116TH CONGRESS 

2D SESSION H. R. 3935 

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 services. 

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

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

3 Transportation to Care Act’’. 

4 SEC. 2. MEDICAID COVERAGE OF CERTAIN MEDICAL 

5 TRANSPORTATION. 

6 (a) CONTINUING REQUIREMENT OF MEDICAID COV7 ERAGE OF NECESSARY TRANSPORTATION.— 

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

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

10 amended— 

11 (A) by striking ‘‘and including provision 

12 for utilization’’ and inserting ‘‘including provi13 sion for utilization’’; and 

14 (B) by inserting after ‘‘supervision of ad15 ministration of the plan’’ the following: ‘‘, and, 

16 subject to section 1903(i), including a specifica17 tion that the single State agency described in 

18 paragraph (5) will ensure necessary transpor19 tation for beneficiaries under the State plan to 

20 and from providers and a description of the 

21 methods that such agency will use to ensure 

22 such transportation’’. 

23 (2) APPLICATION WITH RESPECT TO BENCH24 MARK BENEFIT PACKAGES AND BENCHMARK EQUIV25 ALENT COVERAGE.—Section 1937(a)(1) of the Social 
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1 Security Act (42 U.S.C. 1396u–7(a)(1)) is amend2 ed— 

3 (A) in subparagraph (A), by striking ‘‘sub4 section (E)’’ and inserting ‘‘subparagraphs (E) 

5 and (F)’’; and 

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

7 subparagraph: 

8 ‘‘(F) NECESSARY TRANSPORTATION.—Not9 withstanding the preceding provisions of this 

10 paragraph, a State may not provide medical as11 sistance through the enrollment of an individual 

12 with benchmark coverage or benchmark equiva13 lent coverage described in subparagraph (A)(i) 

14 unless, subject to section 1903(i)(9) and in ac15 cordance with section 1902(a)(4), the bench16 mark benefit package or benchmark equivalent 

17 coverage (or the State)— 

18 ‘‘(i) ensures necessary transportation 

19 for individuals enrolled under such package 

20 or coverage to and from providers; and 

21 ‘‘(ii) provides a description of the 

22 methods that will be used to ensure such 

23 transportation.’’. 

24 (3) LIMITATION ON FEDERAL FINANCIAL PAR25 TICIPATION.—Section 1903(i) of the Social Security 
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1 Act (42 U.S.C. 1396b(i)) is amended by inserting 

2 after paragraph (8) the following new paragraph: 

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

4 non-emergency transportation authorized under sec5 tion 1902(a)(4), unless the State plan provides for 

6 the methods and procedures required under section 

7 1902(a)(30)(A); or’’. 

8 (4) EFFECTIVE DATE.—The amendments made 

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

10 enactment of this Act and shall apply to transpor11 tation furnished on or after such date. 

12 (b) MEDICAID PROGRAM INTEGRITY MEASURES RE13 LATED TO COVERAGE OF NONEMERGENCY MEDICAL

14 TRANSPORTATION.— 

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

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

17 Comptroller General of the United States shall con18 duct a study, and submit to Congress, a report on 

19 coverage under the Medicaid program under title 

20 XIX of the Social Security Act of nonemergency 

21 transportation to medically necessary services. Such 

22 study shall take into account the 2009 report of the 

23 Office of the Inspector General of the Department of 

24 Health and Human Services, titled ‘‘Fraud and 

25 Abuse Safeguards for Medicaid Nonemergency Med-
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1 ical Transportation’’ (OEI–06–07–003200). Such 

2 report shall include the following: 

3 (A) An examination of the 50 States and 

4 the District of Columbia to identify safeguards 

5 to prevent and detect fraud and abuse with re6 spect to coverage under the Medicaid program 

7 of nonemergency transportation to medically 

8 necessary services. 

9 (B) An examination of transportation bro10 kers to identify the range of safeguards against 

11 such fraud and abuse to prevent improper pay12 ments for such transportation. 

13 (C) Identification of the numbers, types, 

14 and outcomes of instances of fraud and abuse, 

15 with respect to coverage under the Medicaid 

16 program of such transportation, that State 

17 Medicaid Fraud Control Units have investigated 

18 in recent years. 

19 (D) Identification of commonalities or 

20 trends in program integrity, with respect to 

21 such coverage, to inform risk management 

22 strategies of States and the Centers for Medi23 care & Medicaid Services. 

24 (2) STAKEHOLDER WORKING GROUP.— 
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1 (A) IN GENERAL.—Not later than one year 

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

3 Secretary of Health and Human Services, 

4 through the Centers for Medicare & Medicaid 

5 Services, shall convene a series of meetings to 

6 obtain input from appropriate stakeholders to 

7 facilitate discussion and shared learning about 

8 the leading practices for improving Medicaid 

9 program integrity, with respect to coverage of 

10 nonemergency transportation to medically nec11 essary services. 

12 (B) TOPICS.—The meetings convened 

13 under subparagraph (A) shall— 

14 (i) focus on ongoing challenges to 

15 Medicaid program integrity as well as lead16 ing practices to address such challenges; 

17 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 
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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 de8 scribed in section 1902(a)(70)(B) of the Social 

9 Security Act (42 U.S.C. 1396a(a)(70)(B)), pro10 viders (including transportation network compa11 nies), Medicaid patient advocates, and such 

12 other individuals specified by the Secretary. 

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

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

15 the Secretary of Health and Human Services, 

16 through the Centers for Medicare & Medicaid Serv17 ices, shall assess guidance issued to States by the 

18 Centers for Medicare & Medicaid Services relating to 

19 Federal requirements for nonemergency transpor20 tation to medically necessary services under the 

21 Medicaid program under title XIX of the Social Se22 curity Act and update such guidance as necessary to 

23 ensure States have appropriate and current guidance 

24 in designing and administering coverage under the 
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1 Medicaid program of nonemergency transportation 

2 to medically necessary services. 

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 

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

12 and 

13 (iii) by inserting after paragraph (86) 

14 the following new paragraph: 

15 ‘‘(87) provide for a mechanism, which may in16 clude attestation, that ensures that, with respect to 

17 any provider (including a transportation network 

18 company) or individual driver of nonemergency 

19 transportation to medically necessary services receiv20 ing payments under such plan (but excluding any 

21 public transit authority), at a minimum— 

22 ‘‘(A) each such provider and individual 

23 driver is not excluded from participation in any 

24 Federal health care program (as defined in sec25 tion 1128B(f)) and is not listed on the exclu-
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1 sion list of the Inspector General of the Depart2 ment 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 pro10 gram the driving history, including any traffic 

11 violations, of each such individual driver em12 ployed by such provider, including any traffic 

13 violations.’’. 

14 (B) EFFECTIVE DATE.— 

15 (i) IN GENERAL.—Except as provided 

16 in clause (ii), the amendments made by 

17 subparagraph (A) shall take effect on the 

18 date of the enactment of this Act and shall 

19 apply to services furnished on or after the 

20 date that is one year after the date of the 

21 enactment of this Act. 

22 (ii) EXCEPTION IF STATE LEGISLA23 TION REQUIRED.—In the case of a State 

24 plan for medical assistance under title XIX 

25 of the Social Security Act which the Sec-
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1 retary of Health and Human Services de2 termines requires State legislation (other 

3 than legislation appropriating funds) in 

4 order for the plan to meet the additional 

5 requirement imposed by the amendments 

6 made by subparagraph (A), the State plan 

7 shall not be regarded as failing to comply 

8 with the requirements of such title solely 

9 on the basis of its failure to meet this ad10 ditional requirement before the first day of 

11 the first calendar quarter beginning after 

12 the close of the first regular session of the 

13 State legislature that begins after the date 

14 of the enactment of this Act. For purposes 

15 of the previous sentence, in the case of a 

16 State that has a 2-year legislative session, 

17 each year of such session shall be deemed 

18 to be a separate regular session of the 

19 State legislature. 

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

21 than one year after the date of the enactment of this 

22 Act, the Secretary of Health and Human Services, 

23 through the Centers for Medicare & Medicaid Serv24 ices, shall analyze, and submit to Congress a report 

25 on, the nation-wide data set under the Transformed 
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1 Medicaid Statistical Information System to identify 

2 recommendations relating to coverage under the 

3 Medicaid program under title XIX of the Social Se4 curity Act of nonemergency transportation to medi5 cally necessary services. 

Passed the House of Representatives September 21, 

2020. 

Attest: 

Clerk. 
116TH CONGRESS 

2D SESSION H. R. 3935 

AN ACT 

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 Med-