

14 subparagraph (A) shall— 

15 (i) focus on ongoing challenges to Med16 icaid program integrity as well as leading 

17 practices to address such challenges; and 

18 (ii) address specific challenges raised 

19 by stakeholders involved in coverage under 

20 the Medicaid program of nonemergency 

21 transportation to medically necessary serv22 ices, including unique considerations for 

23 specific groups of Medicaid beneficiaries 

24 meriting particular attention, such as 

25 American Indians and tribal land issues or 


kjohnson on DSK79L0C42PROD with BILLS
8 

•HR 3935 RH

1 accommodations for individuals with dis2 abilities. 

3 (C) STAKEHOLDERS.—Stakeholders de4 scribed in subparagraph (A) shall include indi5 viduals from State Medicaid programs, brokers 

6 for nonemergency transportation to medically 

7 necessary services that meet the criteria described 

8 in section 1902(a)(70)(B) of the Social Security 

9 Act (42 U.S.C. 1396a(a)(70)(B)), providers (in10 cluding transportation network companies), 

11 Medicaid patient advocates, and such other indi12 viduals specified by the Secretary. 

13 (3) GUIDANCE REVIEW.—Not later than 18 

14 months after the date of the enactment of this Act, the 

15 Secretary of Health and Human Services, through the 

16 Centers for Medicare & Medicaid Services, shall assess 

17 guidance issued to States by the Centers for Medicare 

18 & Medicaid Services relating to Federal requirements 

19 for nonemergency transportation to medically nec20 essary services under the Medicaid program under 

21 title XIX of the Social Security Act and update such 

22 guidance as necessary to ensure States have appro23 priate and current guidance in designing and admin24 istering coverage under the Medicaid program of nonVerDate Sep 11 2014 00:32 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6203 E:\BILLS\H3935.RH H3935

kjohnson on DSK79L0C42PROD with BILLS
9 

•HR 3935 RH

1 emergency transportation to medically necessary serv2 ices. 

3 (4) NEMT TRANSPORTATION PROVIDER AND

4 DRIVER REQUIREMENTS.— 

5 (A) STATE PLAN REQUIREMENT.—Section 

6 1902(a) of the Social Security Act (42 U.S.C. 

7 1396a(a)) is amended— 

8 (i) by striking ‘‘and’’ at the end of 

9 paragraph (85); 

10 (ii) by striking the period at the end of 

11 paragraph (86) and inserting ‘‘; and’’; and 

12 (iii) by inserting after paragraph (86) 

13 the following new paragraph: 

14 ‘‘(87) provide for a mechanism, which may in15 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 receiv19 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 sec24 tion 1128B(f)) and is not listed on the exclusion 


kjohnson on DSK79L0C42PROD with BILLS
10 

•HR 3935 RH

1 list of the Inspector General of the Department 

2 of Health and Human Services; 

3 ‘‘(B) each such individual driver has a 

4 valid driver’s license; 

5 ‘‘(C) each such provider has in place a 

6 process to address any violation of a State drug 

7 law; and 

8 ‘‘(D) each such provider has in place a 

9 process to disclose to the State Medicaid program 

10 the driving history, including any traffic viola11 tions, of each such individual driver employed by 

12 such provider, including any traffic 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 LEGISLATION

22 REQUIRED.—In the case of a State plan for 

23 medical assistance under title XIX of the 

24 Social Security Act which the Secretary of 

25 Health and Human Services determines reVerDate Sep 11 2014 00:32 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6203 E:\BILLS\H3935.RH H3935

kjohnson on DSK79L0C42PROD with BILLS
11 

•HR 3935 RH

1 quires State legislation (other than legisla2 tion appropriating funds) in order for the 

3 plan to meet the additional requirement im4 posed by the amendments made by subpara5 graph (A), the State plan shall not be re6 garded as failing to comply with the re7 quirements of such title solely on the basis 

8 of its failure to meet this additional re9 quirement before the first day of the first 

10 calendar quarter beginning after the close of 

11 the first regular session of the State legisla12 ture that begins after the date of the enact13 ment of this Act. For purposes of the pre14 vious sentence, in the case of a State that 

15 has a 2-year legislative session, each year of 

16 such session shall be deemed to be a separate 

17 regular session of the State legislature. 

18 (5) ANALYSIS OF T–MSIS DATA.—Not later than 

19 one year after the date of the enactment of this Act, 

20 the Secretary of Health and Human Services, through 

21 the Centers for Medicare & Medicaid Services, shall 

22 analyze, and submit to Congress a report on, the na23 tion-wide data set under the Transformed Medicaid 

24 Statistical Information System to identify rec25 ommendations relating to coverage under the MedVerDate Sep 11 2014 00:32 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6203 E:\BILLS\H3935.RH H3935

kjohnson on DSK79L0C42PROD with BILLS
12 

•HR 3935 RH

1 icaid program under title XIX of the Social Security 

2 Act of nonemergency transportation to medically nec3 essary services. 


kjohnson on DSK79L0C42PROD with BILLS

kjohnson on DSK79L0C42PROD with BILLS
Union Calendar No. 411 

116TH CONGRESS 

2D SESSION H. R. 3935 

[Report No. 116–511] 

A BILL 

To amend title XIX of the Social Security Act to 

medically necessary services. icaid coverage of nonemergency transportation to provide for the continuing requirement of MedSEPTEMBER 17, 2020 

Reported with an amendment; committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union 


kjohnson on DSK79L0C42PROD with BILLS