Guides
Seventeen NEMT service packages sorted by constraint
Seventeen NEMT service packages sorted by the constraint each puts on your schedule, vehicles and crew, with four questions for narrowing a first-year list.
What to take away
- Choose by constraint, not by appeal. The seventeen shapes are sorted by what makes them hard: a repeating rhythm, fast response, labor at the door, or a different vehicle or crew.
- Three is the ceiling for the first year. Reliability on a short list beats availability on a long one.
- Packages inside one group compete for the same capacity. Packages across groups compete for the same crew.
- Read the commitment before the description. That is the part that shows up on a Tuesday when a vehicle is out of service.
- Whether a shape can be offered in your state, and to which payers, is a question for your state Medicaid agency, its transportation broker and your own contracts.
Why the first-year list stops at three
Stop at three packages in the first year. A package is a promise you repeat rather than a product you stock, so each addition is another commitment that your vehicles and crew must keep on the worst day of the year, not on an average one.
Nothing here is recommended. The shapes that suit you depend on your fleet, your crew and how far apart your pickups are, and the grouping below matters more than the count. Three shapes from one group pull on the same vehicles at the same times, while shapes drawn from different groups spread that load, though they draw on the same crew.
Four questions to ask of every shape
Run each candidate through the same four questions before pricing anything. A no on the vehicle question turns a package decision into a fleet decision, which is a different and slower choice.
| Question | If the answer is yes | If the answer is no |
|---|---|---|
| Does it repeat? | It builds a schedule; check you can hold the times | You will spend the year selling |
| Can one vehicle deliver it? | You can start now | It is a fleet decision, not a package decision |
| Does it need a second crew member? | Price the whole occupancy at two people | Single crew, but check the lift and transfer expectations |
| Does the account tolerate a firm cancellation window? | The arithmetic works | Price the cancellations in, and say that you have done so |
Shapes built on a repeating rhythm
Choose from this group if you can hold fixed times for months. These shapes fill a schedule, and they make lateness expensive, because a treatment slot behind a late arrival cannot be moved. Each one is listed with the commitment it creates.
Rhythm packages and their commitments
Package
- Fixed-day standing order
- Hours sold for months
- Split standing order
- Afternoon capacity reserved
- Reserved block by hours
- Idle hours if under-used
- Multi-passenger shared run
- One late affects all
- Weekly recurring non-treatment
- Lower urgency, real costs
Commitment
- Fixed-day standing order
- Split standing order
- Reserved block by hours
- Multi-passenger shared run
- Weekly recurring non-treatment
- Fixed-day standing order. The same passengers, same days, same times, for as long as treatment continues. Commitment: you have effectively sold those hours for months, including through holidays and bad weather.
- Split standing order with a will-call return. Outbound at a known time, return whenever the session ends. Commitment: reserved but unscheduled capacity in the afternoon.
- Reserved block by vehicle hours. A stated number of hours per week held for one account. Commitment: idle hours if the account under-uses them, and a difficult conversation if it over-uses them.
- Multi-passenger shared run. Several passengers to the same destination on one vehicle. Commitment: no passenger can be late without affecting the others, and a single cancellation does not free the vehicle.
- Weekly recurring non-treatment trips. Pharmacy, therapy, routine follow-up. Commitment: lower urgency and lower tolerance for a rate that reflects your real costs.
Shapes built on responsiveness
Choose from this group only if you can live without a fixed plan. These shapes sell speed, and they cost you the ability to plan: each one either holds capacity open or accepts that trips already booked may be disturbed.
Responsiveness packages and their commitments
Package
- Discharge will-call
- Capacity held, no booking
- Same-day scheduled
- Open hole or disturb trips
- After-hours and weekend
- Paid standby staffing
- Overflow backup
- Unpredictable volume, reputational risk
Commitment
- Discharge will-call
- Same-day scheduled
- After-hours and weekend
- Overflow backup
- Discharge will-call. A call comes when the patient is ready; the vehicle goes. Commitment: capacity held with no booking attached to it.
- Same-day scheduled. Booked today for later today, inside a stated window. Commitment: a hole in the schedule kept open, or a willingness to disturb existing trips.
- After-hours and weekend cover. Commitmenta staffing arrangement, not a service feature. Somebody is paid to be available.
- Overflow backup for another operator or for a facility's own fleet. Commitment: unpredictable volume, and the reputational risk of being called only when things are already going wrong.
Shapes built on the level of help
These shapes sell labor at the door, and the minutes are real. They are also frequently given away, so the choice is less about the vehicle than about how many minutes per trip you are prepared to staff, time and record.
Assistance ladder and time added
Level
- Curb-to-curb
- Lightest, easiest to staff
- Door-to-door
- Minutes, vehicle unattended
- Door-through-door
- Elevator and corridor time
- Hand-to-hand
- Supervision promise, receiver record
What it adds
- Curb-to-curb
- Door-to-door
- Door-through-door
- Hand-to-hand
- Curb-to-curb. The lightest version and the easiest to staff.
- Door-to-door. The driver goes to the building entrance and back. Adds minutes and leaves the vehicle unattended.
- Door-through-door. The driver goes inside, to an apartment door or a reception desk. Adds elevator and corridor time.
- Hand-to-hand with a named receiver at each end. Commitmenta supervision promise, and a record that shows who received the patient.
The ladder these four sit on, and how each rung changes your timings, is set out in the guide to what a service actually consists of.
Shapes built on a different vehicle or crew
These shapes change what you own or who you employ, so they are the slowest to add and the hardest to withdraw. Treat each one as a fleet decision first and a menu item second, and price it on its own load times and occupancy.
Vehicle and crew packages
Package
- Wheelchair-accessible
- Priced on own load times
- Stretcher transport
- Second crew for whole occupancy
- Bariatric transport
- Equipment, training, extra staffing
- Long-distance transfers
- Vehicle out most of a day
Commitment
- Wheelchair-accessible
- Stretcher transport
- Bariatric transport
- Long-distance transfers
- Wheelchair-accessible transport as a distinct line, priced on its own load times rather than as ambulatory work with an uplift.
- Stretcher transport. Commitmenta second crew member for the entire occupancy, not just for the transfer.
- Bariatric transport. Commitmentequipment, training and often additional staffing, all of which must be confirmed against the equipment manufacturers' own instructions and your insurer.
- Long-distance and out-of-area transfers. Commitmenta vehicle removed from local work for most of a day, which is why these are better priced as a day than as a trip.
Narrowing the list to three or fewer
Work in order, and stop when three remain:
- Mark every shape that your current vehicle and crew could deliver every time.
- Put those through the four questions above and drop any that fail the cancellation or vehicle test.
- Rank what is left by contribution, using the method in the material on ranking service lines.
- Write the winners up as scopes, using the six definitions in packaging NEMT services for accounts.
Adding a package is a capacity decision as much as a sales one, which is why the crew side belongs with the hiring and training material.
Check the payer before you commit
Ask the payer before you promise anything to a facility. States can manage the authorization of NEMT coverage themselves or hand it to a transportation broker or a managed care organization, and the contract you hold with that entity decides what you may offer and bill.
The CMS NEMT booklet for providers says Medicaid rules require the transportation provider to have a contract with the appropriate entity before any services are furnished. A shape that looks strong on paper but has no contract behind it earns nothing.
Say what you offer in words you can defend
If your material says door-through-door, a driver has to go through the door on the worst day of the year. In this trade, an accurate description is also an operational instruction to your own crew, not only a marketing line.
The Federal Trade Commission's small business advertising guide says ad claims on the Internet must be truthful and substantiated. List the shapes publicly, not the prices: the number belongs in a quote that reflects the facility's actual access conditions and appointment times.
When a package turns out wrong
Withdraw it at renewal, with notice, and with an honest explanation of what you got wrong. Withdrawing mid-term without notice is how an operator loses a referral source permanently.
Withdrawal is easiest for the shapes that changed nothing you own. The vehicle and crew shapes are the slowest to add and the hardest to withdraw, which is the strongest reason to keep them out of a first-year list.
Common questions
Which of the seventeen is the best place to start?
Whichever one a local scheduler has just told you they cannot get covered. That is a demand signal, and a list of shapes is not. Check it against the four questions before you say yes, and against your payer's contract.
Can I offer a package I can only deliver most of the time?
No. Offer the version you can deliver every time and take the rest as overflow at a different rate. A promise that fails on a bad day costs more than the revenue from the days it holds.
Can all three come from the same group?
You can, but shapes inside one group compete for the same capacity, so they pull on the same vehicles at the same times. Taking one from each of two groups spreads the load, though both then draw on the same crew.
Is it worth listing packages publicly at all?
List the shapes, not the prices. Facilities want to know what you do, and the number belongs in a quote that reflects their actual access conditions and appointment times.
