Guides
Packaging NEMT services for an account starts with six shared definitions
Packaging NEMT services for a facility account: the six definitions that decide disputes, reserved capacity blocks, and how to price the exceptions.
What to take away
- An account is bought once and delivered a thousand times. Package it around the definitions that will be argued about, not around the services you like offering.
- Six definitions decide almost every disputecompleted trip, wait, cancellation notice, assistance level, access, and reschedule. Agree all six in writing.
- Facilities buy predictability. Offer a reserved block of capacity rather than an open promise to take whatever they send.
- Price the exceptions inside the package. An account that generates frequent exceptions at no cost has bought something you did not intend to sell.
- Contract language, authorization rules and documentation requirements come from the account, your state Medicaid agency and its broker. Confirm them; do not infer them.
Selling to a facility is different from selling to a family. The facility is not the rider and often not the payer. What it is buying is the removal of a problem: a scheduler who currently spends an hour a day chasing rides wants that hour back, reliably, for as long as the arrangement lasts.
Package the offer so that it removes that problem in a way you can staff.
Start from the account's failure, not your service list
Before packaging anything, sit with the person who books and ask them to describe the last three times a ride went wrong. You are listening for which failure they actually care about.
Late arrivals hurt facilities when a treatment slot is fixed. Slow will-call responses hurt them when a discharged patient occupies a bed. Unpredictable drivers hurt them because the family complains to the driver, not to you.
These need different packages. One package sold to all three will underdeliver for two of them.
The six definitions
Write these into the scope before you write a price. Each one is a place where two reasonable people can hold opposite views for months.
Six Definitions to Write Into Scope
- Completed tripdelivery or signed record
- Waithold time before no-show
- Cancellation noticefree vs chargeable
- Assistance levelper trip type
- Accesswho reports obstacles and when
- Reschedulewho bears committed vehicle cost
- A completed trip. Does the trip count when the passenger is delivered, or when the required record is signed and returned? Say which.
- Wait. How long does a driver hold at a pickup before the trip becomes a no-show, and how is that time treated?
- Cancellation notice. The point before which a cancellation costs nothing and after which it consumes a vehicle hour that cannot be refilled. This is the single most valuable line in the document.
- Assistance level. Curb-to-curb, door-to-door or further, stated per trip type rather than in general. The ladder these terms come from is set out in the guide to what a service consists of.
- Access. Who tells you about the step, the gate, the elevator that is out, and by when. An access surprise is a schedule failure that looks like a driver failure.
- Reschedule. What happens when the appointment moves, and who bears the cost of the vehicle already committed.
Sell capacity, not availability
An open promise to take whatever the facility sends is unpriceable and will eventually be tested on your worst day.
Package Shapes and Exposure
Package shape
- Reserved block on fixed days
- Repeating treatment schedules
- Will-call window
- Unpredictable discharge times
- On-request with lead time
- Scattered, low-volume needs
- Blended block plus overflow
- Predictable core, variable tail
Suits an account that
- Reserved block on fixed days
- Idle hours if under-used
- Will-call window
- Vehicle held, no booking
- On-request with lead time
- Hard to fill a day
- Blended block plus overflow
- Two rate structures
Your exposure
- Reserved block on fixed days
- Will-call window
- On-request with lead time
- Blended block plus overflow
The alternative is a reserved block: a stated number of vehicle hours on stated days, held for that account, with anything beyond it taken on a best-efforts basis at a different rate. This is easier to schedule, easier to price and easier to defend when you decline. It also gives the facility something concrete to plan around.
Standing orders fit naturally into a block. Will-call returns fit only if the block includes deliberately unassigned time, because a will-call cannot be scheduled, only reserved for.
Suits an account that
- Reserved block on fixed days
- Runs repeating treatment schedules
- Will-call window
- Discharges at unpredictable times
- On-request with a booking lead time
- Has scattered, low-volume needs
- Blended block plus overflow
- Has a predictable core and a variable tail
Your exposure
- Reserved block on fixed days
- Idle hours if the account under-uses the block
- Will-call window
- Vehicle held with no booking to show for it
- On-request with a booking lead time
- Hard to fill a day around
- Blended block plus overflow
- Two rate structures to administer
Price the exceptions where they occur
Exceptions to Price in Writing
- After-hours requests
- Same-day bookings inside lead time
- Trips outside agreed radius
- Assistance level above contracted
- Second attempt after failed pickup
You do not have to charge for all of them, but you do have to decide in writing which are in the package and which are not. Otherwise a driver standing at a door decides for you.
The cost of these decisions comes back to staffed hours. That is the arithmetic in the material on ranking service lines by what they actually pay.
What the account will ask you to prove
Facilities and brokers verify. Expect to be asked for evidence of insurance, evidence that your vehicles and equipment meet whatever their contract requires, and evidence about the people who will be in the vehicle. Those requirements come from the account and from your state program, and they differ across accounts and across states.
The licensing and compliance guide covers how to establish what applies to you; the Centers for Medicare and Medicaid Services page on the transportation benefit explains why the substance is set at state level.
Your side of this is staffing you can actually supply at the standard promised, which is the point of the hiring and training material, and vehicles that match the modes in the scope, covered in the vehicles and premises guide.
Keep the record the package implies
Each promise in the package needs a record that shows it was kept, produced by the ordinary work rather than by a special effort at month end. Arrival and departure times, the wait clock, the assistance level delivered, who received the patient where that was agreed, and the time a cancellation notice arrived.
Records Each Promise Requires
- Arrival and departure times
- The wait clock
- Assistance level delivered
- Who received the patient
- Time cancellation notice arrived
Beyond the payer's own requirements, the general expectation that a business keeps records supporting its transactions is set out by the Internal Revenue Service. The payer's requirements are stricter and more specific, and they are the ones that decide whether you get paid.
Say only what you will deliver
When you write the package up, describe the assistance level plainly. Do not upgrade the language for effect.
A phrase like full door-through-door support is a commitment about what happens inside a building. Accurate service descriptions are the substance of the Federal Trade Commission's small business advertising guidance. In this trade, an overstated assistance claim is an operational promise your drivers must meet on a wet morning.
Common questions
Should I offer a discount for volume?
Only against a commitment. A discount for expected volume with no reserved block gives away price and keeps all the uncertainty.
What if the account refuses a cancellation window?
Then price the expected cancellations into the rate and say that is what you have done. What you should not do is accept an open cancellation policy at a rate calculated as though every booked trip runs.
Can one package cover several facilities in the same group?
It can if the access conditions and appointment patterns are genuinely similar. Check that assumption at each site before you sign, because one building with a difficult entrance can absorb the margin from the rest.
How long should the agreement run?
Long enough to justify the setup work and short enough that you can reprice once you have measured the real load times. Your first term with any account is a measurement period whether you call it that or not.
