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 serv-
ices. 
Be it enacted by the Senate and House of Representa-
tives 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 COV-
ERAGE 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 provi-
sion for utilization’’; and 
(B) by inserting after ‘‘supervision of ad-
ministration of the plan’’ the following: ‘‘, and, 
subject to section 1903(i), including a specifica-
tion that the single State agency described in 
paragraph (5) will ensure necessary transpor-
tation 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 BENCH-
MARK BENEFIT PACKAGES AND BENCHMARK EQUIV-
ALENT COVERAGE.—Section 1937(a)(1) of the Social
Security Act (42 U.S.C. 1396u–7(a)(1)) is amend-
ed— 
(A) in subparagraph (A), by striking ‘‘sub-
section (E)’’ and inserting ‘‘subparagraphs (E) 
and (F)’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(F) NECESSARY TRANSPORTATION.—Not-
withstanding the preceding provisions of this 
paragraph, a State may not provide medical as-
sistance through the enrollment of an individual 
with benchmark coverage or benchmark equiva-
lent coverage described in subparagraph (A)(i) 
unless, subject to section 1903(i)(9) and in ac-
cordance with section 1902(a)(4), the bench-
mark 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 PAR-
TICIPATION.—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 sec-
tion 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 transpor-
tation furnished on or after such date. 
(b) MEDICAID PROGRAM INTEGRITY MEASURES RE-
LATED
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 con-
duct 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 Med-
ical 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 re-
spect to coverage under the Medicaid program 
of nonemergency transportation to medically 
necessary services. 
(B) An examination of transportation bro-
kers to identify the range of safeguards against 
such fraud and abuse to prevent improper pay-
ments 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 Medi-
care & 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 nec-
essary services. 
(B) 
TOPICS.—The 
meetings 
convened 
under subparagraph (A) shall— 
(i) focus on ongoing challenges to 
Medicaid program integrity as well as lead-
ing 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 serv-
ices, 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 dis-
abilities. 
(C) 
STAKEHOLDERS.—Stakeholders 
de-
scribed in subparagraph (A) shall include indi-
viduals from State Medicaid programs, brokers 
for nonemergency transportation to medically 
necessary services that meet the criteria de-
scribed in section 1902(a)(70)(B) of the Social 
Security Act (42 U.S.C. 1396a(a)(70)(B)), pro-
viders (including transportation network compa-
nies), 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 Serv-
ices, shall assess guidance issued to States by the 
Centers for Medicare & Medicaid Services relating to 
Federal requirements for nonemergency transpor-
tation to medically necessary services under the 
Medicaid program under title XIX of the Social Se-
curity 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 in-
clude attestation, that ensures that, with respect to 
any provider (including a transportation network 
company) or individual driver of nonemergency 
transportation to medically necessary services receiv-
ing 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 sec-
tion 1128B(f)) and is not listed on the exclu-
sion list of the Inspector General of the Depart-
ment 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 pro-
gram the driving history, including any traffic 
violations, of each such individual driver em-
ployed 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
LEGISLA-
TION REQUIRED.—In the case of a State 
plan for medical assistance under title XIX 
of the Social Security Act which the Sec-
retary of Health and Human Services de-
termines 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 ad-
ditional 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 Serv-
ices, 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 Se-
curity Act of nonemergency transportation to medi-
cally necessary services. 
Passed the House of Representatives September 21, 
2020. 
Attest: 
Clerk.