Senior Access to Vaccines Ensured Act of 2021 or the SAVE Act of 2021
This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish a program that provides nonemergency medical transportation (NEMT) for Medicare beneficiaries to COVID-19 vaccination sites during the public health emergency. The CMS must contract with qualified transportation managers to implement the program, with preference given to those with prior experience under a state Medicaid NEMT program. The CMS must also establish criteria for beneficiary participation that is similar to the criteria used by states for Medicaid NEMT services.
To amend title XVIII of the Social Security Act to provide for 
   temporary coverage of certain transportation services for certain 
    individuals under the Medicare program, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Senior Access to Vaccines Ensured 
Act of 2021'' or the ``SAVE Act of 2021''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The Kaiser Family Foundation reported that only about 
        12 percent of Medicare beneficiaries are full Medicare-Medicaid 
        dual eligibles and, thus, have Medicaid coverage for 
        nonemergency medical transportation (NEMT) to access COVID-19 
        vaccination appointments and other health care appointments. 
        According to the Commonwealth Fund, although 45 percent of 
        Medicare beneficiaries have incomes lower than 200 percent of 
        the federal poverty level (FPL), which can limit their 
        transportation options, Medicare does not currently cover NEMT.
            (2) Medicare beneficiaries over the age of 65, according to 
        the Centers for Disease Control, are 24 times more likely to 
        die from COVID-19 than an adult aged 25-54.
            (3) A managed NEMT benefit that offers scheduling and other 
        assistance would improve beneficiaries' access to the COVID-19 
        vaccine. It also would reduce Medicare expenditures by covering 
        more cost-effective alternatives and avoiding the high cost of 
        in-patient COVID-19 treatment.

SEC. 3. COVERAGE OF MANAGED, NONEMERGENT TRANSPORTATION SERVICES FOR 
              CERTAIN INDIVIDUALS.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by adding at the end the following new section:

``SEC. 1899C. MANAGED, NONEMERGENT TRANSPORTATION SERVICES BENEFIT 
              PROGRAM.

    ``(a) Establishment.--The Secretary shall establish a program to be 
known as the `Managed, Nonemergent Transportation Services Benefit 
Program' for purposes of furnishing qualifying individuals not more 
than 2 round-trip managed, nonemergent transportation services (as 
defined in subsection (c)) to COVID-19 vaccination sites (including 
community pharmacies) beginning April 1, 2021, and ending on the last 
day of the emergency period described in section 1135(g)(1)(B).
    ``(b) Contract With Qualified Transportation Manager.--
            ``(1) In general.--For each medicare administrative 
        contractor jurisdiction for a year (beginning with 2021), the 
        Secretary shall enter into a contract with one qualified 
        transportation manager for purposes of arranging for the 
        provision of managed, nonemergent transportation services to 
        qualifying individuals in such region. Such contract shall 
        provide that payment be made by the Secretary for such service 
        on the basis of prepaid capitation payments (taking into 
        account the charge described in paragraph (2)(E)).
            ``(2) Selection.--Not later than 30 days after the date of 
        the enactment of this section, notwithstanding any other 
        provision of law, the Secretary shall award contracts described 
        in paragraph (1) through a competitive bidding process under 
        which the Secretary evaluates applicant entities based on 
        experience, past performance, references, available resources, 
        and cost for purposes of selecting qualified transportation 
        managers, with preference given to applicants with prior 
        satisfactory performance as a transportation broker under a 
        program described in section 1902(a)(70). Not later than 15 
        days after such date of enactment, the Secretary shall publish 
        guidance for prospective qualified transportation managers. 
        Such guidance shall include information on how such manager may 
        enter into a contract described in this subsection and a 
        description of terms and conditions applicable to such managers 
        with such contracts. Such a manager shall meet the following 
        requirements:
                    ``(A) The manager establishes procedures meeting 
                criteria established by the Secretary for addressing 
                beneficiary complaints and ensuring network 
                transportation providers are licensed by the State for 
                purposes of operating vehicles and are competent and 
                courteous.
                    ``(B) The manager is subject to regular audit and 
                oversight by the State in which such manager operates 
                in order to ensure the quality and timeliness of 
                transportation services managed and the adequacy of 
                qualifying individuals' access to medical care and 
                services.
                    ``(C) The manager complies with all requirements 
                specified in the contract described in paragraph (1). 
                Such requirements shall include requirements related 
                to--
                            ``(i) reviews and evaluations to ensure the 
                        quality, appropriateness, and timeliness of 
                        such services arranged by such manager;
                            ``(ii) prohibitions on referrals and 
                        conflict of interest as the Secretary shall 
                        establish (based on the prohibitions on 
                        physician referrals under section 1877 and such 
                        other prohibitions and requirements as the 
                        Secretary determines to be appropriate); and
                            ``(iii) the development and implementation 
                        of a corrective action plan to address any 
                        contract deficiencies.
                    ``(D) The manager establishes procedures for 
                determining an individual's eligibility for managed, 
                nonemergent transportation services under the program 
                established under subsection (a) using criteria 
                established by the Secretary under subsection (c)(3) 
                and for scheduling and organizing the furnishing of 
                such services.
    ``(c) Definition.--For purposes of this section:
            ``(1) Managed, nonemergent transportation services.--The 
        term `managed, nonemergent transportation services' means the 
        transportation of an individual by car, taxi, bus, or other 
        similar means (as specified by the Secretary) to a provider or 
        supplier of services where such individual is to be furnished 
        items or services payable under this title.
            ``(2) Qualified transportation manager.--The term 
        `qualified transportation manager' means an entity that 
        arranges, under contract with the Secretary, for the provision 
        of managed, nonemergent transportation services to qualifying 
        individuals.
            ``(3) Qualifying individual.--The term `qualifying 
        individual' means an individual entitled to benefits under part 
        A who is not enrolled under a Medicare Advantage plan under 
        part C and who is not a full-benefit dual eligible individual 
        (as defined in paragraph (4)) who has no readily-available 
        means of transportation (as determined by the Secretary). In 
        determining whether an individual has no readily-available 
        means of transportation for purposes of the previous sentence, 
        the Secretary shall establish criteria similar to those used by 
        States in making such determinations under a non-emergency 
        medical transportation program under a State plan under title 
        XIX (or a waiver of such plan), such as evaluating whether such 
        individual--
                    ``(A) has a driver's license;
                    ``(B) has a working vehicle available to such 
                individual at such individual's residence;
                    ``(C) is incapable of driving due to a medical 
                condition; and
                    ``(D) has inadequate financial resources to pay for 
                transportation.
            ``(4) Full-benefit dual eligible individual.--
                    ``(A) In general.--The term `full-benefit dual 
                eligible individual' means for a State for a month an 
                individual who--
                            ``(i) is entitled to benefits under part A 
                        or enrolled under part B; and
                            ``(ii) is determined eligible by the State 
                        for medical assistance for full benefits under 
                        title XIX for such month under section 
                        1902(a)(10)(A) or 1902(a)(10)(C), by reason of 
                        section 1902(f), or under any other category of 
                        eligibility for medical assistance for full 
                        benefits under such title, as determined by the 
                        Secretary.
                    ``(B) Treatment of medically needy and other 
                individuals required to spend down.--In applying 
                paragraph (1) in the case of an individual determined 
                to be eligible by the State for medical assistance 
                under section 1902(a)(10)(C) or by reason of section 
                1902(f), the individual shall be treated as meeting the 
                requirement of paragraph (1)(B) for any month if such 
                medical assistance is provided for in any part of the 
                month.
    ``(d) Funding.--The Secretary shall provide for the transfer, from 
the Federal Supplementary Medical Insurance Trust Fund under section 
1841 to the Centers for Medicare & Medicaid Services Program Management 
Account, of such sums as may be necessary for purposes of carrying out 
this section.
    ``(e) Clarification.--The provisions of section 1862(a) shall not 
apply to payments made under a contract described in subsection 
(b)(1).''.
                                 <all>
SAVE Act of 2021
To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes.
SAVE Act of 2021
Senior Access to Vaccines Ensured Act of 2021
Rep. Bishop, Sanford D., Jr.