C.R.S. § 25.5-1-802: Medicaid transportation services - transportation community advisory board - safety and oversight - rules.

(1) The state department shall collaborate with the transportation community advisory board to establish rules and processes for the safety and oversight of nonmedical transportation services and nonemergency medical transportation services provided to medicaid members pursuant to articles 4 to 6 of this title 25.5.

(2) and (3) (Deleted by amendment, L. 2026.)

(4) The transportation broker shall establish the transportation community advisory board, which is composed of representatives of a cross-section of NEMT stakeholders, including members, transportation providers, health-care treatment providers, and disability advocates. The board membership must include:

(a) Medicaid members from both rural and urban areas who utilize NEMT services;

(b) Behavioral health, primary care, and other treatment providers serving medicaid members;

(c) NEMT providers representing:

(I) Rural and urban service areas; and

(II) Large, medium, and small provider organizations;

(d) NEMT providers with experience in management, dispatch, driving, and compliance;

(e) Consumer and disability advocates representing populations with diverse mobility, health, and access needs;

(f) Hospital and health system representatives, including entities involved in discharge planning and care transitions for members;

(g) A representative from the state department with knowledge and specialization in NEMT; and

(h) A nonprofit or public transportation provider representing both rural and urban service areas.

(5) (a) To ensure that the composition of the board represents active transportation providers, forty percent of board members must be providers with direct NEMT operational experience, including management, dispatch, driving, or compliance.

(b) The board shall elect a chair from among its members.

(c) When appointing or approving NEMT provider representatives to the board, the transportation broker and the state department shall ensure equitable representation among:

(I) For-profit transportation providers;

(II) Nonprofit transportation providers; and

(III) Public transportation providers, including local government or public transit agencies.

(6) Board members serve two-year terms. Board members serve without compensation and without reimbursement for expenses.

(7) The board chair and state department shall circulate meeting agendas to the board members at least ten days in advance of meetings. The board shall document meeting minutes and approve meeting minutes within fifteen business days after each meeting. The board must give board members the opportunity to submit written recommendations or comments to the board prior to board action or advice.

(8) The board is an advisory body. The board does not replace or limit the state department's collaboration with NEMT providers when developing rules, processes, or policies.

(9) The board shall provide recommendations to the state department about the state department's rules, processes, and policies that govern NEMT. Final decisions regarding rules, processes, and policies remain the responsibility of the state department.

(10) The state department, in collaboration with the board, shall adopt rules that:

(a) Establish driver, vehicle, and transportation provider credentialing requirements;

(b) Prohibit trip caps, market-share restrictions, or other policies that limit transportation provider participation in the market, except as allowed pursuant to subsection (11) of this section;

(c) Require the state department to host meetings with the board no less than quarterly to review program performance, identify and address program challenges, discuss progress toward program goals, and identify opportunities to enhance efficiency and outcomes of the program;

(d) Require reasonable accommodation of member requests for an alternate or specific transportation provider when operationally feasible;

(e) Create a process for members and transportation providers to file concerns with the state department and for the state department to report to the board the number of concerns filed;

(f) Establish processes for claim submission from transportation providers and payment of transportation providers;

(g) Establish policies regarding the storage, access, retention, and deletion of video recordings of members made during nonemergency medical transportation. The policies must not prohibit the use of video recording for safety or driver accountability purposes.

(h) Develop billing procedures and requirements for the payment of transportation providers;

(i) Develop a process for transportation providers to resolve billing issues with the state department or transportation broker;

(j) Establish policies and procedures to verify member eligibility prior to a member receiving transportation services;

(k) Establish policies requiring transportation providers or the transportation broker, or both, to utilize a digital dispatch software system that automatically records pick-up and drop-off addresses, GPS coordinates, times of pick-up and drop-off, routes driven, miles driven, and the driver and vehicle that performed the trip; and

(l) Establish that members have a right to receive NEMT services that are accessible and appropriate to their individual medical and functional needs, including mobility and communication accommodations.

(11) The state department may impose trip caps or market-share restrictions on a transportation provider as corrective action as part of a corrective action plan based on a transportation provider's documented material performance deficiencies that are supported by objective, measurable criteria applied on an individualized, proportional, and time-limited basis following prior written notice of the deficiencies and a meaningful opportunity to cure.

(12) The state department shall ensure all transportation providers, drivers, and vehicles are credentialed in a manner sufficient to protect member safety and ensure program integrity. The state department shall establish requirements for transportation provider, driver, and vehicle credentialing through contract or program policy. The transportation broker shall verify compliance with credentialing requirements.

(13) Services provided by noncompliant or noncredentialed drivers or in noncompliant or noncredentialed vehicles are not eligible for reimbursement.

(14) For the primary purpose of safety, driver accountability, and fraud prevention, transportation providers shall use vehicles equipped with two-way video dash cameras and a video recording system when transporting members. The video dash camera and video recording system must capture visual documentation of trips, including images of pick-up and drop-off of a member. The policies regarding the use of video recording during transportation services established pursuant to subsection (10)(g) of this section must address member privacy, operational feasibility, and compliance with applicable federal and state laws and related regulatory standards, including medicaid requirements. Video recordings of members are not required for billing purposes but may be used for auditing purposes. This subsection (14) does not apply to transportation providers operating fleets of five or fewer vehicles.

(15) The data collected pursuant to subsection (10)(k) of this section must only be made available to the state department or the transportation broker in digital format.

(16) The state department shall, in accordance with the "State Administrative Procedure Act", article 4 of title 24, provide advanced notice and the opportunity for public comment prior to the implementation of an NEMT rule change.

(17) The state department shall establish billing procedures, documentation requirements, and payment standards for transportation providers pursuant to subsection (10)(f) of this section. The procedures must be consistent with state and federal medicaid requirements and must not require payment for claims that do not meet applicable program integrity, documentation, or eligibility standards. The procedures must establish:

(a) Required claim formats and supporting documents;

(b) Claim denial criteria; and

(c) Reimbursement requirements.

(18) The state department may issue interim operational guidance to clarify procedures, improve administrative efficiency, or provide technical instructions to transportation providers. Interim guidance must not substantively change billing, documentation, or payment standards identified in the procedures adopted pursuant to subsection (17) of this section, except as necessary to address program integrity risks, including fraud, waste, or abuse, or to ensure compliance with state or federal law. In instances of fraud, waste, or abuse of NEMT services, the state department may provide immediate interim operational guidance if the state department includes the justification for the interim operational guidance in the guidance and provides reasonable advanced notice to affected transportation providers, unless immediate action is required to prevent ongoing fraud. If the state department takes immediate action, the actions must be:

(a) Limited in scope and duration;

(b) Include prompt written notice explaining the change;

(c) Applied prospectively to the extent permitted by state and federal law and must not alter claims submitted prior to the effective date of the interim operational guidance, except as required to address fraud, waste, or abuse.

(19) The state department shall notify transportation providers of new billing or documentation requirements or substantive changes, whether issued by rule or by interim guidance, at least thirty days before the changes become effective. Forms, templates, or documentation that was valid prior to the effective date of a new rule continues to be valid through its expiration or until the end of the notice period, whichever is later.

(20) Nothing in this section entitles a provider to payment or limits the state department's authority to deny, recoup, or adjust claims in accordance with state or federal law.

(21) Matters outside the scope of the board or that cannot be resolved among board members must be directed to the state department.