For those with chronic conditions, the need for care remains even in the midst of a pandemic, requiring those all-important NEMT trips to provide transportation to appointments. The life and death scenarios of the pandemic go far beyond COVID-positive patients, and can affect all those who require both frequent and acute care.

As the country moves into its fourth month of pandemic response, the impacts of this virus on our health systems, economy, essential workers and population writ large continue to emerge. In an effort to offer additional relief, the House of Representatives passed the fourth Coronavirus response bill. This recently passed legislation (“H.R. 6800“), known as The Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, is the largest package yet, totaling $3 trillion. Included within the HEROES Act was a provision that moves the NEMT benefit into Medicaid statute. Additional language focusing on program integrity was included within the final package including driver credentialing provisions.

The HEROES Act

• Codifies the regulatory requirement that state Medicaid programs cover non-emergency medical transportation (NEMT)
• Addresses Medicaid Program Integrity related to NEMT –
  • Includes funding for a GAO study to complete a “report on coverage under the Medicaid program […] of nonemergency transportation to medically necessary services” covering topics such as safeguards to prevent and detect fraud and abuse, an examination of transportation brokers, identification of numbers, types, and outcomes or instances of NEMT fraud and abuse, and identification of commonalities or trends in program integrity;
  • Convenes a stakeholder working group for a series of meetings to obtain the groups input on leading practices for improving Medicaid NEMT program integrity. Stakeholders shall include: state Medicaid agencies, brokers, providers, Medicaid patients advocates, and others. (Meeting topics to include: ongoing challenges and leading practices in addressing program integrity, unique considerations for specific groups of Medicaid beneficiaries such as American Indians or individuals for disabilities)
  • Creates NEMT Provider and Driver Requirements that ensure each individual driver has a valid driver’s license, and ensure providers have in place processes to address any violation of state drug laws and disclose individual driver’s driver history to State Medicaid programs. It also ensures that “each […] provider and individual drivers is not excluded from participation in any Federal health care program […]and is not listed on the exclusion list of the Inspector General of the Department of Health and Human Services.” This provision applies to any provider (including transportation network companies (TNCs)) or individual driver of nonemergency transportation to medically necessary services under Medicaid, but excludes any public transit authorities.
  • Requires the analysis and submission of a congressional report on the nation-wide data set under the Transformed Medicaid Statistical Information System (T-MSIS) relating to NEMT services.

In addition to the full section of the bill dedicated to NEMT, a number of other provisions may be relevant to NEMT brokers, providers and/or drivers:

• Direct aid to governments, workers, and individuals – Provides nearly $1 trillion in aid for states, cities and local governments, including tribal entities, territories, and the District of Columbia
• Premium Pay to Essential Workers – References throughout the bill to “premium pay” for essential workers, stating that “Employers that apply for and receive grants will pay essential workers $13 per hour premium pay on top of regular wages. Essential workers are eligible for up to $10,000 for work performed from January 27, 2020 until 60 days after the last day of the COVID-19 Public Health Emergency.”
• Public-transit specific provisions: Find CTAA’s summary of the HEROES Act and public transit services here.

Given the bill passed the House on a partisan vote, it is likely to sit in the Senate, and unlikely to become law in its current form. Despite this, there are a few important takeaways that readers should note.

First, the fact that NEMT language was included in this bill illustrates and confirms there is an appetite for full codification of the NEMT benefit in Medicaid. Despite challenges from the administration in recent years, Congress has repeatedly shown support for NEMT services as a mandatory NEMT benefit.

Second, it reiterates the importance of program integrity, and shows that even if there are concerns, Congress is working to address then (rather than eliminate the benefit). The inclusion of provider and driver requirements illustrate the importance of safety, security, and quality of service, while the inclusion of stakeholder convenings acknowledge more discussion on how to best provide NEMT services is still needed.

Third, both the GAO study and congressional report on T-MSIS data show us that there is finally movement of individuals who seek to understand the data. Whether or not the data exists in a cohesive form is another question. Either way, CTAA is encouraged to see these provisions included in the bill.

In conclusion, no matter what happens next with the HEROES Bill, NEMT’s inclusion within the package places it in a strong position to be included at the table in future COVID-19 related discussions, and legislation.

A quick note on federal advocacy for NEMT:

CTAA encourages any members interested in this issue to message to their Representative and Senators regarding previously introduced House and Senate NEMT Bills (H.R. 3935) and (S. 2846), as well as the NEMT provisions in the HEROES Act. Despite the encouraging movements these past few months, we are not yet to the finish line with regard to the protection of the NEMT benefit. We encourage you to email your Congressional offices directly, or use the new Contact Congress Tool created by our partners at the Medical Transportation Access Coalition.