2nd Engrossment - 88th Legislature (2013 - 2014) Posted on 03/21/2014 08:55am
A bill for an act
relating to human services; modifying nonemergency medical transportation
services provisions; amending Minnesota Statutes 2012, section 256B.0625,
subdivisions 17a, 18a, 18b, 18c, 18d, 18g, by adding a subdivision; Minnesota
Statutes 2013 Supplement, section 256B.0625, subdivisions 17, 18e; repealing
Minnesota Statutes 2013 Supplement, section 256B.0625, subdivision 18f.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Minnesota Statutes 2013 Supplement, section 256B.0625, subdivision 17,
is amended to read:
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(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. Nonemergency medical transportation service includes, but is not
limited to, special transportation service, defined in section 174.29, subdivision 1.
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deleted text begin (a)deleted text end new text begin (b) new text end 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) deleted text begin an ambulancedeleted text end new text begin nonemergency medical transportation providers who meet the
requirements of this subdivision;
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new text begin (2) ambulancesnew text end , as defined in section 144E.001, subdivision 2;
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(2) special transportation; or
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(3) deleted text begin common carrier including, but not limited to, bus, taxicab, other commercial
carrier, or private automobiledeleted text end new text begin taxicabs and public transit, as defined in section 174.22,
subdivision 7; or
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new text begin (4) not-for-hire vehicles, including volunteer driversnew text end .
deleted text begin (b)deleted text end new text begin (c) new text end Medical assistance covers deleted text begin special transportation, as defined in Minnesota
Rules, part 9505.0315, subpart 1, item F, if the recipient has a physical or mental
impairment that would prohibit the recipient from safely accessing and using a bus,
taxi, other commercial transportation, or private automobile.deleted text end new text begin 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.
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(d) The administrative agency of nonemergency medical transportation must:
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(1) adhere to the policies defined by the commissioner in consultation with the
Nonemergency Medical Transportation Advisory Committee;
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(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;
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(3) provide data monthly to the commissioner on appeals, complaints, no-shows,
canceled trips, and number of trips by mode; and
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(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.
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(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 under paragraph (h), clauses (4), (5), (6), and (7).
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new text begin (f) new text end The commissioner may use an order by the recipient's attending physician
new text begin or a medical or mental health professionalnew text end to certify that the recipient requires
deleted text begin special transportation servicesdeleted text end new text begin nonemergency medical transportation servicesnew text end . deleted text begin Special
deleted text end new text begin Nonemergency medical new text end transportation providers shall perform driver-assisted services for
eligible individualsnew text begin , when appropriatenew text end . 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 Specialdeleted text end new text begin Nonemergency medical
new text end transportation providers must deleted text begin obtain written documentation from the health care service
provider who is serving the recipient being transported, identifying the time that the
recipient arrived. Specialdeleted text end new text begin 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 new text end transportation
providers may not bill for separate base rates for the continuation of a trip beyond the
original destination. deleted text begin Specialdeleted text end new text begin Nonemergency medical new text end transportation providers must take
deleted text begin recipientsdeleted text end new text begin clients new text end 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 deleted text begin recipientdeleted text end new text begin client new text end receives authorization from the local agency. deleted text begin The
minimum medical assistance reimbursement rates for special transportation services are:
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(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;
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(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
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(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;
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deleted text begin (2)deleted text end new text begin Clients requesting client mileage reimbursement must sign the trip log attesting
mileage traveled to obtain covered medical services.
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(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,
a vehicle that is not stretcher-accessible or lift/ramp equipped designed to transport seven
or fewer persons, and 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.
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(h) 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.
Clients can be found eligible for the most appropriate of the following modes:
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(1) client reimbursement, which includes client mileage reimbursement provided
to clients who have their own transportation or family who provides transportation to
the client;
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(2) volunteer transport, which includes transportation by volunteers using their
own vehicle;
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(3) unassisted transport, which includes transportation provided to a client by a
taxicab or public transit. If a taxicab or publicly operated transit system is not available,
the client can receive transportation from another nonemergency medical transportation
provider;
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(4) assisted transport, which includes transport provided to clients who require
assistance by a nonemergency medical transportation provider;
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(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;
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(6) protected transport, which includes transport to a client who has received a
prescreening that has deemed other forms of transportation inappropriate and who requires
a provider certified as a protected transport provider; and
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(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.
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(i) Local agencies shall administer and reimburse for modes defined in paragraph
(h), clauses (1) to (3). The commissioner shall administer and reimburse for modes
defined in paragraph (h), clauses (4) to (7). In accordance with subdivision 18e, by July 1,
2016, the local agency shall be the single administrative agency and shall administer and
reimburse for modes defined in paragraph (h), clauses (1), (2), (3), (4), (5), (6), and (7).
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(j) The commissioner shall:
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(1) in consultation with the Nonemergency Medical Transportation Advisory
Committee, verify that the mode and use of nonemergency medical transportation is
appropriate;
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(2) verify that the client is going to an approved medical appointment; and
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(3) investigate all complaints and appeals.
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(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 sanctions and monetary recovery actions in sections
256B.041 and 256B.064, and all applicable Minnesota Rules.
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(l) Payments for nonemergency medical transportation shall be paid based on the
client's assessed mode, not the type of vehicle used to provide the service. The medical
assistance reimbursement rates for nonemergency medical transportation services payable
by or on behalf of the commissioner for nonemergency medical transportation services are:
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(1) up to 80 percent of the Internal Revenue Service standard mileage rate for client
reimbursement;
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(2) up to 200 percent of the Internal Revenue Service standard mileage rate for
volunteer transport;
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(3) equivalent to the standard fare when provided by public transit and $11 for the
base rate and $1.30 per mile for unassisted transport when provided by a nonemergency
medical transportation provider;
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(4) $13 for the base rate and $1.30 per mile for assisted transport;
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(5) $17 for the base rate and $1.35 per mile for lift-equipped/ramp transport;
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(6) $75 for the base rate and $3.30 per mile for protected transport; and
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(7) $60 for the base rate, $2.40 per mile, and $9 per trip for an additional attendant
for stretcher transport if deemed medically necessary.
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(m) The mileage reimbursement rates for nonemergency medical transportation in
paragraph (l), clauses (3) to (7), are subject to a quarterly fuel adjustment. Reimbursement
rates shall be adjusted quarterly by the commissioner within existing, identified, and
available appropriations when the statewide average price of regular grade gasoline is over
$3.50 per gallon, as calculated by the Oil Price Information Service. The average price of
regular grade gasoline is determined on the first Monday of the last month of the quarter,
with the corresponding rate adjustment effective on the first day of the following month.
Rate adjustments shall be one percent for each ten-cent increment change in the statewide
average price of regular grade gasoline.
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new text begin (n) new text end The base rates for deleted text begin specialdeleted text end new text begin nonemergency medical new text end transportation services in areas
defined under RUCA to be super rural shall be equal to the reimbursement rate established
in deleted text begin clause (1)deleted text end new text begin paragraph (l), clauses (1) to (7),new text end plus 11.3 percentdeleted text begin ;deleted text end new text begin ,new text end and
deleted text begin (3)deleted text end for deleted text begin specialdeleted text end new text begin nonemergency medical new text end transportation services in areas defined under
RUCA to be rural or super rural areas:
(i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125
percent of the respective mileage rate in deleted text begin clause (1)deleted text end new text begin paragraph (l), clauses (1) to (7)new text end ; and
(ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to
112.5 percent of the respective mileage rate in deleted text begin clause (1)deleted text end new text begin paragraph (l), clauses (1) to (7)new text end .
deleted text begin (c)deleted text end new text begin (o) new text end For purposes of reimbursement rates for deleted text begin specialdeleted text end new text begin nonemergency medical
new text end transportation services under paragraph (b), 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 (d)deleted text end new text begin (p) 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 (e)deleted text end new text begin (q) new text end Effective for services provided deleted text begin on or afterdeleted text end new text begin between new text end September 1, 2011, new text begin and
June 30, 2014, new text end 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.
Minnesota Statutes 2012, section 256B.0625, subdivision 17a, is amended to
read:
(a) 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.
(b) Effective for services provided deleted text begin on or afterdeleted text end new text begin between new text end September 1, 2011, new text begin and June
30, 2014, new text end 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.
Minnesota Statutes 2012, section 256B.0625, subdivision 18a, is amended to
read:
(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) Medical assistance direct mileage reimbursement to the eligible person or the
eligible person's driver may not exceed deleted text begin 20 centsdeleted text end new text begin 80 percent of the Internal Revenue
Service standard mileage ratenew text end per mile.
(d) 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.
Minnesota Statutes 2012, section 256B.0625, subdivision 18b, is amended to
read:
The commissioner shall not use a
broker or coordinator for any purpose related to new text begin nonemergency medical new text end transportation
services under subdivision 18.
Minnesota Statutes 2012, section 256B.0625, subdivision 18c, is amended to
read:
(a) The Nonemergency Medical Transportation Advisory Committee shall advise the
commissioner on the administration of nonemergency medical transportation covered
under medical assistance. The advisory committee shall meet at least quarterly new text begin the first
year following January 1, 2015, and at least biannually thereafter new text end and may meet more
frequently as required by the commissioner. The advisory committee shall annually
elect a chair from among its members, who shall work with the commissioner or the
commissioner's designee to establish the agenda for each meeting. The commissioner, or
the commissioner's designee, shall attend all advisory committee meetings.
(b) The Nonemergency Medical Transportation Advisory Committee shall advise
and make recommendations to the commissioner on:
(1) deleted text begin the development of, and periodicdeleted text end updates todeleted text begin , adeleted text end new text begin the nonemergency medical
transportation new text end policy manual deleted text begin for nonemergency medical transportation servicesdeleted text end ;
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(2) policies and a funding source for reimbursing no-load miles;
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(3) policies to prevent waste, fraud, and abuse, and to improve the efficiency of the
nonemergency medical transportation system;
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(4) other issues identified in the 2011 evaluation report by the Office of the
Legislative Auditor on medical nonemergency transportation; and
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deleted text begin (5)deleted text end new text begin (2) new text end other aspects of the nonemergency medical transportation system, as
requested by the commissionerdeleted text begin .deleted text end new text begin ; and
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(3) other aspects of the nonemergency medical transportation system, as requested by:
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(i) a committee member, who may request an item to be placed on the agenda for
a future meeting. The request may be considered by the committee and voted upon.
If the motion carries, the meeting agenda item may be developed for presentation to
the committee; and
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(ii) a member of the public, who may approach the committee by letter or e-mail
requesting that an item be placed on a future meeting agenda. The request may be
considered by the committee and voted upon. If the motion carries, the agenda item may
be developed for presentation to the committee.
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(c) The Nonemergency Medical Transportation Advisory Committee shall
coordinate its activities with the Minnesota Council on Transportation Access established
under section 174.285. The chair of the advisory committee, or the chair's designee, shall
attend all meetings of the Minnesota Council on Transportation Access.
(d) The Nonemergency Medical Transportation Advisory Committee shall expire
December 1, deleted text begin 2014deleted text end new text begin 2019new text end .
Minnesota Statutes 2012, section 256B.0625, subdivision 18d, is amended to
read:
(a) The Nonemergency Medical
Transportation Advisory Committee consists of:
(1) deleted text begin two voting members who represent counties, at least one of whom must represent
a county or counties other than Anoka, Carver, Chisago, Dakota, Hennepin, Isanti,
Ramsey, Scott, Sherburne, Washington, and Wrightdeleted text end new text begin four voting members who represent
counties, utilizing the rural urban commuting area classification system. As defined in
subdivision 17, these members shall be designated as follows:
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(i) two counties within the 11-county metropolitan area;
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(ii) one county representing the rural area of the state; and
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(iii) one county representing the super rural area of the state.
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new text begin The Association of Minnesota Counties shall appoint one county within the 11-county
metropolitan area and one county representing the super rural area of the state. The
Minnesota Inter-County Association shall appoint one county within the 11-county
metropolitan area and one county representing the rural area of the statenew text end ;
(2) deleted text begin fourdeleted text end new text begin three new text end voting members who represent medical assistance recipients, including
persons with physical and developmental disabilities, persons with mental illness, seniors,
children, and low-income individuals;
(3) four voting members who represent providers that deliver nonemergency medical
transportation services to medical assistance enrollees;
(4) two voting members of the house of representatives, one from the majority
party and one from the minority party, appointed by the speaker of the house, and two
voting members from the senate, one from the majority party and one from the minority
party, appointed by the Subcommittee on Committees of the Committee on Rules and
Administration;
(5) one voting member who represents demonstration providers as defined in section
256B.69, subdivision 2;
(6) one voting member who represents an organization that contracts with state or
local governments to coordinate transportation services for medical assistance enrollees;
deleted text begin and
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(7) new text begin one voting member who represents the Minnesota State Council on Disability;
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new text begin (8) new text end the commissioner of transportation or the commissioner's designee, who shall
serve as a voting membernew text begin ;
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(9) one voting member appointed by the Minnesota Ambulance Association; and
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new text begin (10) one voting member appointed by the Minnesota Hospital Associationnew text end .
(b) Members of the advisory committee shall not be employed by the Department of
Human Services. Members of the advisory committee shall receive no compensation.
Minnesota Statutes 2013 Supplement, section 256B.0625, subdivision 18e,
is amended to read:
deleted text begin (a)deleted text end The
commissioner shall implement a single administrative structure and delivery system
for nonemergency medical transportation, beginning new text begin the latter of the date the single
administrative assessment tool required in this paragraph is available for use, as
determined by the commissioner or by new text end July 1, deleted text begin 2014deleted text end new text begin 2016new text end . deleted text begin The single administrative
structure and delivery system must:
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(1) eliminate the distinction between access transportation services and special
transportation services;
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(2) enable all medical assistance recipients to follow the same process to obtain
nonemergency medical transportation, regardless of their level of need;
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(3) provide a single oversight framework for all providers of nonemergency medical
transportation; and
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(4) provide flexibility in service delivery, recognizing that clients fall along a
continuum of needs and resources.
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(b) The commissioner shall present to the legislature, by January 15, 2014,
legislation necessary to implement the single administrative structure and delivery system
for nonemergency medical transportation.
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(c) In developing the single administrative structure and delivery system and the draft
legislation, the commissioner shall consult with the Nonemergency Medical Transportation
Advisory Committee.
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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.
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Minnesota Statutes 2012, section 256B.0625, subdivision 18g, is amended to
read:
deleted text begin The commissioner, in consultation
with the Nonemergency Medical Transportation Advisory Committee, shall establish
performance measures to assess the cost-effectiveness and quality of nonemergency
medical transportation. At a minimum, performance measures should include the number
of unique participants served by type of transportation provider, number of trips provided
by type of transportation provider, and cost per trip by type of transportation provider. The
commissioner must also consider the measures identified in the January 2012 Department
of Human Services report to the legislature on nonemergency medical transportation.
deleted text end Beginning in calendar year deleted text begin 2013deleted text end new text begin 2015new text end , the commissioner shall collect, audit, and analyze
performance data on nonemergency medical transportation annually and report this
information on the agency's Web site. The commissioner shall periodically supplement
this information with the results of consumer surveys of the quality of services, and shall
make these survey findings available to the public on the agency Web site.
Minnesota Statutes 2012, section 256B.0625, is amended by adding a
subdivision to read:
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The following subdivisions do not apply to managed
care plans and county-based purchasing plans:
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(1) subdivision 17, paragraphs (d) to (m);
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(2) subdivision 18e; and
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(3) subdivision 18g.
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For purposes of this section, the following definitions
apply:
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(1) "new provider" is a nonemergency medical transportation service provider that
was not required to comply with special transportation service operating standards before
the effective date of this act; and
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(2) "commissioner" is the commissioner of human services.
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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 the
date that the commissioner of transportation begins certifying new providers under the
terms of this act and successor legislation.
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The commissioner shall periodically
transmit to the Department of Transportation the number of variance applications received
and the number granted.
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On or before February
1, 2015, the commissioner of transportation shall report to the chairs and ranking
minority members of the senate and house of representatives committees and divisions
with jurisdiction over transportation and human services concerning implementing this
act. The report must contain recommendations of the commissioner of transportation
concerning statutes, session laws, and rules that must be amended, repealed, enacted, or
adopted to implement the terms of this act. The recommendations must include, without
limitation, the amount of the fee that would be required to cover the costs of Department of
Transportation supervision of inspection and certification, as well as any needed statutory
rulemaking or other authority to be granted to the commissioner of transportation.
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Minnesota Statutes 2013 Supplement, section 256B.0625, subdivision 18f,
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is
repealed.
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Sections 1 to 10 are effective August 1, 2014.
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