SF 1292

1st Engrossment - 89th Legislature (2015 - 2016) Posted on 09/09/2015 02:33pm

A bill for an act
relating to human services; regulating nonemergency medical transportation
providers; modifying payment rates for nonemergency medical transportation
services; amending Minnesota Statutes 2014, sections 174.29, subdivision 1;
174.30, subdivisions 3, 4, by adding a subdivision; 256B.0625, subdivisions 17,
17a, 18a, 18e; Laws 2014, chapter 312, article 24, section 45, subdivision 2.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2014, section 174.29, subdivision 1, is amended to read:

Subdivision 1.

Definition.

For the purpose of sections 174.29 and 174.30 "special
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
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 transportation service includes but is not limited to service provided
by specially equipped buses, vans, taxis, and volunteers driving private automobiles. new text begin
Special transportation service also means those nonemergency medical transportation
services under section 256B.0625, subdivision 17, that are subject to the operating
standards for special transportation service under sections 174.29 to 174.30 and Minnesota
Rules, chapter 8840.
new text end

Sec. 2.

Minnesota Statutes 2014, section 174.30, subdivision 3, is amended to read:

Subd. 3.

Other standards; wheelchair securement new text begin ; protected transport new text end .

(a) A
special 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 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.

new text begin (c) For vehicles designated as protected transport under section 256B.0625,
subdivision 17, paragraph (h), the commissioner of transportation, during the
commissioner's inspection, shall check to ensure the safety provisions contained in that
paragraph are in working order.
new text end

Sec. 3.

Minnesota Statutes 2014, section 174.30, subdivision 4, is amended to read:

Subd. 4.

Vehicle and equipment inspection; rules; decal; complaint contact
information new text begin ; restrictions on name of service new text end .

(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
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 transportation service in a vehicle that does not conspicuously display a decal
issued by the commissioner.

(e) new text begin All special transportation service providers shall pay an annual fee of $45 to
obtain a decal. Providers of ambulance service, as defined in section 144E.001, subdivision
3, are exempt from the annual fee. Fees collected under this paragraph are appropriated to
the commissioner to pay for administering the special transportation service program.
new text end

new text begin (f) new text end Special 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
transportation service vehicles shall display contact information for the commissioner of
transportation.

new text begin (g) Nonemergency medical transportation providers must comply with Minnesota
Rules, part 8840.5450, except that a provider may use the phrase "nonemergency medical
transportation" in its name or in advertisements or information describing the service.
new text end

Sec. 4.

Minnesota Statutes 2014, section 174.30, is amended by adding a subdivision
to read:

new text begin Subd. 4b. new text end

new text begin Variance from the standards. new text end

new text begin A nonemergency medical transportation
provider who was not subject to the standards in this section prior to July 1, 2014, must
apply for a variance from the commissioner if the provider cannot meet the standards
within six months of the date of enactment of this subdivision. The commissioner may
grant or deny the variance application. Variances, if granted, shall not exceed 60 days
unless extended by the commissioner.
new text end

Sec. 5.

Minnesota Statutes 2014, section 256B.0625, subdivision 17, is amended to read:

Subd. 17.

Transportation costs.

(a) "Nonemergency medical transportation
service" means motor vehicle transportation provided by a public or private person
that serves Minnesota health care program beneficiaries who do not require emergency
ambulance service, as defined in section 144E.001, subdivision 3, to obtain covered
medical services. deleted text begin Nonemergency medical transportation service includes, but is not
deleted text end deleted text begin limited to, special transportation service, defined in section deleted text end deleted text begin 174.29, subdivision 1 deleted text end deleted text begin .
deleted text end

(b) 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) nonemergency medical transportation providers who meet the requirements
of this subdivision;

(2) ambulances, as defined in section 144E.001, subdivision 2;

(3) taxicabs deleted text begin and deleted text end new text begin ;
new text end

new text begin (4) new text end public transit, as defined in section 174.22, subdivision 7; or

deleted text begin (4) deleted text end new text begin (5) new text end not-for-hire vehicles, including volunteer drivers.

(c) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to
174.30 and Minnesota Rules, chapter 8840, and in consultation with the Minnesota
Department of Transportation. All nonemergency medical transportation providers shall
bill for nonemergency medical transportation services in accordance with Minnesota
health care programs criteria. Publicly operated transit systems, volunteers, and
not-for-hire vehicles are exempt from the requirements outlined in this paragraph.

(d) The administrative agency of nonemergency medical transportation must:

(1) adhere to the policies defined by the commissioner in consultation with the
Nonemergency Medical Transportation Advisory Committee;

(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;

(3) provide data monthly to the commissioner on appeals, complaints, no-shows,
canceled trips, and number of trips by mode; and

(4) by July 1, 2016, in accordance with subdivision 18e, utilize a Web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by
providers, and ensures prompt payment for nonemergency medical transportation services.

(e) Until the commissioner implements the single administrative structure and
delivery system under subdivision 18e, clients shall obtain their level-of-service certificate
from the commissioner or an entity approved by the commissioner that does not dispatch
rides for clients using modes new text begin of transportation new text end under paragraph (h), clauses (4), (5), (6),
and (7).

(f) The commissioner may use an order by the recipient's attending physician or a
medical or mental health professional to certify that the recipient requires nonemergency
medical transportation services. Nonemergency medical transportation providers shall
perform driver-assisted services for eligible individuals, when appropriate. 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.
deleted text begin Nonemergency medical transportation providers must have trip logs, which include pickup
and drop-off times, signed by the medical provider or client attesting mileage traveled to
obtain covered medical services, whichever is deemed most appropriate. Nonemergency
medical transportation providers may not bill for separate base rates for the continuation
of a trip beyond the original destination. Nonemergency medical transportation providers
must take clients 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 client receives authorization from the local agency. The minimum
medical assistance reimbursement rates for special transportation services are:
deleted text end

deleted text begin (1)(i) $17 for the base rate and $1.35 per mile for special transportation services to
eligible persons who need a wheelchair-accessible van;
deleted text end

deleted text begin (ii) $11.50 for the base rate and $1.30 per mile for special transportation services to
eligible persons who do not need a wheelchair-accessible van; and
deleted text end

deleted text begin (iii) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip,
for special transportation services to eligible persons who need a stretcher-accessible
vehicle; and
deleted text end

deleted text begin (2) deleted text end new text begin Nonemergency medical transportation providers must take clients 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:
new text end

new text begin (1) for clients required to receive their level-of-service certificate under paragraph
(e), the client receives authorization from the commissioner or entity that issues the
certificate; or
new text end

new text begin (2) for clients not required to receive their level-of-service certificate under
paragraph (e), the client receives authorization from the local agency.
new text end

new text begin Nonemergency medical transportation providers may not bill for separate base rates
for the continuation of a trip beyond the original destination. Nonemergency medical
transportation providers must maintain trip logs, which include pickup and drop-off times,
signed by the medical provider or client, whichever is deemed most appropriate, attesting
to mileage traveled to obtain covered medical services. new text end Clients requesting client mileage
reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
services.

deleted text begin (g) The covered modes of nonemergency medical transportation include
transportation provided directly by clients or family members of clients with their own
transportation, volunteers using their own vehicles, taxicabs, and public transit, or
provided to a client who needs a stretcher-accessible vehicle, a lift/ramp equipped vehicle,
or a vehicle that is not stretcher-accessible or lift/ramp equipped designed to transport ten
or fewer persons. Upon implementation of a new rate structure, a new covered mode of
nonemergency medical transportation shall include transportation provided to a client who
needs a protected vehicle that is not an ambulance or police car and has safety locks, a
video recorder, and a transparent thermoplastic partition between the passenger and the
vehicle driver.
deleted text end

deleted text begin (h) deleted text end new text begin (g) new text end The administrative agency shall use the level of service process established
by the commissioner in consultation with the Nonemergency Medical Transportation
Advisory Committee to determine the client's most appropriate mode of transportation.
If public transit or a certified transportation provider is not available to provide the
appropriate service mode for the client, the client may receive a onetime service upgrade.

new text begin (h) new text end The deleted text begin new deleted text end new text begin covered new text end modes of transportation, which may not be implemented
without a new rate structure, are:

(1) client reimbursement, which includes client mileage reimbursement provided to
clients who have their own transportation new text begin , new text end or new text begin to new text end family new text begin or an acquaintance new text end who provides
transportation to the client;

(2) volunteer transport, which includes transportation by volunteers using their
own vehicle;

(3) unassisted transport, which includes transportation provided to a client by a
taxicab or public transit. If a taxicab or deleted text begin publicly operated deleted text end new text begin public new text end transit deleted text begin system deleted text end is not
available, the client can receive transportation from another nonemergency medical
transportation provider;

(4) assisted transport, which includes transport provided to clients who require
assistance by a nonemergency medical transportation provider;

(5) lift-equipped/ramp transport, which includes transport provided to a client who
is dependent on a device and requires a nonemergency medical transportation provider
with a vehicle containing a lift or ramp;

(6) protected transport, which includes transport new text begin provided new text end to a client who has
received a prescreening that has deemed other forms of transportation inappropriate and
who requires a provider new text begin : (i) with a protected vehicle that is not an ambulance or police car
and has safety locks, a video recorder, and a transparent thermoplastic partition between
the passenger and the vehicle driver; and (ii) who is new text end certified as a protected transport
provider; and

(7) stretcher transport, which includes transport for a client in a prone or supine
position and requires a nonemergency medical transportation provider with a vehicle that
can transport a client in a prone or supine position.

(i) deleted text begin In accordance with subdivision 18e, by July 1, 2016, deleted text end The local agency shall be
the single administrative agency and shall administer and reimburse for modes defined in
paragraph (h) according to deleted text begin a new rate structure, once this is adopted deleted text end new text begin paragraphs (l) and
(m) when the commissioner has developed, made available, and funded the Web-based
single administrative structure, assessment tool, and level of need assessment under
subdivision 18e. The local agency's financial obligation is limited to funds provided by
the state or federal government new text end .

(j) The commissioner shall:

(1) in consultation with the Nonemergency Medical Transportation Advisory
Committee, verify that the mode and use of nonemergency medical transportation is
appropriate;

(2) verify that the client is going to an approved medical appointment; and

(3) investigate all complaints and appeals.

(k) The administrative agency shall pay for the services provided in this subdivision
and seek reimbursement from the commissioner, if appropriate. As vendors of medical
care, local agencies are subject to the provisions in section 256B.041, the sanctions and
monetary recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160
to 9505.2245.

(l) new text begin Payments for nonemergency medical transportation must be paid based on
the client's assessed mode under paragraph (g), not the type of vehicle used to provide
the service. The medical assistance reimbursement rates for nonemergency medical
transportation services that are payable by or on behalf of the commissioner for
nonemergency medical transportation services are:
new text end

new text begin (1) up to 80 percent of the Internal Revenue Service business deduction rate for
client reimbursement;
new text end

new text begin (2) up to 200 percent of the Internal Revenue Service business deduction rate for
volunteer transport;
new text end

new text begin (3) equivalent to the standard fare for unassisted transport when provided by public
transit, and $11 for the base rate and $1.30 per mile when provided by a nonemergency
medical transportation provider;
new text end

new text begin (4) $13 for the base rate and $1.30 per mile for assisted transport;
new text end

new text begin (5) $18 for the base rate and $1.55 per mile for lift-equipped/ramp transport;
new text end

new text begin (6) $75 for the base rate and $2.40 per mile for protected transport; and
new text end

new text begin (7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip
for an additional attendant if deemed medically necessary.
new text end

deleted text begin The base rates for special transportation services in areas defined under RUCA
to be super rural shall be equal to the reimbursement rate established in paragraph (f),
clause (1), plus 11.3 percent, and for special deleted text end new text begin (m) The base rate for nonemergency medical
transportation services in areas defined under RUCA to be super rural is equal to 111.3
percent of the respective base rate in paragraph (l), clauses (1) to (7). The mileage rate
for nonemergency medical new text end transportation services in areas defined under RUCA to be
rural or super rural areas new text begin is new text end :

(1) for a trip equal to 17 miles or less, deleted text begin mileage reimbursement shall be deleted text end equal to 125
percent of the respective mileage rate in paragraph deleted text begin (f) deleted text end new text begin (l) new text end , deleted text begin clause deleted text end new text begin clauses new text end (1) new text begin to (7) new text end ; and

(2) for a trip between 18 and 50 miles, deleted text begin mileage reimbursement shall be deleted text end equal to
112.5 percent of the respective mileage rate in paragraph deleted text begin (f) deleted text end new text begin (l) new text end , deleted text begin clause deleted text end new text begin clauses new text end (1) new text begin to (7) new text end .

deleted text begin (m) deleted text end new text begin (n) new text end For purposes of reimbursement rates for deleted text begin special deleted text end new text begin nonemergency medical new text end
transportation services under deleted text begin paragraph (c) deleted text end new text begin paragraphs (l) and (m) new text end , the zip code of the
recipient's place of residence shall determine whether the urban, rural, or super rural
reimbursement rate applies.

deleted text begin (n) deleted text end new text begin (o) new text end 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.

deleted text begin (o) 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 for services provided on or after January 1, 2012,
to reflect this reduction.
deleted text end

Sec. 6.

Minnesota Statutes 2014, section 256B.0625, subdivision 17a, is amended to
read:

Subd. 17a.

Payment for ambulance services.

deleted text begin (a) deleted text end 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.

deleted text begin (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.
deleted text end

Sec. 7.

Minnesota Statutes 2014, section 256B.0625, subdivision 18a, is amended to
read:

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) deleted text begin Medical assistance direct mileage reimbursement to the eligible person or the
eligible person's driver may not exceed 20 cents per mile.
deleted text end

deleted text begin (d) deleted text end 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.

Sec. 8.

Minnesota Statutes 2014, section 256B.0625, subdivision 18e, is amended to
read:

Subd. 18e.

Single administrative structure and delivery system.

The
commissioner new text begin , in coordination with the commissioner of transportation, new text end shall implement
a single administrative structure and delivery system for nonemergency medical
transportation, beginning the latter of the date the single administrative assessment tool
required in this subdivision is available for use, as determined by the commissioner or by
July 1, 2016.

In coordination with the Department of Transportation, the commissioner shall
develop and authorize a Web-based single administrative structure and assessment
tool, which must operate 24 hours a day, seven days a week, to facilitate the enrollee
assessment process for nonemergency medical transportation services. The Web-based
tool shall facilitate the transportation eligibility determination process initiated by clients
and client advocates; shall include an accessible automated intake and assessment
process and real-time identification of level of service eligibility; and shall authorize an
appropriate and auditable mode of transportation authorization. The tool shall provide a
single framework for reconciling trip information with claiming and collecting complaints
regarding inappropriate level of need determinations, inappropriate transportation modes
utilized, and interference with accessing nonemergency medical transportation. The
Web-based single administrative structure shall operate on a trial basis for one year from
implementation and, if approved by the commissioner, shall be permanent thereafter.
The commissioner shall seek input from the Nonemergency Medical Transportation
Advisory Committee to ensure the software is effective and user-friendly and make
recommendations regarding funding of the single administrative system.

Sec. 9.

Laws 2014, chapter 312, article 24, section 45, subdivision 2, is amended to read:

Subd. 2.

Application for and terms of variance.

A new provider may apply to the
commissioner, on a form supplied by the commissioner for this purpose, for a variance
from special transportation service operating standards. The commissioner may grant or
deny the variance application. Variances expire on the earlier of February 1, 2016, or deleted text begin the
date that the commissioner of transportation begins certifying new providers under the
terms of this act and successor legislation deleted text end new text begin one year after the date the variance was issued.
The commissioner must not grant variances under this subdivision after June 30, 2015 new text end .