S.F. _____ Section 1. NEW SECTION . 324A.8 Application to Medicaid 1 managed care organizations. 2 For the purposes of this chapter, a Medicaid managed 3 care organization under contract with the department of 4 human services to provide services, including nonemergency 5 medical transportation and home and community-based services 6 waiver transportation services, to Medicaid members, shall 7 be considered an entity receiving federal, state, or local 8 aid to provide or contract for public transit services or 9 transportation to a specific client group. In addition to all 10 other applicable requirements under this chapter, in order to 11 comply with the requirement of coordinating and consolidating 12 funding and resulting services to the maximum extent possible 13 with the urban or regional transit system in providing or 14 contracting for public transit services or transportation to 15 a specific client group, Medicaid managed care organizations 16 shall provide an urban or regional transit system with the 17 right of first refusal in providing nonemergency medical 18 transportation and home and community-based services waiver 19 transportation services to Medicaid members. 20 Sec. 2. NONEMERGENCY MEDICAL TRANSPORTATION AND 21 HOME AND COMMUNITY-BASED SERVICES WAIVER TRANSPORTATION 22 SERVICES —— PUBLIC TRANSIT SYSTEMS —— MEDICAID MANAGED CARE 23 ORGANIZATION CONTRACTS. The department of human services shall 24 contractually require a Medicaid managed care organization, 25 when utilizing a public transit system to provide nonemergency 26 medical transportation or home and community-based services 27 waiver transportation services to Medicaid members, to do all 28 of the following: 29 1. Utilize the appropriate urban or regional transit system 30 as the coordinator of transportation services to efficiently 31 schedule shared trips to decrease the fragmentation of services 32 and the burden on Medicaid members. 33 2. Provide the urban or regional transit system the right of 34 first refusal in providing all such transportation services. 35 -1- LSB 2448XC (10) 89 pf/rh 1/ 3

S.F. _____ 3. If a Medicaid member is also a federal Americans with 1 Disabilities Act (ADA) paratransit-eligible user of the 2 complementary paratransit service, provide cost-based Medicaid 3 services reimbursement for a paratransit trip rather than the 4 limited fare reimbursement amount authorized under 49 C.F.R. 5 §37.131(c) requiring subsidization through local tax levies. 6 4. Ensure that the reimbursement rate paid to the 7 appropriate urban or regional transit system for these services 8 is sufficient to avoid cost transference to and increased 9 expenditure of local tax levies, including local property 10 taxes. 11 5. Ensure compliance with this chapter. 12 EXPLANATION 13 The inclusion of this explanation does not constitute agreement with 14 the explanation’s substance by the members of the general assembly. 15 This bill relates to the provision of nonemergency medical 16 transportation (NEMT) and home and community-based services 17 waiver transportation services through public transit systems 18 under the Medicaid program. 19 The bill provides that for the purposes of Code chapter 324A 20 (transportation programs), a Medicaid managed care organization 21 (MCO) under contract with the department of human services 22 (DHS) to provide Medicaid program services, including NEMT 23 and home and community-based services waiver transportation 24 services, to Medicaid members, shall be considered an entity 25 receiving federal, state, or local aid to provide or contract 26 for public transit services or transportation to a specific 27 client group. In part, the Code chapter requires that such an 28 entity must coordinate and consolidate funding and resulting 29 services, to the maximum extent possible, with the urban or 30 regional transit system; and must comply with certain criteria 31 including maximizing efficiencies, reducing duplication, and 32 coordinating the planning for transportation services at the 33 urban and regional level. The bill includes as part of the 34 requirement to coordinate and consolidate funding and resulting 35 -2- LSB 2448XC (10) 89 pf/rh 2/ 3

S.F. _____ services to the maximum extent possible, a requirement that 1 Medicaid managed care organizations shall provide an urban or 2 regional transit system with the right of first refusal in 3 providing nonemergency medical transportation and home and 4 community-based services waiver transportation services to 5 Medicaid members. 6 The bill also requires DHS to contractually require an 7 MCO, when utilizing public transit systems to provide NEMT 8 or home and community-based services waiver transportation 9 services to Medicaid members to: utilize the urban or 10 regional transit system as the coordinator of transportation 11 services to efficiently schedule shared trips to decrease the 12 fragmentation of services and the burden on Medicaid members; 13 provide the urban or regional transit system the right of first 14 refusal in providing all such transportation services; if a 15 Medicaid member is also a paratransit-eligible user of the 16 complementary paratransit service under the federal Americans 17 with Disabilities Act (ADA), provide cost-based Medicaid 18 services reimbursement for paratransit trips rather than the 19 reimbursement rate under the ADA which shall not exceed twice 20 the fare that would be charged to an individual paying full 21 fare and requiring subsidization through local tax levies; 22 ensure that the reimbursement rate paid to an urban or regional 23 transit system for these services is sufficient to avoid cost 24 transference to and increased expenditure of local tax levies, 25 including local property taxes; and ensure compliance with Code 26 chapter 324A. 27 -3- LSB 2448XC (10) 89 pf/rh 3/ 3