1.1 	A bill for an act
1.2 	relating to human services; eliminating rate reductions for nonemergency 
1.3 	medical transportation and ambulance services;amending Minnesota Statutes 
1.4 	2014, section 256B.0625, subdivisions 17, 17a.
1.5 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6 	Section 1. Minnesota Statutes 2014, section 256B.0625, subdivision 17, is amended to 
1.7 	read:
1.8 		Subd. 17.Transportation costs. (a) "Nonemergency medical transportation 
1.9 	service" means motor vehicle transportation provided by a public or private person 
1.10 	that serves Minnesota health care program beneficiaries who do not require emergency 
1.11 	ambulance service, as defined in section 144E.001, subdivision 3, to obtain covered 
1.12 	medical services. Nonemergency medical transportation service includes, but is not 
1.13 	limited to, special transportation service, defined in section 174.29, subdivision 1.
1.14 	(b) Medical assistance covers medical transportation costs incurred solely for 
1.15 	obtaining emergency medical care or transportation costs incurred by eligible persons in 
1.16 	obtaining emergency or nonemergency medical care when paid directly to an ambulance 
1.17 	company, common carrier, or other recognized providers of transportation services. 
1.18 	Medical transportation must be provided by:
1.19 	(1) nonemergency medical transportation providers who meet the requirements 
1.20 	of this subdivision;
1.21 	(2) ambulances, as defined in section 144E.001, subdivision 2;
1.22 	(3) taxicabs and public transit, as defined in section 174.22, subdivision 7; or
1.23 	(4) not-for-hire vehicles, including volunteer drivers.
2.1 	(c) Medical assistance covers nonemergency medical transportation provided by 
2.2 	nonemergency medical transportation providers enrolled in the Minnesota health care 
2.3 	programs. All nonemergency medical transportation providers must comply with the 
2.4 	operating standards for special transportation service as defined in sections 174.29 to 
2.5 	174.30 and Minnesota Rules, chapter 8840, and in consultation with the Minnesota 
2.6 	Department of Transportation. All nonemergency medical transportation providers shall 
2.7 	bill for nonemergency medical transportation services in accordance with Minnesota 
2.8 	health care programs criteria. Publicly operated transit systems, volunteers, and 
2.9 	not-for-hire vehicles are exempt from the requirements outlined in this paragraph.
2.10 	(d) The administrative agency of nonemergency medical transportation must:
2.11 	(1) adhere to the policies defined by the commissioner in consultation with the 
2.12 	Nonemergency Medical Transportation Advisory Committee;
2.13 	(2) pay nonemergency medical transportation providers for services provided to 
2.14 	Minnesota health care programs beneficiaries to obtain covered medical services;
2.15 	(3) provide data monthly to the commissioner on appeals, complaints, no-shows, 
2.16 	canceled trips, and number of trips by mode; and
2.17 	(4) by July 1, 2016, in accordance with subdivision 18e, utilize a Web-based single 
2.18 	administrative structure assessment tool that meets the technical requirements established 
2.19 	by the commissioner, reconciles trip information with claims being submitted by 
2.20 	providers, and ensures prompt payment for nonemergency medical transportation services.
2.21 	(e) Until the commissioner implements the single administrative structure and 
2.22 	delivery system under subdivision 18e, clients shall obtain their level-of-service certificate 
2.23 	from the commissioner or an entity approved by the commissioner that does not dispatch 
2.24 	rides for clients using modes under paragraph (h), clauses (4), (5), (6), and (7).
2.25 	(f) The commissioner may use an order by the recipient's attending physician or a 
2.26 	medical or mental health professional to certify that the recipient requires nonemergency 
2.27 	medical transportation services. Nonemergency medical transportation providers shall 
2.28 	perform driver-assisted services for eligible individuals, when appropriate. Driver-assisted 
2.29 	service includes passenger pickup at and return to the individual's residence or place of 
2.30 	business, assistance with admittance of the individual to the medical facility, and assistance 
2.31 	in passenger securement or in securing of wheelchairs or stretchers in the vehicle. 
2.32 	Nonemergency medical transportation providers must have trip logs, which include pickup 
2.33 	and drop-off times, signed by the medical provider or client attesting mileage traveled to 
2.34 	obtain covered medical services, whichever is deemed most appropriate. Nonemergency 
2.35 	medical transportation providers may not bill for separate base rates for the continuation 
2.36 	of a trip beyond the original destination. Nonemergency medical transportation providers 
3.1 	must take clients to the health care provider, using the most direct route, and must not 
3.2 	exceed 30 miles for a trip to a primary care provider or 60 miles for a trip to a specialty 
3.3 	care provider, unless the client receives authorization from the local agency. The minimum 
3.4 	medical assistance reimbursement rates for special transportation services are:
3.5 	(1)(i) $17 for the base rate and $1.35 per mile for special transportation services to 
3.6 	eligible persons who need a wheelchair-accessible van;
3.7 	(ii) $11.50 for the base rate and $1.30 per mile for special transportation services to 
3.8 	eligible persons who do not need a wheelchair-accessible van; and
3.9 	(iii) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, 
3.10 	for special transportation services to eligible persons who need a stretcher-accessible 
3.11 	vehicle; and
3.12 	(2) clients requesting client mileage reimbursement must sign the trip log attesting 
3.13 	mileage traveled to obtain covered medical services.
3.14 	(g) The covered modes of nonemergency medical transportation include 
3.15 	transportation provided directly by clients or family members of clients with their own 
3.16 	transportation, volunteers using their own vehicles, taxicabs, and public transit, or 
3.17 	provided to a client who needs a stretcher-accessible vehicle, a lift/ramp equipped vehicle, 
3.18 	or a vehicle that is not stretcher-accessible or lift/ramp equipped designed to transport ten 
3.19 	or fewer persons. Upon implementation of a new rate structure, a new covered mode of 
3.20 	nonemergency medical transportation shall include transportation provided to a client who 
3.21 	needs a protected vehicle that is not an ambulance or police car and has safety locks, a 
3.22 	video recorder, and a transparent thermoplastic partition between the passenger and the 
3.23 	vehicle driver.
3.24 	(h) The administrative agency shall use the level of service process established by the 
3.25 	commissioner in consultation with the Nonemergency Medical Transportation Advisory 
3.26 	Committee to determine the client's most appropriate mode of transportation. If public 
3.27 	transit or a certified transportation provider is not available to provide the appropriate 
3.28 	service mode for the client, the client may receive a onetime service upgrade. The new 
3.29 	modes of transportation, which may not be implemented without a new rate structure, are:
3.30 	(1) client reimbursement, which includes client mileage reimbursement provided 
3.31 	to clients who have their own transportation or family who provides transportation to 
3.32 	the client;
3.33 	(2) volunteer transport, which includes transportation by volunteers using their 
3.34 	own vehicle;
3.35 	(3) unassisted transport, which includes transportation provided to a client by a 
3.36 	taxicab or public transit. If a taxicab or publicly operated transit system is not available, 
4.1 	the client can receive transportation from another nonemergency medical transportation 
4.2 	provider;
4.3 	(4) assisted transport, which includes transport provided to clients who require 
4.4 	assistance by a nonemergency medical transportation provider;
4.5 	(5) lift-equipped/ramp transport, which includes transport provided to a client who 
4.6 	is dependent on a device and requires a nonemergency medical transportation provider 
4.7 	with a vehicle containing a lift or ramp;
4.8 	(6) protected transport, which includes transport to a client who has received a 
4.9 	prescreening that has deemed other forms of transportation inappropriate and who requires 
4.10 	a provider certified as a protected transport provider; and
4.11 	(7) stretcher transport, which includes transport for a client in a prone or supine 
4.12 	position and requires a nonemergency medical transportation provider with a vehicle that 
4.13 	can transport a client in a prone or supine position.
4.14 	(i) In accordance with subdivision 18e, by July 1, 2016, the local agency shall be 
4.15 	the single administrative agency and shall administer and reimburse for modes defined in 
4.16 	paragraph (h) according to a new rate structure, once this is adopted.
4.17 	(j) The commissioner shall:
4.18 	(1) in consultation with the Nonemergency Medical Transportation Advisory 
4.19 	Committee, verify that the mode and use of nonemergency medical transportation is 
4.20 	appropriate;
4.21 	(2) verify that the client is going to an approved medical appointment; and
4.22 	(3) investigate all complaints and appeals.
4.23 	(k) The administrative agency shall pay for the services provided in this subdivision 
4.24 	and seek reimbursement from the commissioner, if appropriate. As vendors of medical 
4.25 	care, local agencies are subject to the provisions in section 256B.041, the sanctions and 
4.26 	monetary recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 
4.27 	to 9505.2245.
4.28 	(l) The base rates for special transportation services in areas defined under RUCA to 
4.29 	be super rural shall be equal to the reimbursement rate established in paragraph (f), clause 
4.30 	(1), plus 11.3 percent, and for special transportation services in areas defined under RUCA 
4.31 	to be rural or super rural areas:
4.32 	(1) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125 
4.33 	percent of the respective mileage rate in paragraph (f), clause (1); and
4.34 	(2) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to 
4.35 	112.5 percent of the respective mileage rate in paragraph (f), clause (1).
5.1 	(m) For purposes of reimbursement rates for special transportation services under 
5.2 	paragraph (c), the zip code of the recipient's place of residence shall determine whether 
5.3 	the urban, rural, or super rural reimbursement rate applies.
5.4 	(n) For purposes of this subdivision, "rural urban commuting area" or "RUCA" 
5.5 	means a census-tract based classification system under which a geographical area is 
5.6 	determined to be urban, rural, or super rural.
5.7 	(o) Effective for services provided on or after September 1, 2011, nonemergency 
5.8 	transportation rates, including special transportation, taxi, and other commercial carriers, 
5.9 	are reduced 4.5 percent. Payments made to managed care plans and county-based 
5.10 	purchasing plans must be reduced for services provided on or after January 1, 2012, to 
5.11 	reflect this reduction. Effective for services provided on or after July 1, 2015, the 4.5 
5.12 	percent rate reduction shall not apply to nonemergency medical transportation services 
5.13 	provided by:
5.14 	(1) ambulances licensed under chapter 144E; or
5.15 	(2) nonemergency medical transportation vehicles when operated under a current 
5.16 	certificate of compliance issued by the commissioner of transportation under section 
5.17 	174.30.

5.18 	Sec. 2. Minnesota Statutes 2014, section 256B.0625, subdivision 17a, is amended to 
5.19 	read:
5.20 		Subd. 17a.Payment for ambulance services. (a) Medical assistance covers 
5.21 	ambulance services. Providers shall bill ambulance services according to Medicare 
5.22 	criteria. Nonemergency ambulance services shall not be paid as emergencies. Effective 
5.23 	for services rendered on or after July 1, 2001, medical assistance payments for ambulance 
5.24 	services shall be paid at the Medicare reimbursement rate or at the medical assistance 
5.25 	payment rate in effect on July 1, 2000, whichever is greater.
5.26 	(b) Effective for services provided on or after September 1, 2011, through June 30, 
5.27 	2015, ambulance services payment rates are reduced 4.5 percent. Payments made to 
5.28 	managed care plans and county-based purchasing plans must be reduced for services 
5.29 	provided on or after January 1, 2012, to reflect this reduction.