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[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3935 Engrossed in House (EH)]

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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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Protecting Patients Transportation 
to Care Act''.

SEC. 2. MEDICAID COVERAGE OF CERTAIN MEDICAL TRANSPORTATION.

    (a) Continuing Requirement of Medicaid Coverage of Necessary 
Transportation.--
            (1) Requirement.--Section 1902(a)(4) of the Social Security 
        Act (42 U.S.C. 1396a(a)(4)) is amended--
                    (A) by striking ``and including provision for 
                utilization'' and inserting ``including provision for 
                utilization''; and
                    (B) 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''.
            (2) Application with respect to benchmark benefit packages 
        and benchmark equivalent coverage.--Section 1937(a)(1) of the 
        Social Security Act (42 U.S.C. 1396u-7(a)(1)) is amended--
                    (A) in subparagraph (A), by striking ``subsection 
                (E)'' and inserting ``subparagraphs (E) and (F)''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(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)--
                            ``(i) ensures necessary transportation for 
                        individuals enrolled under such package or 
                        coverage to and from providers; and
                            ``(ii) provides a description of the 
                        methods that will be used to ensure such 
                        transportation.''.
            (3) Limitation on federal financial participation.--Section 
        1903(i) of the Social Security Act (42 U.S.C. 1396b(i)) is 
        amended by inserting after paragraph (8) the following new 
        paragraph:
            ``(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) 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) Medicaid Program Integrity Measures Related to Coverage of 
Nonemergency Medical Transportation.--
            (1) 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) 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) An examination of transportation brokers to 
                identify the range of safeguards against such fraud and 
                abuse to prevent improper payments for such 
                transportation.
                    (C) 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) 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) Stakeholder working group.--
                    (A) In general.--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 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) Topics.--The meetings convened under 
                subparagraph (A) shall--
                            (i) focus on ongoing challenges to Medicaid 
                        program integrity as well as leading practices 
                        to address such challenges; and
                            (ii) 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) 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 the Secretary.
            (3) 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 the Centers 
        for Medicare & Medicaid Services relating to Federal 
        requirements for nonemergency transportation to medically 
        necessary services under the 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) Nemt transportation provider and driver requirements.--
                    (A) State plan requirement.--Section 1902(a) of the 
                Social Security Act (42 U.S.C. 1396a(a)) is amended--
                            (i) by striking ``and'' at the end of 
                        paragraph (85);
                            (ii) by striking the period at the end of 
                        paragraph (86) and inserting ``; and''; and
                            (iii) by inserting after paragraph (86) the 
                        following new paragraph:
            ``(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--
                    ``(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;
                    ``(B) each such individual driver has a valid 
                driver's license;
                    ``(C) each such provider has in place a process to 
                address any violation of a State drug law; and
                    ``(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) Effective date.--
                            (i) 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) 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) 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.

            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 provide for the 
      continuing requirement of Medicaid coverage of nonemergency 
            transportation to medically necessary services.
```