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Assurance of Transportation

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:

  1. 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;
  2. Each such individual driver has a valid driver’s license;
  3. Each such provider has in place a process to address any violation of a state drug law; and,
  4. 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.
Congress made corresponding amendments to section 1937(a)(1) of the SSA, adding a new paragraph (F) applying substantially the same assurance of transportation requirements for benchmark and benchmark equivalent coverage, also known as Alternative Benefit Plans (ABPs).  Prior to this amendment, the assurance of transportation in ABPs was required by regulation under 42 CFR § 440.390, which references the state plan assurance of transportation requirement in 42 CFR § 431.53

Stakeholder Listening Sessions

As 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