1040 
(3) MEDICAID PROGRAM.—The term ‘‘Medicaid 
program’’ means, with respect to a State, the State 
program under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) (including any waiver or 
demonstration under such title or under section 1115 
of such Act (42 U.S.C. 1315) relating to such title). 
(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(5) STATE.—The term ‘‘State’’ has the meaning 
given such term for purposes of title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.). 
SEC. 103. COVERAGE AT NO COST SHARING OF COVID–19 
VACCINE AND TREATMENT. 
(a) MEDICAID.— 
(1) IN GENERAL.—Section 1905(a)(4) of the So-
cial Security Act (42 U.S.C. 1396d(a)(4)) is amend-
ed— 
(A) by striking ‘‘and (D)’’ and inserting 
‘‘(D)’’; and 
(B) by striking the semicolon at the end and 
inserting ‘‘; (E) during the portion of the emer-
gency period described in paragraph (1)(B) of 
section 1135(g) beginning on the date of the en-
actment of the Investing in America’s Health 
Care During the COVID–19 Pandemic Act, a
1041 
COVID–19 vaccine licensed under section 351 of 
the Public Health Service Act, or approved or 
authorized under sections 505 or 564 of the Fed-
eral Food, Drug, and Cosmetic Act, and admin-
istration of the vaccine; (F) during such portion 
of the emergency period described in paragraph 
(1)(B) of section 1135(g), items or services for 
the prevention or treatment of COVID–19, in-
cluding drugs approved or authorized under such 
section 505 or such section 564 or, without re-
gard 
to 
the 
requirements 
of 
section 
1902(a)(10)(B) (relating to comparability), in 
the case of an individual who is diagnosed with 
or presumed to have COVID–19, during such 
portion of such emergency period during which 
such individual is infected (or presumed in-
fected) with COVID–19, the treatment of a con-
dition that may complicate the treatment of 
COVID–19;’’. 
(2) PROHIBITION OF COST SHARING.— 
(A) IN GENERAL.—Subsections (a)(2) and 
(b)(2) of section 1916 of the Social Security Act 
(42 U.S.C. 1396o) are each amended— 
(i) in subparagraph (F), by striking 
‘‘or’’ at the end;
1042 
(ii) in subparagraph (G), by striking 
‘‘; and’’ and inserting ‘‘, or’’; and 
(iii) by adding at the end the following 
subparagraphs: 
‘‘(H) during the portion of the emergency 
period described in paragraph (1)(B) of section 
1135(g) beginning on the date of the enactment 
of this subparagraph, a COVID–19 vaccine li-
censed under section 351 of the Public Health 
Service Act, or approved or authorized under 
section 505 or 564 of the Federal Food, Drug, 
and Cosmetic Act, and the administration of 
such vaccine, or 
‘‘(I) during such portion of the emergency 
period described in paragraph (1)(B) of section 
1135(g), any item or service furnished for the 
treatment of COVID–19, including drugs ap-
proved or authorized under such section 505 or 
such section 564 or, in the case of an individual 
who is diagnosed with or presumed to have 
COVID–19, during the portion of such emer-
gency period during which such individual is in-
fected (or presumed infected) with COVID–19, 
the treatment of a condition that may complicate 
the treatment of COVID–19; and’’.
1043 
(B) APPLICATION
TO
ALTERNATIVE
COST 
SHARING.—Section 1916A(b)(3)(B) of the Social 
Security Act (42 U.S.C. 1396o–1(b)(3)(B)) is 
amended— 
(i) in clause (xi), by striking ‘‘any 
visit’’ and inserting ‘‘any service’’; and 
(ii) by adding at the end the following 
clauses: 
‘‘(xii) During the portion of the emer-
gency period described in paragraph (1)(B) 
of section 1135(g) beginning on the date of 
the enactment of this clause, a COVID–19 
vaccine licensed under section 351 of the 
Public Health Service Act, or approved or 
authorized under section 505 or 564 of the 
Federal Food, Drug, and Cosmetic Act, and 
the administration of such vaccine. 
‘‘(xiii) During such portion of the 
emergency period described in paragraph 
(1)(B) of section 1135(g), an item or service 
furnished for the treatment of COVID–19, 
including drugs approved or authorized 
under such section 505 or such section 564 
or, in the case of an individual who is diag-
nosed with or presumed to have COVID–19,
1044 
during such portion of such emergency pe-
riod during which such individual is in-
fected (or presumed infected) with COVID– 
19, the treatment of a condition that may 
complicate the treatment of COVID–19.’’. 
(C) 
CLARIFICATION.—The 
amendments 
made by this subsection shall apply with respect 
to a State plan of a territory in the same man-
ner as a State plan of one of the 50 States. 
(b) STATE PEDIATRIC VACCINE DISTRIBUTION PRO-
GRAM.—Section 1928 of the Social Security Act (42 U.S.C. 
1396s) is amended— 
(1) in subsection (a)(1)— 
(A) in subparagraph (A), by striking ‘‘; 
and’’ and inserting a semicolon; 
(B) in subparagraph (B), by striking the 
period and inserting ‘‘; and’’; and 
(C) by adding at the end the following sub-
paragraph: 
‘‘(C) during the portion of the emergency 
period described in paragraph (1)(B) of section 
1135(g) beginning on the date of the enactment 
of this subparagraph, each vaccine-eligible child 
(as defined in subsection (b)) is entitled to re-
ceive a COVID–19 vaccine from a program-reg-
1045 
istered provider (as defined in subsection (h)(7)) 
without charge for— 
‘‘(i) the cost of such vaccine; or 
‘‘(ii) the administration of such vac-
cine.’’; 
(2) in subsection (c)(2)— 
(A) in subparagraph (C)(ii), by inserting ‘‘, 
but, during the portion of the emergency period 
described in paragraph (1)(B) of section 1135(g) 
beginning on the date of the enactment of the In-
vesting in America’s Health Care During the 
COVID–19 Pandemic Act, may not impose a fee 
for the administration of a COVID–19 vaccine’’ 
before the period; and 
(B) by adding at the end the following sub-
paragraph: 
‘‘(D) The provider will provide and admin-
ister an approved COVID–19 vaccine to a vac-
cine-eligible child in accordance with the same 
requirements as apply under the preceding sub-
paragraphs to the provision and administration 
of a qualified pediatric vaccine to such a child.’’; 
and 
(3) in subsection (d)(1), in the first sentence, by 
inserting ‘‘, including, during the portion of the emer-
1046 
gency period described in paragraph (1)(B) of section 
1135(g) beginning on the date of the enactment of the 
Investing in America’s Health Care During the 
COVID–19 Pandemic Act, with respect to a COVID– 
19 vaccine licensed under section 351 of the Public 
Health Service Act, or approved or authorized under 
section 505 or 564 of the Federal Food, Drug, and 
Cosmetic Act’’ before the period. 
(c) CHIP.— 
(1) IN GENERAL.—Section 2103(c) of the Social 
Security Act (42 U.S.C. 1397cc(c)) is amended by 
adding at the end the following paragraph: 
‘‘(11) COVERAGE
OF
COVID–19
VACCINES
AND 
TREATMENT.—Regardless of the type of coverage elect-
ed by a State under subsection (a), child health assist-
ance provided under such coverage for targeted low- 
income children and, in the case that the State elects 
to provide pregnancy-related assistance under such 
coverage pursuant to section 2112, such pregnancy-re-
lated assistance for targeted low-income pregnant 
women (as defined in section 2112(d)) shall include 
coverage, during the portion of the emergency period 
described in paragraph (1)(B) of section 1135(g) be-
ginning on the date of the enactment of this para-
graph, of—
1047 
‘‘(A) a COVID–19 vaccine licensed under 
section 351 of the Public Health Service Act, or 
approved or authorized under section 505 or 564 
of the Federal Food, Drug, and Cosmetic Act, 
and the administration of such vaccine; and 
‘‘(B) any item or service furnished for the 
treatment of COVID–19, including drugs ap-
proved or authorized under such section 505 or 
such section 564, or, in the case of an individual 
who is diagnosed with or presumed to have 
COVID–19, during the portion of such emer-
gency period during which such individual is in-
fected (or presumed infected) with COVID–19, 
the treatment of a condition that may complicate 
the treatment of COVID–19.’’. 
(2) PROHIBITION
OF
COST
SHARING.—Section 
2103(e)(2) of the Social Security Act (42 U.S.C. 
1397cc(e)(2)), as amended by section 6004(b)(3) of the 
Families First Coronavirus Response Act, is amend-
ed— 
(A) in the paragraph header, by inserting 
‘‘A
COVID–19
VACCINE, COVID–19
TREATMENT,’’ 
before ‘‘OR
PREGNANCY-RELATED
ASSISTANCE’’; 
and
1048 
(B) by striking ‘‘visits described in section 
1916(a)(2)(G), or’’ and inserting ‘‘services de-
scribed in section 1916(a)(2)(G), vaccines de-
scribed in section 1916(a)(2)(H) administered 
during the portion of the emergency period de-
scribed in paragraph (1)(B) of section 1135(g) 
beginning on the date of the enactment of the In-
vesting in America’s Health Care During the 
COVID–19 Pandemic Act, items or services de-
scribed in section 1916(a)(2)(I) furnished during 
such emergency period, or’’. 
(d) CONFORMING AMENDMENTS.—Section 1937 of the 
Social Security Act (42 U.S.C. 1396u–7) is amended— 
(1) in subsection (a)(1)(B), by inserting ‘‘, under 
subclause (XXIII) of section 1902(a)(10)(A)(ii),’’ after 
‘‘section 1902(a)(10)(A)(i)’’; and 
(2) in subsection (b)(5), by adding before the pe-
riod the following: ‘‘, and, effective on the date of the 
enactment of the Investing in America’s Health Care 
During the COVID–19 Pandemic Act, must comply 
with subparagraphs (F) through (I) of subsections 
(a)(2) and (b)(2) of section 1916 and subsection 
(b)(3)(B) of section 1916A’’. 
(e) EFFECTIVE DATE.—The amendments made by this 
section shall take effect on the date of enactment of this Act
1049 
and shall apply with respect to a COVID–19 vaccine begin-
ning on the date that such vaccine is licensed under section 
351 of the Public Health Service Act (42 U.S.C. 262), or 
approved or authorized under section 505 or 564 of the Fed-
eral Food, Drug, and Cosmetic Act. 
SEC. 104. OPTIONAL COVERAGE AT NO COST SHARING OF 
COVID–19 TREATMENT AND VACCINES UNDER 
MEDICAID FOR UNINSURED INDIVIDUALS. 
(a) IN GENERAL.—Section 1902(a)(10) of the Social 
Security Act (42 U.S.C. 1396a(a)(10) is amended, in the 
matter following subparagraph (G), by striking ‘‘and any 
visit described in section 1916(a)(2)(G)’’ and inserting the 
following: ‘‘, any COVID–19 vaccine that is administered 
during any such portion (and the administration of such 
vaccine), any item or service that is furnished during any 
such portion for the treatment of COVID–19, including 
drugs approved or authorized under section 505 or 564 of 
the Federal Food, Drug, and Cosmetic Act, or, in the case 
of an individual who is diagnosed with or presumed to have 
COVID–19, during the period such individual is infected 
(or presumed infected) with COVID–19, the treatment of 
a condition that may complicate the treatment of COVID– 
19, and any services described in section 1916(a)(2)(G)’’. 
(b) DEFINITION OF UNINSURED INDIVIDUAL.—
1050 
(1) IN
GENERAL.—Subsection (ss) of section 
1902 of the Social Security Act (42 U.S.C. 1396a) is 
amended to read as follows: 
‘‘(ss) UNINSURED INDIVIDUAL DEFINED.—For pur-
poses of this section, the term ‘uninsured individual’ means, 
notwithstanding any other provision of this title, any indi-
vidual who is not covered by minimum essential coverage 
(as defined in section 5000A(f)(1) of the Internal Revenue 
Code of 1986).’’. 
(2) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall take effect and apply as if in-
cluded in the enactment of the Families First 
Coronavirus Response Act (Public Law 116–127). 
(c) CLARIFICATION REGARDING EMERGENCY SERV-
ICES FOR CERTAIN INDIVIDUALS.—Section 1903(v)(2) of 
the Social Security Act (42 U.S.C. 1396b(v)(2)) is amended 
by adding at the end the following flush sentence: 
‘‘For purposes of subparagraph (A), care and services 
described in such subparagraph include any in vitro 
diagnostic product described in section 1905(a)(3)(B) 
(and the administration of such product), any 
COVID–19 vaccine (and the administration of such 
vaccine), any item or service that is furnished for the 
treatment of COVID–19, including drugs approved or 
authorized under section 505 or 564 of the Federal
1051 
Food, Drug, and Cosmetic Act, or a condition that 
may complicate the treatment of COVID–19, and any 
services described in section 1916(a)(2)(G).’’. 
(d) INCLUSION OF COVID–19 CONCERN AS AN EMER-
GENCY CONDITION.—Section 1903(v)(3) of the Social Secu-
rity Act (42 U.S.C. 1396b(v)(3)) is amended by adding at 
the end the following flush sentence: 
‘‘Such term includes any indication that an alien de-
scribed in paragraph (1) may have contracted 
COVID–19.’’. 
SEC. 105. MEDICAID COVERAGE FOR CITIZENS OF FREELY 
ASSOCIATED STATES. 
(a) IN GENERAL.—Section 402(b)(2) of the Personal 
Responsibility and Work Opportunity Reconciliation Act 
of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at the 
end the following new subparagraph: 
‘‘(G) MEDICAID EXCEPTION FOR CITIZENS 
OF FREELY ASSOCIATED STATES.—With respect 
to eligibility for benefits for the designated Fed-
eral program defined in paragraph (3)(C) (relat-
ing to the Medicaid program), section 401(a) 
and paragraph (1) shall not apply to any indi-
vidual who lawfully resides in 1 of the 50 States 
or the District of Columbia in accordance with 
the Compacts of Free Association between the
1052 
Government of the United States and the Gov-
ernments of the Federated States of Micronesia, 
the Republic of the Marshall Islands, and the Re-
public of Palau and shall not apply, at the op-
tion of the Governor of Puerto Rico, the Virgin 
Islands, Guam, the Northern Mariana Islands, 
or American Samoa as communicated to the Sec-
retary of Health and Human Services in writ-
ing, to any individual who lawfully resides in 
the respective territory in accordance with such 
Compacts.’’. 
(b) EXCEPTION TO 5–YEAR LIMITED ELIGIBILITY.— 
Section 403(d) of such Act (8 U.S.C. 1613(d)) is amended— 
(1) in paragraph (1), by striking ‘‘or’’ at the 
end; 
(2) in paragraph (2), by striking the period at 
the end and inserting ‘‘; or’’; and 
(3) by adding at the end the following new para-
graph: 
‘‘(3) 
an 
individual 
described 
in 
section 
402(b)(2)(G), but only with respect to the designated 
Federal program defined in section 402(b)(3)(C).’’. 
(c) DEFINITION
OF
QUALIFIED
ALIEN.—Section 
431(b) of such Act (8 U.S.C. 1641(b)) is amended—
1053 
(1) in paragraph (6), by striking ‘‘; or’’ at the 
end and inserting a comma; 
(2) in paragraph (7), by striking the period at 
the end and inserting ‘‘, or’’; and 
(3) by adding at the end the following new para-
graph: 
‘‘(8) an individual who lawfully resides in the 
United States in accordance with a Compact of Free 
Association referred to in section 402(b)(2)(G), but 
only with respect to the designated Federal program 
defined in section 402(b)(3)(C) (relating to the Med-
icaid program).’’. 
(d) 
APPLICATION
TO
STATE
PLANS.—Section 
1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(A)(i)) is amended by inserting after subclause 
(IX) the following: 
‘‘(X) who are described in section 
402(b)(2)(G) of the Personal Responsi-
bility and Work Opportunity Rec-
onciliation Act of 1996 and eligible for 
benefits under this title by reason of 
application of such section;’’. 
(e) CONFORMING AMENDMENTS.—Section 1108 of the 
Social Security Act (42 U.S.C. 1308) is amended—
1054 
(1) in subsection (f), in the matter preceding 
paragraph (1), by striking ‘‘subsections (g) and (h) 
and section 1935(e)(1)(B)’’ and inserting ‘‘subsections 
(g), (h), and (i) and section 1935(e)(1)(B)’’; and 
(2) by adding at the end the following: 
‘‘(i) EXCLUSION OF MEDICAL ASSISTANCE EXPENDI-
TURES FOR CITIZENS OF FREELY ASSOCIATED STATES.— 
Expenditures for medical assistance provided to an indi-
vidual described in section 431(b)(8) of the Personal Re-
sponsibility and Work Opportunity Reconciliation Act of 
1996 (8 U.S.C. 1641(b)(8)) shall not be taken into account 
for purposes of applying payment limits under subsections 
(f) and (g).’’. 
(f) EFFECTIVE DATE.—The amendments made by this 
section shall apply to benefits for items and services fur-
nished on or after the date of the enactment of this Act. 
SEC. 106. TEMPORARY INCREASE IN MEDICAID DSH ALLOT-
MENTS. 
(a) IN GENERAL.—Section 1923(f)(3) of the Social Se-
curity Act (42 U.S.C. 1396r–4(f)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘and sub-
paragraph (E)’’ and inserting ‘‘and subparagraphs 
(E) and (F)’’; and 
(2) by adding at the end the following new sub-
paragraph:
1055 
‘‘(F) TEMPORARY
INCREASE
IN
ALLOT-
MENTS DURING CERTAIN PUBLIC HEALTH EMER-
GENCY.—The DSH allotment for any State for 
each of fiscal years 2020 and 2021 is equal to 
102.5 percent of the DSH allotment that would 
be determined under this paragraph for the State 
for each respective fiscal year without applica-
tion of this subparagraph, notwithstanding sub-
paragraphs (B) and (C). For each fiscal year 
after fiscal year 2021, the DSH allotment for a 
State for such fiscal year is equal to the DSH 
allotment that would have been determined 
under this paragraph for such fiscal year if this 
subparagraph had not been enacted.’’. 
(b) DSH ALLOTMENT
ADJUSTMENT
FOR
TEN-
NESSEE.—Section 1923(f)(6)(A)(vi) of the Social Security 
Act (42 U.S.C. 1396r–4(f)(6)(A)(vi)) is amended— 
(1) by striking ‘‘Notwithstanding any other pro-
vision of this subsection’’ and inserting the following: 
‘‘(I) 
IN
GENERAL.—Notwith-
standing any other provision of this 
subsection (except as provided in sub-
clause (II) of this clause)’’; and 
(2) by adding at the end the following:
1056 
‘‘(II) TEMPORARY
INCREASE
IN 
ALLOTMENTS.—The DSH allotment for 
Tennessee for each of fiscal years 2020 
and 
2021 
shall 
be 
equal 
to 
$54,427,500.’’. 
(c) SENSE OF CONGRESS.—It is the sense of Congress 
that a State should prioritize making payments under the 
State plan of the State under title XIX of the Social Secu-
rity Act (42 U.S.C. 1396 et seq.) (or a waiver of such plan) 
to disproportionate share hospitals that have a higher share 
of COVID–19 patients relative to other such hospitals in 
the State. 
SEC. 107. ALLOWING FOR MEDICAL ASSISTANCE UNDER 
MEDICAID FOR INMATES DURING 30-DAY PE-
RIOD PRECEDING RELEASE. 
(a) IN GENERAL.—The subdivision (A) following 
paragraph (30) of section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d(a)) is amended by inserting ‘‘and ex-
cept during the 30-day period preceding the date of release 
of such individual from such public institution’’ after ‘‘med-
ical institution’’. 
(b) REPORT.—Not later than June 30, 2022, the Med-
icaid and CHIP Payment and Access Commission shall 
submit a report to Congress on the Medicaid inmate exclu-
sion under the subdivision (A) following paragraph (30) of
1057 
section 1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)). Such report may, to the extent practicable, in-
clude the following information: 
(1) The number of incarcerated individuals who 
would otherwise be eligible to enroll for medical as-
sistance under a State plan approved under title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.) (or 
a waiver of such a plan). 
(2) Access to health care for incarcerated indi-
viduals, including a description of medical services 
generally available to incarcerated individuals. 
(3) A description of current practices related to 
the discharge of incarcerated individuals, including 
how prisons interact with State Medicaid agencies to 
ensure that such individuals who are eligible to enroll 
for medical assistance under a State plan or waiver 
described in paragraph (1) are so enrolled. 
(4) If determined appropriate by the Commis-
sion, recommendations for Congress, the Department 
of Health and Human Services, or States regarding 
the Medicaid inmate exclusion. 
(5) Any other information that the Commission 
determines would be useful to Congress.
1058 
SEC. 108. 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 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
1059 
(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.’’. 
(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
1060 
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 
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
1061 
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. 
(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-
1062 
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 
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
1063 
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-
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—
1064 
(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 
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
1083 
the last day of the month in which the emergency 
period (as described in section 1135(g)(1)(B)) 
ends.’’. 
(b) 
COVERAGE
PERIOD
FOR
INDIVIDUALS 
TRANSITIONING
FROM
OTHER
COVERAGE.—Section 
1838(e) of the Social Security Act (42 U.S.C. 1395q(e)) is 
amended— 
(1) by striking ‘‘pursuant to section 1837(i)(3) 
or 1837(i)(4)(B)—’’ and inserting the following: 
‘‘pursuant to— 
‘‘(1) section 1837(i)(3) or 1837(i)(4)(B)—’’; 
(2) by redesignating paragraphs (1) and (2) as 
subparagraphs (A) and (B), respectively, and moving 
the indentation of each such subparagraph 2 ems to 
the right; 
(3) by striking the period at the end of the sub-
paragraph (B), as so redesignated, and inserting ‘‘; 
or’’; and 
(4) by adding at the end the following new para-
graph: 
‘‘(2) section 1837(i)(5), the coverage period shall 
begin on the first day of the month following the 
month in which the individual so enrolls.’’. 
(c) FUNDING.—The Secretary of Health and Human 
Services shall provide for the transfer from the Federal Hos-