Federal regulations require State Medicaid agencies to specify in the State plan that they will ensure necessary transportation for clients to and from providers and describe the methods that the agency will use to meet this requirement. Section 209(a)(4) of Consolidated Appropriations Act 2021 adds the assurance of transportation to Medicaid statute and limits Federal Financial Participation for Non- Emergency Medical Transportation (NEMT) expenditures unless the state plan provides for utilization management of such services. Medicaid agencies are also required to offer and provide clients of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services with necessary assistance with transportation if requested. States may pay for transportation services as an administrative expense or as an optional service. Many states combine the two methods in order to provide maximum access.
Minimum Requirements for Drivers – Section 209
Section 209 of the Consolidated Appropriations Act, 2021 also adds a NEMT provider and driver requirement. Specifically, Section 209 added Section 1902(a)(87) of the Social Security Act (SSA) requiring the Medicaid Plan to provide for a mechanism which may include an attestation that ensures any provider including transportation network companies and individual drivers meet specific minimum requirements. Those minimum requirements are:
- Each provider or individual driver is not excluded from participation in any federal health care program (as defined in section 1128B(f) of the Act) and is not listed on the exclusion list of the Inspector General of the U.S. Department of Health and Human Services;
- Each such individual driver has a valid driver’s license;
- Each such provider has in place a process to address any violation of a state drug law; and,
- 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.
Stakeholder Listening SessionsAs required under section 209, CMS held a series of stakeholder meetings to obtain input and shared learning about the leading practices for improving Medicaid program integrity for NEMT. Sessions were focused on the expertise and perspectives offered by the stakeholder group. A link to the recording and transcript of each of these sessions is provided below.
Section 209 Stakeholder Listening Sessions
- March 10, 2022 - Provider Enrollment Requirements and Eligibility Determinations for Providers/Drivers
- March 31, 2022 - Program Integrity, Correct Billing Concerns, Documentation and Data Requirements for NEMT Providers
- April 13, 2022 - NEMT Coordination Topics – Brokers, MCO’s Community Transportation and Paratransit Services
- April 28, 2022 - Economic Factors and Cost Containment Challenges in NEMT
NEMT Initial and Expanded Reports to Congress
Under Section 209(b)(5), CMS was required to issue a Medicaid Non-Emergency Transportation Report to Congress.
In June 2022, an initial Medicaid Non-Emergency Medical Transportation (NEMT) Report to Congress provides state- and national-level information on the number of Medicaid beneficiaries who used Medicaid NEMT overall and among different beneficiary subgroups, as well as the types of services they accessed using NEMT. The report examines T-MSIS data for calendar years 2018 through 2020 where states cover such services as a medical service expenditure.
In July 2023, a second, expanded Medicaid Non-Emergency Medical Transportation in Medicaid, 2018–2021 Report to Congress provides T-MSIS data for an additional calendar year (through 2021). The report also includes an extensive analysis of Medicaid coverage of NEMT such as the types of medical services accessed when using NEMT by beneficiary subgroup, monthly trends in the use of NEMT versus telehealth services, and a comparison by delivery model of the volume of NEMT services used by states.