Nonemergency Medical Transportation Advisory Committee policy proposal

Language

Nain Points:
County auministeieu piogiam iequiiing that all pioviueis bill the county.
Counties will manage the level of seivice application.
o The application no longei iequiies meuical peisonal to auministei
anu shoulu theiefoie cost less.
Counties aie iequiieu to use a softwaie piogiam that veiifies tiip
infoimation with billing anu ensuies piompt payment to pioviueis.
uieatei emphasis anu iequiiements to encouiage the use of public
tianspoitation when available anu appiopiiate
Recommenuation of one FTE at BBS to pioviue oveisight anu NENT uata
collection
New NENT pioviuei iegulations in NNB0T Law
o The new iequiiements will iequiie all NENT pioviueis aie ceitifieu
as NENT pioviueis. This may iequiie an inciease of staff at NNB0T
to license these pioviueis. It is iecommenueu that pioviueis pay a fee
to mitigate the costs of hiiing new staff.
o Theie may be an inciease in pioviuei eniollment at BBS.
Rates
o Peisonal mileage inciease
o volunteei mileage inciease
o New Noues of tianspoitation anu new iates
NENT Committee
o Recommenueu to meet at minimum twice yeaily anu as neeueu.


256B.0625 Covered Services
Subd. 17. Transportation costs. (a) Medical assistance covers medical transportation
costs incurred solely for obtaining emergency medical care or transportation costs
incurred by eligible persons in obtaining emergency or nonemergency medical care when
paid directly to an ambulance company, common carrier or other recognized providers of
transportation services.
Medical transportation must be provided by:
(1) an ambulance, as defined in section 144E.001, subdivision 2;
(2) special transportation nonemergency medical transportation service vehicle; or
(3) common carrier including, but not limited to, bus, light rail taxicab, other
commercial carrier, or private automobile.
(b) Medical assistance covers special transportation nonemergency medical
transportation services, as defined as in Minnesota Rules, part 9505.0315, subpart 1, item
F, if the recipient has a physical or mental impairment that would prohibit the recipient
from safely accessing and using a bus, taxi, other commercial transportation, or private
automobile ., motor vehicle transportation provided by a public or private transportation
services provider or person that is designed to serve Minnesota Health Care Programs
beneficiaries to obtain covered medical services who do not require ambulance service,


as defined in Minnesota Statutes, section 144E.001, subdivision 3.

The commissioner may use the county level of service assessment an order by the
recipient's attending physician to certify a specific mode or level of nonemergency
medical transportation service that the recipient requires special transportation services.
Special transportation Nonemergency Medical Transportation service providers shall
perform driver-assisted services for eligible individuals. Driver-assisted service includes
passenger pickup at and return to the individual's residence or place of business,
assistance with admittance of the individual to the medical facility, and assistance in
passenger securement or in securing of wheelchairs or stretchers in the vehicle. Special
transportation providers must obtain written documentation from the health care service
provider who is serving the recipient being transported, identifying the time that the
recipient arrived. Special transportation Nonemergency Medical Transportation service
providers may not bill for separate base rates for the continuation of a trip beyond the
original destination. Special transportation Nonemergency Medical Transportation
service providers must take recipients to the health care provider, using the most direct
route, and must not exceed 30 miles for a trip to a primary care provider or 60 miles for a
trip to a specialty care provider, unless the recipient receives authorization from the local
agency.

The minimum medical assistance reimbursement rates for special transportation
nonemergency medical transportation services are:
(1)(i) $17XX for the base rate and $1.35XX per mile for special transportation
nonemergency medical transportation services to eligible persons who need a wheelchair-
accessible van lift-equipped/ramp transport;
(ii) $11.50XX for the base rate and $1.30XX per mile for special transportation
nonemergency medical transportation services to eligible persons who do not need a
wheelchair-accessible van assisted transport; and
(iii) $60XX for the base rate and $2.40XX per mile, and an attendant rate of $9
XX per trip, for special transportation nonemergency medical transportation services to
eligible persons who need a stretcher-accessible vehicle stretcher;
(iv) $XX for the base rate and $XX per mile, for nonemergency medical
transportation to eligible persons who need protected transport.
(v) $XX for the base rate and $XX per mile, for nonemergency medical
transportation to eligible persons who need unassisted transport.
(2) the base rates for special transportation nonemergency medical transportation
services in areas defined under RUCA to be super rural shall be equal to the
reimbursement rate established in clause (1) plus 11.3 percent; and
(3) for special transportation nonemergency medical transportation services in
areas defined under RUCA to be rural or super rural areas:
(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to
125 percent of the respective mileage rate in clause (1); and
(ii) for a trip between over 18 and 50 miles, mileage reimbursement shall be equal
to 112.5 percent of the respective mileage rate in clause (1).
(c) For purposes of reimbursement rates for special transportation nonemergency
medical transportation services under paragraph


(b), the zip code of the recipient's place of residence shall determine whether the
urban, rural, or super rural reimbursement rate applies.
(d) For purposes of this subdivision, "rural urban commuting area" or "RUCA"
means a census-tract based classification system under which a geographical area is
determined to be urban, rural, or super rural.
(e) Effective for services provided on or after September 1, 2011, nonemergency
transportation rates, including special transportation, taxi, and other commercial carriers,
are reduced 4.5 percent. Payments made to managed care plans and county-based
purchasing plans must be reduced 4.5% for services provided on or after January 1, 2012,
to reflect this reduction.
(4) Mileage reimbursement for nonemergency medical transportation services is
subject to a Fuel Adjustment Rate. The per-mile rate will increase 1% for every 10 cents
above the $XX per gallon
(5) The commissioner will increase nonemergency medical transportation rates to
reflect any savings realized from changes made to the program in FY2014-2015.

Subd. 17a. Payment for ambulance services. (a) Medical assistance covers ambulance
services. Providers shall bill ambulance services according to Medicare criteria.
Nonemergency ambulance services shall not be paid as emergencies. Effective for
services rendered on or after July 1, 2001, medical assistance payments for ambulance
services shall be paid at the Medicare reimbursement rate or at the medical assistance
payment rate in effect on July 1, 2000, whichever is greater.
(b) Effective for services provided on or after September 1, 2011, ambulance
services payment rates are reduced 4.5 percent. Payments made to managed care plans
and county-based purchasing plans must be reduced for services provided on or after
January 1, 2012, to reflect this reduction.

Subd. 18. Bus or taxicab transportation. To the extent authorized by rule of the state
agency, medical assistance covers the most appropriate and cost-effective form of
transportation incurred by any ambulatory eligible person for obtaining nonemergency
medical care.

Subd. 18a. Access to medical services. (a) Medical assistance reimbursement for meals
for persons traveling to receive medical care may not exceed $5.50 for breakfast, $6.50
for lunch, or $8 for dinner.
(b) Medical assistance reimbursement for lodging for persons traveling to receive
medical care may not exceed $50 per day unless prior authorized by the local agency.
(c) Medical assistance direct mileage reimbursement to the eligible person or the
eligible person's driver may not exceed 20 cents per mile.
(d) Regardless of the number of employees that an enrolled health care provider
may have, medical assistance covers sign and oral language interpreter services when
provided by an enrolled health care provider during the course of providing a direct,
person-to-person covered health care service to an enrolled recipient with limited English
proficiency or who has a hearing loss and uses interpreting services. Coverage for face-
to-face oral language interpreter services shall be provided only if the oral language
interpreter used by the enrolled health care provider is listed in the registry or roster


established under section 144.058.

Subd. 18b. Broker dispatching prohibition. The commissioner shall not use a broker or
coordinator for any purpose related to transportation services under subdivision 18.

Subd. 18c. Nonemergency Medical Transportation Advisory Committee. (a) The
Nonemergency Medical Transportation Advisory Committee shall advise the
commissioner on the administration of nonemergency medical transportation covered
under medical assistance. The advisory committee shall meet at least quarterly and may
meet more frequently as required by the commissioner. The advisory committee shall
annually elect a chair from among its members, who shall work with the commissioner or
the commissioner's designee to establish the agenda for each meeting. The commissioner,
or the commissioner's designee, shall attend all advisory committee meetings.
(b) The Nonemergency Medical Transportation Advisory Committee shall advise
and make recommendations to the commissioner on:
(1) the development of, and periodic updates to, all updates to the a
Nonemergency Medical Transportation policy manual for nonemergency medical
transportation services;
(2) policies and a funding source for reimbursing no-load miles;
(3) policies to prevent waste, fraud, and abuse, and to improve the efficiency of
the nonemergency medical transportation system;
(4) other issues identified in the 2011 evaluation report by the Office of the
Legislative Auditor on medical nonemergency transportation; and
(5) other aspects of the nonemergency medical transportation system, as requested
by the commissioner.
(c) The Nonemergency Medical Transportation Advisory Committee shall
coordinate its activities with the Minnesota Council on Transportation Access established
under section 174.285. The chair of the advisory committee, or the chair's designee, shall
attend all meetings of the Minnesota Council on Transportation Access.
(d) The Nonemergency Medical Transportation Advisory Committee shall expire
December 1, 20149.

Subd. 18d. Advisory committee members. (a) The Nonemergency Medical
Transportation Advisory Committee consists of:
(1) two voting members who represent counties, at least one of whom must
represent a county or counties other than Anoka, Carver, Chisago, Dakota, Hennepin,
Isanti, Ramsey, Scott, Sherburne, Washington, and Wright;
(2) four voting members who represent medical assistance recipients, including
persons with physical and developmental disabilities, persons with mental illness,
seniors, children, and low-income individuals;
(3) four voting members who represent providers that deliver nonemergency
medical transportation services to medical assistance enrollees;
(4) two voting members of the house of representatives, one from the majority
party and one from the minority party, appointed by the speaker of the house, and two
voting members from the senate, one from the majority party and one from the minority
party, appointed by the Subcommittee on Committees of the Committee on Rules and


Administration;
(5) one voting member who represents demonstration providers as defined in
section 256B.69, subdivision 2;
(6) one voting member who represents an organization that contracts with state or
local governments to coordinate transportation services for medical assistance enrollees;
and
(7) the commissioner of transportation or the commissioner's designee, who shall
serve as a voting member.
(b) Members of the advisory committee shall not be employed by the Department
of Human Services. Members of the advisory committee shall receive no compensation.

Subd. 18e. Single administrative structure and delivery system. (a) The county shall
administer nonemergency medical transportation services.
The county administrative structure and delivery system must:
(1) utilize the modes of transportation as recommended by the nonemergency
medical transportation advisory committee;
(2) adhere to the policies as defined in the nonemergency medical transportation
policy manual;
(3) utilize a software system that verifies trip information with billing and ensures
prompt payment to Nonemergency Medical Transportation providers; and
(4) provide data to the department of human services on complaints, no shows,
cancelled trips and number of trips by mode.
(b) The commissioner shall: (1) conduct random on street observations of
providers to verify that the mode of Nonemergency Medical Transportations is
appropriate and client is going to a Minnesota Health Care Program approved
appointment.
(2) Verify complaints for accuracy and post information on the agencys website.
commissioner shall implement a single administrative structure and delivery system for
nonemergency medical transportation, beginning July 1, 2014. The single administrative
structure and delivery system must:
(1) eliminate the distinction between access transportation services and special
transportation services;
(2) enable all medical assistance recipients to follow the same process to obtain
nonemergency medical transportation, regardless of their level of need;
(3) provide a single oversight framework for all providers of nonemergency
medical transportation; and
(4) provide flexibility in service delivery, recognizing that clients fall along a
continuum of needs and resources.
(b) The commissioner shall present to the legislature, by January 15, 2014,
legislation necessary to implement the single administrative structure and delivery system
for nonemergency medical transportation.
(c) In developing the single administrative structure and delivery system and the
draft legislation, the commissioner shall consult with the Nonemergency Medical
Transportation Advisory Committee.

Subd. 18f. Enrollee assessment process. (a) The commissioner shall require that the


administrator of nonemergency medical transportation county shall adhere to the
assessment process recommended by the Nonemergency Medical Transportation
Advisory Committee. The commissioner shall implement, by July 1, 2014, the
comprehensive, statewide, standard assessment process for medical assistance enrollees
seeking nonemergency medical transportation services recommended by the
Nonemergency Medical Transportation Advisory Committee. Beginning July 1, 2015, the
county shall administer the assessment process recommended by the Nonemergency
Medical Transportation Advisory Committee. The assessment process must identify a
client's level of needs, abilities, and resources, and match the client with the mode of
transportation in the client's service area that best meets those needs.
(b) The assessment process must:
(1) address mental health diagnoses when determining the most appropriate mode
of transportation;
(2) base decisions on clearly defined criteria that are available to clients,
providers, and counties;
(3) be standardized across the state and be aligned with other similar existing
processes;
(4) allow for extended periods of eligibility for certain types of nonemergency
transportation when a client's condition is unlikely to change; and
(5) increase the use of public transportation when appropriate and cost-effective,
including offering monthly bus passes to clients.

Subd. 18g. Use of standardized measures. The commissioner, in consultation with
the Nonemergency Medical Transportation Advisory Committee, shall establish
performance measures to assess the cost-effectiveness and quality of nonemergency
medical transportation. At a minimum, performance measures should include the number
of unique participants served by type of transportation provider, number of trips provided
by type of transportation provider, and cost per trip by type of transportation provider.
The commissioner must also consider the measures identified in the January 2012
Department of Human Services report to the legislature on nonemergency medical
transportation. Beginning in calendar year 20135, the commissioner shall collect, audit,
and analyze performance data on nonemergency medical transportation annually and
report this information on the agency's Web site. The commissioner shall periodically
supplement this information with the results of consumer surveys of the quality of
services, and shall make these survey findings available to the public on the agency Web
site.


Below is proposed language to coordinate with NEMT advisory committee
recommendation to create new NEMT specific rule. NOTE: this is based on
DOT statute but 174.29 WILL NOT be changed; there will be no changes to
special transportation statute. The new language may be placed in 256B, if
appropriate.

174.29 COORDINATION OF SPECIAL NONEMERGENCY MEDICAL
TRANSPORTATION SERVICE.


Subdivision 1.Definition. For the purpose of sections 174.29 and 174.30 "special
nonemergency medical transportation service" means motor vehicle transportation
provided on a regular basis by a public or private entity or person that is designed
exclusively or primarily to serve Medicaid beneficiaries to obtain covered medical
services individuals who are elderly or disabled and who are unable to use regular means
of transportation but do not require ambulance service, as defined in section 144E.001,
subdivision 3. Special Nonemergency medical transportation service includes but is not
limited to service provided by specially equipped buses, vans, taxis, and volunteers
driving private automobiles.
Subd. 2.Coordination of services. In order to provide more adequate access to
transportation service for the elderly and disabled with Medicaid beneficiaries with
nonemergency medical special transportation needs and to more efficiently utilize public
and private funds expended for that purpose, all state agencies that assist, provide,
reimburse, or regulate special nonemergency medical transportation services shall
promote, support, and facilitate coordination of those services with other special
nonemergency medical transportation services and with regular transportation services
offered to the general public.
Subd. 3. [Expired]
History: Ex1979 c 1 s 27; 1982 c 556 s 1; 1986 c 420 s 4; 1987 c 209 s 39; 1987 c 384
art 2 s 43; 1997 c 199 s 14; 2005 c 56 s 1


174.30 OPERATING STANDARDS FOR SPECIAL NONEMERGENCY
MEDICAL TRANSPORTATION SERVICE.
Subdivision 1.Applicability. (a) The operating standards for special nonemergency
medical transportation service adopted under this section do not apply to special
nonemergency medical transportation provided by:
(1) a common carrier operating on fixed routes and schedules;
(2) a volunteer driver using a private automobile;
(3) a school bus as defined in section 169.011, subdivision 71; or
(4) an emergency ambulance regulated under chapter 144:
(b) The operating standards adopted under this section only apply to providers of special
nonemergency medical transportation service who receive grants or other financial
assistance from either the state or the federal government, or both, to provide or assist in
providing that service; except that the operating standards adopted under this section do
not apply to any nursing home licensed under section 144A.02, to any board and care
facility licensed under section 144.50, or to any day training and habilitation services, day
care, or group home facility licensed under sections 245A.01 to 245A.19 unless the
facility or program provides transportation to nonresidents on a regular basis and the
facility receives reimbursement, other than per diem payments, for that service under
rules promulgated by the commissioner of human services.
(c) Notwithstanding paragraph (b), the operating standards adopted under this section do
not apply to any vendor of services licensed under chapter 245B that provides
transportation services to consumers or residents of other vendors licensed under chapter
245B and transports 15 or fewer persons, including consumers or residents and the driver.
Subd. 2.Rules. (a) The commissioner of transportation shall adopt by rule standards for


the operation of vehicles used to provide special nonemergency medical transportation
service which are reasonably necessary to protect the health and safety of individuals
using that service. The commissioner, as far as practicable, consistent with the purpose of
the standards, shall avoid adoption of standards that unduly restrict any public or private
entity or person from providing special nonemergency medical transportation service
because of the administrative or other cost of compliance.
(b) Standards adopted under this section must include but are not limited to:
(1) qualifications of drivers and attendants, including driver training requirements
that must be met before a driver provides special transportation;
(2) safety of vehicles and necessary safety equipment;
(3) general requirements concerning inspection and maintenance of vehicles,
replacement vehicles, standard vehicle equipment, and specialized equipment necessary
to ensure vehicle usability and safety for disabled persons; and
(4) minimum insurance requirements.
(c) The commissioner shall consult with the Council on Disability before making
a decision on a variance from the standards.

Subd. 2a.Vehicle and equipment safety; provider responsibilities. (a) Every special
nonemergency medical transportation service provider shall systematically inspect,
repair, and maintain, or cause to be inspected, repaired, and maintained, the vehicles and
equipment subject to the control of the provider. Each vehicle and its equipment must be
inspected daily. A vehicle may not be operated in a condition that is likely to cause an
accident or breakdown of the vehicle. Equipment, including specialized equipment
necessary to ensure vehicle usability and safety for disabled persons, must be in proper
and safe operating condition at all times.
(b) Each special nonemergency medical nonemergency medical transportation
provider shall maintain the following records for each vehicle:
(1) an identification of the vehicle, including make, serial number, and year, and,
if the vehicle is not owned by the provider, the name and address of the person furnishing
the vehicle;
(2) a schedule of inspection and maintenance operations to be performed;
(3) a record of inspections, repairs, and maintenance showing the date and nature;
(4) a lubrication record; and
(5) a record of tests conducted to ensure that emergency doors or windows and
wheelchair lifts function properly.

Subd. 3.Other standards; wheelchair securement. (a) A special nonemergency medical
transportation service that transports individuals occupying wheelchairs is subject to the
provisions of sections 299A.11 to 299A.18 concerning wheelchair securement devices.
The commissioners of transportation and public safety shall cooperate in the enforcement
of this section and sections 299A.11 to 299A.18 so that a single inspection is sufficient to
ascertain compliance with sections 299A.11 to 299A.18 and with the standards adopted
under this section. Representatives of the Department of Transportation may inspect
wheelchair securement devices in vehicles operated by special nonemergency medical
transportation service providers to determine compliance with sections 299A.11 to
299A.18 and to issue certificates under section 299A.14, subdivision 4.


(b) In place of a certificate issued under section 299A.14, the commissioner may issue a
decal under subdivision 4 for a vehicle equipped with a wheelchair securement device if
the device complies with sections 299A.11 to 299A.18 and the decal displays the
information in section 299A.14, subdivision 4.
Subd. 4.Vehicle and equipment inspection; rules; decal; complaint contact
information. (a) The commissioner shall inspect or provide for the inspection of vehicles
at least annually. In addition to scheduled annual inspections and reinspections scheduled
for the purpose of verifying that deficiencies have been corrected, unannounced
inspections of any vehicle may be conducted.
(b) On determining that a vehicle or vehicle equipment is in a condition that is
likely to cause an accident or breakdown, the commissioner shall require the vehicle to be
taken out of service immediately. The commissioner shall require that vehicles and
equipment not meeting standards be repaired and brought into conformance with the
standards and shall require written evidence of compliance from the operator before
allowing the operator to return the vehicle to service.
(c) The commissioner shall provide in the rules procedures for inspecting
vehicles, removing unsafe vehicles from service, determining and requiring compliance,
and reviewing driver qualifications.
(d) The commissioner shall design a distinctive decal to be issued to special
nonemergency medical transportation service providers with a current certificate of
compliance under this section. A decal is valid for one year from the last day of the
month in which it is issued. A person who is subject to the operating standards adopted
under this section may not provide special nonemergency medical transportation service
in a vehicle that does not conspicuously display a decal issued by the commissioner
(e) special nonemergency medical transportation service providers shall
prominently display in each vehicle all contact information for the submission of
complaints regarding the transportation services provided to that individual. All vehicles
providing service under section 473.386 shall display contact information for the
Metropolitan Council. All other special nonemergency medical transportation service
vehicles shall display contact information for the commissioner of transportation.
Subd. 4a.Certification of special nonemergency medical transportation provider. The
commissioner shall annually evaluate or provide for the evaluation of each provider of
special nonemergency medical transportation service regulated under this section and
certify that the provider is in compliance with the standards under this section.
Subd. 5.Rules. The rules authorized under this section shall be adopted in accordance
with the provisions of the Administrative Procedure Act, sections 14.001 to 14.69.
Subd. 6.Preemption of other requirements. (a) Notwithstanding any other law,
ordinance, or resolution to the contrary, an operator of special nonemergency medical
transportation service that has been issued a current certificate of compliance under
subdivision 4a for vehicles used to provide that service is not required to obtain any other
state or local permit, license or certificate as a condition of operating the vehicles for that
purpose. This subdivision does not exempt any vehicle from the requirements imposed on
vehicles generally as a condition of using the public streets and highways.
(b) The requirements of sections 169.781 to 169.783 and chapter 221 do not apply to
vehicles when they are being operated under a current certificate of compliance issued by
the commissioner.


Subd. 7.Enforcement. No state agency, political subdivision, or other public agency shall
provide any capital or operating assistance to or reimbursement for special nonemergency
medical medical transportation service unless the operator providing the service has a
current certificate of compliance issued under subdivision 4a.
Subd. 8.Administrative penalties. The commissioner may issue an order requiring
violations of this section and the operating standards adopted under this section to be
corrected and assessing monetary penalties of up to $1,000 for all violations identified
during a single inspection, investigation, or audit. Section 221.036 applies to
administrative penalty orders issued under this section or section 174.315. The
commissioner shall suspend, without a hearing, a special nonemergency medical
transportation service provider's certificate of compliance for failure to pay, or make
satisfactory arrangements to pay, an administrative penalty when due.
Penalties collected under this section must be deposited in the state treasury and credited
to the trunk highway fund.
Subd. 9.Complaints; report; data classification. (a) The commissioner shall investigate
all complaints over which the commissioner has jurisdiction regarding special
nonemergency medical transportation service providers regulated under this section.
(b) By January 15, 2009, and in every subsequent odd-numbered year by January 15, the
commissioner shall submit a report to the chairs and ranking minority members of the
house of representatives and senate committees having jurisdiction over transportation
policy and finance. The report must identify each complaint investigated by the
commissioner under paragraph (a), including, but not limited to, any findings and steps
taken for resolution of the complaint.
(c) When information is furnished to the Department of Transportation that alleges a
violation of this section, an operating standard adopted under this section, or section
174.315, the following data are classified as confidential data or protected nonpublic
data:
(1) names of complainants;
(2) complaint letters; and
(3) other unsolicited data when furnished by a person who is not the subject of the
data and who is not a department employee.
History: Ex1979 c 1 s 28; 1982 c 424 s 130; 1982 c 556 s 2; 1984 c 654 art 5 s 58; 1987
c 88 s 1-7; 1987 c 354 s 8; 1987 c 384 art 2 s 1; 1989 c 209 art 2 s 1; 1989 c 318 s 6;
1990 c 422 s 10; 1992 c 578 s 12; 1993 c 339 s 1; 1995 c 155 s 3-8; 1Sp2003 c 14 art 3 s
1; 2008 c 287 art 1 s 72,73