The nemt compliance checklist: organize your evidence

What to take away

A new owner usually has the rules roughly right and the evidence badly organized. That combination passes for a year and then fails an audit, because an audit does not ask whether you complied. It asks you to show it.

So this is an evidence checklist. Work down it and fill in the second column.

The evidence sheet

Against each, write where the document is, who is responsible for it and when it expires. That last column is the one that earns the exercise.

How the sheet behaves over a year

The last two rows are why a folder fails and a sheet works: they expire per item rather than per business, so nothing lines up.

Sample your own trip records

The most common audit finding is not a rule breach. It is a trip that cannot be evidenced as billed.

Once a month, pick a handful of completed trips at random and check, from the record alone, that you can establish: who authorized it, who was carried, when the vehicle arrived and left at each end, what level of service was delivered, the vehicle and driver, and whatever signature or confirmation your payer requires.

Routing and dispatch records belong in the same sample: the manifest as assigned, the driver's log, and the mileage or odometer entry that shows the trip ran as authorized. When a payer disputes a trip, those are the records that show where the vehicle actually went.

If any of those is missing or was reconstructed later, the fix belongs in the daily process rather than in a reminder to try harder. Records are only reliable when the ordinary work produces them, and which records your program expects at all is part of the map in the licensing and compliance guide.

Match your words to your records

A quiet source of trouble is a mismatch between what your service description says and what your records show. If your scope says door-to-door and the record shows only a drop time, the record does not evidence what you sold.

Fix this by using the same terms in the contract, the dispatch instruction and the completed record. Which terms your program itself expects you to use is one of the things to establish during the sequence of calls that finds out what you need.

Equipment and accessibility

Equipment obligations come from the manufacturers' instructions, your conversion, your insurer, your contract and your state program, read together. Keep the instructions where a driver can reach them and keep the maintenance record where you can produce it. The purchasing side of this is covered in the vehicles and premises guide.

Federal cargo securement rules — 49 CFR Part 393, Subpart I — are sometimes filed by new owners as their securement standard. They govern how freight is restrained, and a passenger is not freight. The standard to file instead is the ADA's vehicle requirements for lifts, ramps and securement, together with the manufacturer's documentation for the tie-downs and occupant restraints your vehicles carry: WC19 wheelchairs and SAE J2249 systems. Filing the wrong standard is worse than filing none, because it looks like diligence.

Accessibility duties are a separate matter and a real one. Title III of the Americans with Disabilities Act, and the Department of Justice's ADA guide for small businesses, give the shape of them; what applies to your operation is a question for a qualified adviser rather than for any checklist.

Know who sets each rule

Half of compliance work is knowing which body to call. The transportation benefit is administered state by state, as the Centers for Medicare and Medicaid Services page explains, so your state agency and its broker set most of what you deal with daily: provider enrollment through the state Medicaid provider enrollment portal, your National Provider Identifier from the NPPES registry, and the broker's credentialing packet and provider agreement. Passenger carrier authority comes from your state motor vehicle or public utility commission and, for interstate work, from the FMCSA's USDOT number and MC operating authority. Local permits come from the city or county licensing office.

Insurance conditions function as rules in practice, and they belong in the same review as everything else. Your state sets the minimum liability limits for passenger carriers, and a broker contract can set a higher one. Read the conditions attached to your policy, not just the certificate of coverage.

A review that happens on a date

Twice a year, take the sheet and do four things. Confirm nothing has changed with each issuing body. Renew anything within three months of expiry. Re-read the current version of each contract rather than the one you signed. Record who you spoke to and when.

That record of having asked is itself useful. It is also the only defense against a requirement that changed while nobody was watching.

Common questions

How far back should I keep trip records?

Ask your payer and your contract, and keep to the longest period any of them specifies. Do not average the answers.

What if I discover a gap in past records?

Do not manufacture the missing document. Record what happened, what you have changed so it does not recur, and take advice about anything already billed. A gap you found and fixed reads very differently from a gap an auditor found.

Who should own the sheet?

One named person, with a named deputy. Shared ownership of a renewal calendar means nobody watches it.

Is a written procedure needed for everything?

No. Write procedures for what your contracts require, for anything a driver must do the same way every time, and for anything where getting it wrong hurts a passenger. That list is shorter than a manual and it gets read.