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 TRANS-
PORTATION. 
(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’’. 
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(2) APPLICATION WITH RESPECT TO BENCHMARK 
BENEFIT
PACKAGES
AND
BENCHMARK
EQUIVALENT 
COVERAGE.—Section 1937(a)(1) of the Social Secu-
rity Act (42 U.S.C. 1396u–7(a)(1)) is amended— 
(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 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.’’. 
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(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 TRANS-
PORTATION.— 
(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 medi-
cally necessary services. Such study shall take into ac-
count the 2009 report of the Office of the Inspector 
General of the Department of Health and Human 
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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 non-
emergency 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 pro-
gram 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 & Med-
icaid Services. 
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(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 ob-
tain input from appropriate stakeholders to fa-
cilitate discussion and shared learning about the 
leading practices for improving Medicaid pro-
gram integrity, with respect to coverage of non-
emergency transportation to medically necessary 
services. 
(B) TOPICS.—The meetings convened under 
subparagraph (A) shall— 
(i) focus on ongoing challenges to Med-
icaid 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 serv-
ices, including unique considerations for 
specific groups of Medicaid beneficiaries 
meriting particular attention, such as 
American Indians and tribal land issues or 
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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 described 
in section 1902(a)(70)(B) of the Social Security 
Act (42 U.S.C. 1396a(a)(70)(B)), providers (in-
cluding 
transportation 
network 
companies), 
Medicaid patient advocates, and such other indi-
viduals 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 nec-
essary services under the Medicaid program under 
title XIX of the Social Security Act and update such 
guidance as necessary to ensure States have appro-
priate and current guidance in designing and admin-
istering coverage under the Medicaid program of non-
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emergency transportation to medically necessary serv-
ices. 
(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 exclusion 
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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 viola-
tions, 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 re-
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quires State legislation (other than legisla-
tion appropriating funds) in order for the 
plan to meet the additional requirement im-
posed by the amendments made by subpara-
graph (A), the State plan shall not be re-
garded as failing to comply with the re-
quirements of such title solely on the basis 
of its failure to meet this additional re-
quirement before the first day of the first 
calendar quarter beginning after the close of 
the first regular session of the State legisla-
ture that begins after the date of the enact-
ment of this Act. For purposes of the pre-
vious 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 na-
tion-wide data set under the Transformed Medicaid 
Statistical Information System to identify rec-
ommendations relating to coverage under the Med-
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icaid program under title XIX of the Social Security 
Act of nonemergency transportation to medically nec-
essary services. 
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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 
provide for the continuing requirement of Med-
icaid coverage of nonemergency transportation to 
medically necessary services. 
SEPTEMBER 17, 2020 
Reported with an amendment; committed to the Com-
mittee of the Whole House on the State of the Union 
and ordered to be printed 
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