1.1A bill for an act1.2relating to health; clarifying nonemergency medical transportation level of care 1.3and transportation costs; prohibiting a broker or coordinator from dispatching 1.4nonemergency medical transportation;amending Minnesota Statutes 2008, 1.5sections 256B.04, subdivision 14a; 256B.0625, subdivision 17, by adding a 1.6subdivision.1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:1.8    Section 1. Minnesota Statutes 2008, section 256B.04, subdivision 14a, is amended to 1.9read:1.10    Subd. 14a. Level of need determination. Nonemergency medical transportation 1.11level of need determinations must be performed by a physician, a registered nurse working 1.12under direct supervision of a physician, a physician's assistant, a nurse practitioner, a 1.13licensed practical nurse, or a discharge planner. Nonemergency medical transportation 1.14level of need determinations must not be performed more than semiannually on any 1.15individual, unless the individual's circumstances have sufficiently changed so as to require 1.16a new level of need determination. Nonemergency medical transportation level of need 1.17determinations must not be performed more than every seven years on an individual, 1.18if a physician certifies that the individual's medical condition that requires the use of 1.19nonemergency medical transportation is permanent and is not likely to improve, and this 1.20certification by the physician is confirmed by a level of need determination. Individuals 1.21residing in licensed nursing facilities are exempt from a level of need determination and 1.22are eligible for special transportation services until the individual no longer resides in a 1.23licensed nursing facility. If a person authorized by this subdivision to perform a level of 1.24need determination determines that an individual requires stretcher transportation, the 1.25individual is presumed to maintain that level of need until otherwise determined by a 2.1person authorized to perform a level of need determination, or for six months, whichever 2.2is sooner.2.3    Sec. 2. Minnesota Statutes 2008, section 256B.0625, subdivision 17, is amended to 2.4read:2.5    Subd. 17. Transportation costs. (a) For purposes of this subdivision, the following 2.6terms have the meanings given unless otherwise provided for in this subdivision:2.7(1) "special transportation" means nonemergency medical transportation to or from a 2.8covered service that is provided to a recipient who has a physical or mental impairment 2.9that prohibits the recipient from independently and safely accessing and using a bus, taxi, 2.10other commercial transportation, or private automobile;2.11(2) "access transportation service" means curb-to-curb nonemergency medical 2.12transportation to or from a covered service that is provided to a recipient without a 2.13physical or mental impairment, but who requires transportation services to be able to 2.14access a covered service, and who are unable to do so by bus or private automobile; and 2.15(3) "medical transportation" means the transport of a recipient to obtain a covered 2.16service or the transport of a recipient after the covered service is provided.2.17(b) Medical assistance covers medical transportation costs incurred solely for 2.18obtaining emergency medical care or transportation costs incurred by eligible persons in 2.19obtaining emergency or nonemergency medical care when paid directly to an ambulance 2.20company, common carrier, or other recognized providers of transportation services.2.21Medical transportation must be provided by:2.22(1) an ambulance, as defined in section 144E.001, subdivision 2;2.23(2) special transportation;2.24(3) access transportation; or2.25(4) other common carrier, including but not limited to, bus, taxi, other commercial 2.26carrier, or private automobile.2.27(b) Medical assistance covers special transportation, as defined in Minnesota Rules, 2.28part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that 2.29would prohibit the recipient from safely accessing and using a bus, taxi, other commercial 2.30transportation, or private automobile.2.31(c) "Rural urban commuting area" or "RUCA" means an area determined to be 2.32urban, rural, or super rural by the Centers for Medicare and Medicaid Services for 2.33purposes of Medicare reimbursement of ambulance services.2.34The commissioner may use an order by the recipient's attending physician to certify that 2.35the recipient requires special transportation services. Special transportation includes3.1providers shall perform  driver-assisted service to services for eligible individuals. 3.2Driver-assisted service includes passenger pickup at and return to the individual's 3.3residence or place of business, assistance with admittance of the individual to the medical 3.4facility, and assistance in passenger securement or in securing of wheelchairs or stretchers 3.5in the vehicle. Special transportation providers must obtain written documentation from 3.6the health care service provider who is serving the recipient being transported, identifying 3.7the time that the recipient arrived. Special transportation and access transportation3.8providers may not bill for separate base rates for the continuation of a trip beyond the 3.9original destination. Special transportation and access transportation providers must take 3.10recipients to the nearest appropriate health care provider, using the most direct route 3.11available as determined by a commercially available software program approved by the 3.12commissioner and designated by the provider as the program to be used to determine the 3.13route and mileage for all trips. The maximum minimum medical assistance reimbursement 3.14rates for special nonemergency medical transportation services are:3.15(1) for areas defined under RUCA as urban:3.16(1) (i) $17 for the base rate and $1.35 per mile for special transportation services to 3.17eligible persons who need a wheelchair-accessible van;3.18(2) (ii) $11.50 for the base rate and $1.30 per mile for special transportation services 3.19to eligible persons who do not need a wheelchair-accessible van; and3.20(iii) $10 for the base rate and $1.35 per mile for access transportation services to 3.21eligible persons who need a wheelchair-accessible van;3.22(iv) $10 for the base rate and $1.30 per mile for access transportation services to 3.23eligible persons who do not need a wheelchair-accessible van;3.24(3) (v) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, 3.25for services to eligible persons who need a stretcher-accessible vehicle; and3.26(vi) for all special transportation and access transportation services for a trip equal to 3.27or exceeding 51 miles, the provider shall receive mileage reimbursement for each mile 3.28equal to or exceeding 51 miles at 125 percent of the respective mileage rates in this clause;3.29(2) the base rates for special transportation services and access transportation in 3.30areas defined under RUCA as rural, shall be equal to the reimbursement rate established in 3.31clause (1) plus one percent;3.32(3) the base rate for special transportation and access transportation services in areas 3.33defined under RUCA as super rural shall be equal to the reimbursement rate established in 3.34clause (1) plus 22.6 percent; and3.35(4) for special transportation and access transportation services defined under RUCA 3.36as rural and super rural areas;4.1(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 150 4.2percent of the respective mileage rate in clause (1);4.3(ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to 100 4.4percent of the respective mileage rate in clause (1); and4.5(iii) for a trip equal to or exceeding 51 miles, mileage reimbursement shall be equal 4.6to 125 percent of the respective mileage rate in clause (1), items (i) to (v).4.7(d) For purposes of reimbursement rates for special transportation and access 4.8transportation services under paragraph (c), the recipient's place of residence shall 4.9determine whether the urban, rural, or super rural reimbursement rate applies.4.10(e) For all special transportation and access transportation services, the transportation 4.11provider must obtain delivery confirmation of the recipient by the medical provider to 4.12whom the recipient is delivered.4.13    Sec. 3. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 4.14subdivision to read:4.15    Subd. 17b.Broker dispatching prohibition.The commissioner shall not use 4.16a broker or coordinator to manage or dispatch nonemergency medical transportation 4.17services.4.18    Sec. 4. REIMBURSEMENT REFORM ACT.4.19This act shall be referred to as the "Nonemergency Medical Transportation Reform 4.20Act of 2009."