| 1 | 1 | | 1.1 A bill for an act |
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| 2 | 2 | | 1.2 relating to human services; providing a fuel adjustment for nonemergency medical |
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| 3 | 3 | | 1.3 transportation and ambulance service reimbursement; amending Minnesota Statutes |
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| 4 | 4 | | 1.4 2022, section 256B.0625, subdivisions 17, 17a, 18h. |
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| 5 | 5 | | 1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: |
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| 6 | 6 | | 1.6 Section 1. Minnesota Statutes 2022, section 256B.0625, subdivision 17, is amended to |
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| 7 | 7 | | 1.7read: |
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| 8 | 8 | | 1.8 Subd. 17.Transportation costs.(a) "Nonemergency medical transportation service" |
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| 9 | 9 | | 1.9means motor vehicle transportation provided by a public or private person that serves |
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| 10 | 10 | | 1.10Minnesota health care program beneficiaries who do not require emergency ambulance |
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| 11 | 11 | | 1.11service, as defined in section 144E.001, subdivision 3, to obtain covered medical services. |
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| 12 | 12 | | 1.12 (b) Medical assistance covers medical transportation costs incurred solely for obtaining |
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| 13 | 13 | | 1.13emergency medical care or transportation costs incurred by eligible persons in obtaining |
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| 14 | 14 | | 1.14emergency or nonemergency medical care when paid directly to an ambulance company, |
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| 15 | 15 | | 1.15nonemergency medical transportation company, or other recognized providers of |
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| 16 | 16 | | 1.16transportation services. Medical transportation must be provided by: |
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| 17 | 17 | | 1.17 (1) nonemergency medical transportation providers who meet the requirements of this |
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| 18 | 18 | | 1.18subdivision; |
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| 19 | 19 | | 1.19 (2) ambulances, as defined in section 144E.001, subdivision 2; |
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| 20 | 20 | | 1.20 (3) taxicabs that meet the requirements of this subdivision; |
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| 21 | 21 | | 1.21 (4) public transit, as defined in section 174.22, subdivision 7; or |
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| 22 | 22 | | 1Section 1. |
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| 23 | 23 | | REVISOR AGW/AK 23-0016301/03/23 |
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| 24 | 24 | | State of Minnesota |
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| 25 | 25 | | This Document can be made available |
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| 26 | 26 | | in alternative formats upon request |
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| 27 | 27 | | HOUSE OF REPRESENTATIVES |
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| 28 | 28 | | H. F. No. 196 |
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| 29 | 29 | | NINETY-THIRD SESSION |
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| 30 | 30 | | Authored by Huot01/09/2023 |
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| 31 | 31 | | The bill was read for the first time and referred to the Committee on Health Finance and Policy 2.1 (5) not-for-hire vehicles, including volunteer drivers, as defined in section 65B.472, |
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| 32 | 32 | | 2.2subdivision 1, paragraph (h). |
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| 33 | 33 | | 2.3 (c) Medical assistance covers nonemergency medical transportation provided by |
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| 34 | 34 | | 2.4nonemergency medical transportation providers enrolled in the Minnesota health care |
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| 35 | 35 | | 2.5programs. All nonemergency medical transportation providers must comply with the |
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| 36 | 36 | | 2.6operating standards for special transportation service as defined in sections 174.29 to 174.30 |
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| 37 | 37 | | 2.7and Minnesota Rules, chapter 8840, and all drivers must be individually enrolled with the |
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| 38 | 38 | | 2.8commissioner and reported on the claim as the individual who provided the service. All |
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| 39 | 39 | | 2.9nonemergency medical transportation providers shall bill for nonemergency medical |
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| 40 | 40 | | 2.10transportation services in accordance with Minnesota health care programs criteria. Publicly |
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| 41 | 41 | | 2.11operated transit systems, volunteers, and not-for-hire vehicles are exempt from the |
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| 42 | 42 | | 2.12requirements outlined in this paragraph. |
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| 43 | 43 | | 2.13 (d) An organization may be terminated, denied, or suspended from enrollment if: |
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| 44 | 44 | | 2.14 (1) the provider has not initiated background studies on the individuals specified in |
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| 45 | 45 | | 2.15section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or |
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| 46 | 46 | | 2.16 (2) the provider has initiated background studies on the individuals specified in section |
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| 47 | 47 | | 2.17174.30, subdivision 10, paragraph (a), clauses (1) to (3), and: |
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| 48 | 48 | | 2.18 (i) the commissioner has sent the provider a notice that the individual has been |
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| 49 | 49 | | 2.19disqualified under section 245C.14; and |
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| 50 | 50 | | 2.20 (ii) the individual has not received a disqualification set-aside specific to the special |
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| 51 | 51 | | 2.21transportation services provider under sections 245C.22 and 245C.23. |
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| 52 | 52 | | 2.22 (e) The administrative agency of nonemergency medical transportation must: |
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| 53 | 53 | | 2.23 (1) adhere to the policies defined by the commissioner; |
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| 54 | 54 | | 2.24 (2) pay nonemergency medical transportation providers for services provided to |
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| 55 | 55 | | 2.25Minnesota health care programs beneficiaries to obtain covered medical services; |
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| 56 | 56 | | 2.26 (3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled |
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| 57 | 57 | | 2.27trips, and number of trips by mode; and |
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| 58 | 58 | | 2.28 (4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single |
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| 59 | 59 | | 2.29administrative structure assessment tool that meets the technical requirements established |
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| 60 | 60 | | 2.30by the commissioner, reconciles trip information with claims being submitted by providers, |
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| 61 | 61 | | 2.31and ensures prompt payment for nonemergency medical transportation services. |
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| 62 | 62 | | 2Section 1. |
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| 63 | 63 | | REVISOR AGW/AK 23-0016301/03/23 3.1 (f) Until the commissioner implements the single administrative structure and delivery |
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| 64 | 64 | | 3.2system under subdivision 18e, clients shall obtain their level-of-service certificate from the |
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| 65 | 65 | | 3.3commissioner or an entity approved by the commissioner that does not dispatch rides for |
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| 66 | 66 | | 3.4clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7). |
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| 67 | 67 | | 3.5 (g) The commissioner may use an order by the recipient's attending physician, advanced |
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| 68 | 68 | | 3.6practice registered nurse, physician assistant, or a medical or mental health professional to |
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| 69 | 69 | | 3.7certify that the recipient requires nonemergency medical transportation services. |
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| 70 | 70 | | 3.8Nonemergency medical transportation providers shall perform driver-assisted services for |
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| 71 | 71 | | 3.9eligible individuals, when appropriate. Driver-assisted service includes passenger pickup |
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| 72 | 72 | | 3.10at and return to the individual's residence or place of business, assistance with admittance |
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| 73 | 73 | | 3.11of the individual to the medical facility, and assistance in passenger securement or in securing |
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| 74 | 74 | | 3.12of wheelchairs, child seats, or stretchers in the vehicle. |
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| 75 | 75 | | 3.13 Nonemergency medical transportation providers must take clients to the health care |
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| 76 | 76 | | 3.14provider using the most direct route, and must not exceed 30 miles for a trip to a primary |
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| 77 | 77 | | 3.15care provider or 60 miles for a trip to a specialty care provider, unless the client receives |
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| 78 | 78 | | 3.16authorization from the local agency. |
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| 79 | 79 | | 3.17 Nonemergency medical transportation providers may not bill for separate base rates for |
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| 80 | 80 | | 3.18the continuation of a trip beyond the original destination. Nonemergency medical |
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| 81 | 81 | | 3.19transportation providers must maintain trip logs, which include pickup and drop-off times, |
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| 82 | 82 | | 3.20signed by the medical provider or client, whichever is deemed most appropriate, attesting |
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| 83 | 83 | | 3.21to mileage traveled to obtain covered medical services. Clients requesting client mileage |
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| 84 | 84 | | 3.22reimbursement must sign the trip log attesting mileage traveled to obtain covered medical |
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| 85 | 85 | | 3.23services. |
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| 86 | 86 | | 3.24 (h) The administrative agency shall use the level of service process established by the |
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| 87 | 87 | | 3.25commissioner to determine the client's most appropriate mode of transportation. If public |
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| 88 | 88 | | 3.26transit or a certified transportation provider is not available to provide the appropriate service |
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| 89 | 89 | | 3.27mode for the client, the client may receive a onetime service upgrade. |
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| 90 | 90 | | 3.28 (i) The covered modes of transportation are: |
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| 91 | 91 | | 3.29 (1) client reimbursement, which includes client mileage reimbursement provided to |
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| 92 | 92 | | 3.30clients who have their own transportation, or to family or an acquaintance who provides |
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| 93 | 93 | | 3.31transportation to the client; |
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| 94 | 94 | | 3.32 (2) volunteer transport, which includes transportation by volunteers using their own |
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| 95 | 95 | | 3.33vehicle; |
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| 96 | 96 | | 3Section 1. |
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| 97 | 97 | | REVISOR AGW/AK 23-0016301/03/23 4.1 (3) unassisted transport, which includes transportation provided to a client by a taxicab |
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| 98 | 98 | | 4.2or public transit. If a taxicab or public transit is not available, the client can receive |
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| 99 | 99 | | 4.3transportation from another nonemergency medical transportation provider; |
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| 100 | 100 | | 4.4 (4) assisted transport, which includes transport provided to clients who require assistance |
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| 101 | 101 | | 4.5by a nonemergency medical transportation provider; |
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| 102 | 102 | | 4.6 (5) lift-equipped/ramp transport, which includes transport provided to a client who is |
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| 103 | 103 | | 4.7dependent on a device and requires a nonemergency medical transportation provider with |
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| 104 | 104 | | 4.8a vehicle containing a lift or ramp; |
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| 105 | 105 | | 4.9 (6) protected transport, which includes transport provided to a client who has received |
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| 106 | 106 | | 4.10a prescreening that has deemed other forms of transportation inappropriate and who requires |
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| 107 | 107 | | 4.11a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety |
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| 108 | 108 | | 4.12locks, a video recorder, and a transparent thermoplastic partition between the passenger and |
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| 109 | 109 | | 4.13the vehicle driver; and (ii) who is certified as a protected transport provider; and |
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| 110 | 110 | | 4.14 (7) stretcher transport, which includes transport for a client in a prone or supine position |
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| 111 | 111 | | 4.15and requires a nonemergency medical transportation provider with a vehicle that can transport |
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| 112 | 112 | | 4.16a client in a prone or supine position. |
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| 113 | 113 | | 4.17 (j) The local agency shall be the single administrative agency and shall administer and |
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| 114 | 114 | | 4.18reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the |
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| 115 | 115 | | 4.19commissioner has developed, made available, and funded the web-based single administrative |
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| 116 | 116 | | 4.20structure, assessment tool, and level of need assessment under subdivision 18e. The local |
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| 117 | 117 | | 4.21agency's financial obligation is limited to funds provided by the state or federal government. |
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| 118 | 118 | | 4.22 (k) The commissioner shall: |
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| 119 | 119 | | 4.23 (1) verify that the mode and use of nonemergency medical transportation is appropriate; |
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| 120 | 120 | | 4.24 (2) verify that the client is going to an approved medical appointment; and |
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| 121 | 121 | | 4.25 (3) investigate all complaints and appeals. |
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| 122 | 122 | | 4.26 (l) The administrative agency shall pay for the services provided in this subdivision and |
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| 123 | 123 | | 4.27seek reimbursement from the commissioner, if appropriate. As vendors of medical care, |
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| 124 | 124 | | 4.28local agencies are subject to the provisions in section 256B.041, the sanctions and monetary |
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| 125 | 125 | | 4.29recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245. |
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| 126 | 126 | | 4.30 (m) Payments for nonemergency medical transportation must be paid based on the client's |
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| 127 | 127 | | 4.31assessed mode under paragraph (h), not the type of vehicle used to provide the service. The |
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| 128 | 128 | | 4.32medical assistance reimbursement rates for nonemergency medical transportation services |
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| 129 | 129 | | 4Section 1. |
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| 130 | 130 | | REVISOR AGW/AK 23-0016301/03/23 5.1that are payable by or on behalf of the commissioner for nonemergency medical |
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| 131 | 131 | | 5.2transportation services are: |
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| 132 | 132 | | 5.3 (1) $0.22 per mile for client reimbursement; |
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| 133 | 133 | | 5.4 (2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer |
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| 134 | 134 | | 5.5transport; |
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| 135 | 135 | | 5.6 (3) equivalent to the standard fare for unassisted transport when provided by public |
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| 136 | 136 | | 5.7transit, and $11 for the base rate and $1.30 per mile when provided by a nonemergency |
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| 137 | 137 | | 5.8medical transportation provider; |
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| 138 | 138 | | 5.9 (4) $13 for the base rate and $1.30 per mile for assisted transport; |
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| 139 | 139 | | 5.10 (5) $18 for the base rate and $1.55 per mile for lift-equipped/ramp transport; |
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| 140 | 140 | | 5.11 (6) $75 for the base rate and $2.40 per mile for protected transport; and |
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| 141 | 141 | | 5.12 (7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for |
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| 142 | 142 | | 5.13an additional attendant if deemed medically necessary. |
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| 143 | 143 | | 5.14 (n) The base rate for nonemergency medical transportation services in areas defined |
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| 144 | 144 | | 5.15under RUCA to be super rural is equal to 111.3 percent of the respective base rate in |
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| 145 | 145 | | 5.16paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation |
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| 146 | 146 | | 5.17services in areas defined under RUCA to be rural or super rural areas is: |
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| 147 | 147 | | 5.18 (1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage |
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| 148 | 148 | | 5.19rate in paragraph (m), clauses (1) to (7); and |
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| 149 | 149 | | 5.20 (2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage |
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| 150 | 150 | | 5.21rate in paragraph (m), clauses (1) to (7). |
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| 151 | 151 | | 5.22 (o) For purposes of reimbursement rates for nonemergency medical transportation |
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| 152 | 152 | | 5.23services under paragraphs (m) and (n), the zip code of the recipient's place of residence |
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| 153 | 153 | | 5.24shall determine whether the urban, rural, or super rural reimbursement rate applies. |
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| 154 | 154 | | 5.25 (p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means |
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| 155 | 155 | | 5.26a census-tract based classification system under which a geographical area is determined |
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| 156 | 156 | | 5.27to be urban, rural, or super rural. |
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| 157 | 157 | | 5.28 (q) The commissioner, when determining reimbursement rates for nonemergency medical |
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| 158 | 158 | | 5.29transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed |
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| 159 | 159 | | 5.30under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2). |
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| 160 | 160 | | 5Section 1. |
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| 161 | 161 | | REVISOR AGW/AK 23-0016301/03/23 6.1 (r) Effective for the first day of each calendar quarter in which the price of gasoline as |
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| 162 | 162 | | 6.2posted publicly by the United States Energy Information Administration exceeds $3.00 per |
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| 163 | 163 | | 6.3gallon, the commissioner shall adjust the rate paid per mile in paragraph (m) by one percent |
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| 164 | 164 | | 6.4up or down for every increase or decrease of ten cents for the price of gasoline. The increase |
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| 165 | 165 | | 6.5or decrease must be calculated using a base gasoline price of $3.00. The percentage increase |
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| 166 | 166 | | 6.6or decrease must be calculated using the average of the most recently available price of all |
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| 167 | 167 | | 6.7grades of gasoline for Minnesota as posted publicly by the United States Energy Information |
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| 168 | 168 | | 6.8Administration. |
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| 169 | 169 | | 6.9 EFFECTIVE DATE.This section is effective July 1, 2023. |
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| 170 | 170 | | 6.10 Sec. 2. Minnesota Statutes 2022, section 256B.0625, subdivision 17a, is amended to read: |
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| 171 | 171 | | 6.11 Subd. 17a.Payment for ambulance services.(a) Medical assistance covers ambulance |
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| 172 | 172 | | 6.12services. Providers shall bill ambulance services according to Medicare criteria. |
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| 173 | 173 | | 6.13Nonemergency ambulance services shall not be paid as emergencies. Effective for services |
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| 174 | 174 | | 6.14rendered on or after July 1, 2001, medical assistance payments for ambulance services shall |
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| 175 | 175 | | 6.15be paid at the Medicare reimbursement rate or at the medical assistance payment rate in |
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| 176 | 176 | | 6.16effect on July 1, 2000, whichever is greater. |
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| 177 | 177 | | 6.17 (b) Effective for services provided on or after July 1, 2016, medical assistance payment |
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| 178 | 178 | | 6.18rates for ambulance services identified in this paragraph are increased by five percent. |
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| 179 | 179 | | 6.19Capitation payments made to managed care plans and county-based purchasing plans for |
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| 180 | 180 | | 6.20ambulance services provided on or after January 1, 2017, shall be increased to reflect this |
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| 181 | 181 | | 6.21rate increase. The increased rate described in this paragraph applies to ambulance service |
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| 182 | 182 | | 6.22providers whose base of operations as defined in section 144E.10 is located: |
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| 183 | 183 | | 6.23 (1) outside the metropolitan counties listed in section 473.121, subdivision 4, and outside |
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| 184 | 184 | | 6.24the cities of Duluth, Mankato, Moorhead, St. Cloud, and Rochester; or |
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| 185 | 185 | | 6.25 (2) within a municipality with a population of less than 1,000. |
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| 186 | 186 | | 6.26 (c) Effective for the first day of each calendar quarter in which the price of gasoline as |
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| 187 | 187 | | 6.27posted publicly by the United States Energy Information Administration exceeds $3.00 per |
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| 188 | 188 | | 6.28gallon, the commissioner shall adjust the rate paid per mile in paragraphs (a) and (b) by one |
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| 189 | 189 | | 6.29percent up or down for every increase or decrease of ten cents for the price of gasoline. The |
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| 190 | 190 | | 6.30increase or decrease must be calculated using a base gasoline price of $3.00. The percentage |
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| 191 | 191 | | 6.31increase or decrease must be calculated using the average of the most recently available |
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| 192 | 192 | | 6.32price of all grades of gasoline for Minnesota as posted publicly by the United States Energy |
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| 193 | 193 | | 6.33Information Administration. |
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| 194 | 194 | | 6Sec. 2. |
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| 195 | 195 | | REVISOR AGW/AK 23-0016301/03/23 7.1 EFFECTIVE DATE.This section is effective July 1, 2023. |
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| 196 | 196 | | 7.2 Sec. 3. Minnesota Statutes 2022, section 256B.0625, subdivision 18h, is amended to read: |
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| 197 | 197 | | 7.3 Subd. 18h.Nonemergency medical transportation provisions related to managed |
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| 198 | 198 | | 7.4care.(a) The following nonemergency medical transportation subdivisions apply to managed |
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| 199 | 199 | | 7.5care plans and county-based purchasing plans: |
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| 200 | 200 | | 7.6 (1) subdivision 17, paragraphs (a), (b), (i), and (n); |
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| 201 | 201 | | 7.7 (2) subdivision 18; and |
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| 202 | 202 | | 7.8 (3) subdivision 18a. |
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| 203 | 203 | | 7.9 (b) A nonemergency medical transportation provider must comply with the operating |
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| 204 | 204 | | 7.10standards for special transportation service specified in sections 174.29 to 174.30 and |
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| 205 | 205 | | 7.11Minnesota Rules, chapter 8840. Publicly operated transit systems, volunteers, and not-for-hire |
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| 206 | 206 | | 7.12vehicles are exempt from the requirements in this paragraph. |
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| 207 | 207 | | 7.13 (c) Managed care and county-based purchasing plans must provide a fuel adjustment |
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| 208 | 208 | | 7.14for nonemergency medical transportation payment rates when the price of gasoline exceeds |
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| 209 | 209 | | 7.15$3.00 per gallon. |
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| 210 | 210 | | 7.16 EFFECTIVE DATE.This section is effective July 1, 2023. |
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| 211 | 211 | | 7Sec. 3. |
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| 212 | 212 | | REVISOR AGW/AK 23-0016301/03/23 |
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