Packaging nemt services customers understand

What to take away

Owners tend to describe their offering by vehicle. Customers experience it as a level of help. Those two descriptions diverge quickly, and the space between them is where a facility ends up angry about a service you never agreed to provide.

This guide sets out the dimensions a service is actually made of, so that a package you offer is one you can staff and price.

The three dimensions

Every trip you sell is a point in three axes. Write any offering as a triple and it stops being vague.

A wheelchair door-to-door standing order and a wheelchair curb-to-curb one-off are the same mode and different businesses. The first fills a schedule and punishes lateness severely. The second is easy to plan and hard to fill a day with.

The assistance ladder, rung by rung

This is the part most often left undefined in a contract, and the part a patient's family judges you on.

Curb-to-curb. The driver stops at the curb. The rider gets from the building door to the vehicle, and into the seat or the securement, without the driver's hands. The driver operates the lift or ramp.

Door-to-door. The driver meets the rider at the building entrance, helps them to the vehicle and into the securement, and repeats that at the destination. Nothing inside the building is included.

Door-through-door. The driver goes inside, helps the rider through the lobby, the elevator or the corridor, and settles them at the destination.

Hand-to-hand. The driver transfers the rider to a named person — a nurse, a technician, a family member — and does not leave until that person has taken over.

Each rung up adds labor that does not appear on a mileage report and does not fit inside a routing estimate. If you sell rung three at a rung one price, the loss is invisible in your accounts until you look at trips completed per staffed hour.

Use the Federal Trade Commission's guidance on advertising for small businesses as the right frame for describing this publicly.

What you say the service includes is a claim. It should match what a driver is actually instructed and paid to do.

Trip patterns decide your schedule, not your vehicle

A standing order is a repeating booking, most obviously for dialysis. It runs on a fixed weekly rhythm for as long as treatment continues. It is the best work to hold and the least forgiving.

The clinic has a chair slot, and a late pickup disrupts more than one person, disturbing a sequence of appointments behind them.

A will-call return is a trip where the outbound time is known and the return time is not. Somebody calls when the patient is discharged or finished. You cannot schedule it, only reserve for it. Operations that treat a will-call as an ordinary booking discover that a vehicle has been sitting for an unknown period while other trips went late.

Long-distance transfers occupy a vehicle for most of a day and remove it from local work entirely. They are worth pricing as a day rather than as a trip.

One-off scheduled appointments are the easiest to plan and the hardest to build a business on, because they arrive unpredictably and rarely repeat.

Who is buying, and what they mean by service

The same package means different things to different buyers, which is why a single price list rarely survives contact.

A dialysis clinic buys reliability on a repeating pattern. A hospital discharge planner buys responsiveness on a will-call. A skilled nursing facility buys a predictable partner for a mixed set of appointments. A managed care plan or a state broker buys documented compliance with its own trip and record rules. A family buys attentiveness at the door.

The Centers for Medicare and Medicaid Services description of the non-emergency transportation benefit explains why the public side of this is arranged state by state. What that means practically is that the documentation attached to a trip is defined by your state program or its broker, and your service description has to be compatible with theirs.

Those rules arrive with names attached. State Medicaid NEMT benefits are usually run through a broker or managed transportation contractor — ModivCare, formerly LogistiCare, and MTM are two that operate in many states — or through the state program office itself. The trip authorization and the documentation your drivers complete come from that contract, so a package that cannot produce the paperwork a broker asks for is not a package you can sell to that buyer.

Building a package that survives a bad day

A package is a promise repeated many times. Write each one with these five statements filled in.

Those five lines prevent more arguments than any amount of relationship management.

You will be asked to soften them during negotiation, and softening the cancellation window quietly costs the most. A vehicle hour lost to a late cancellation is gone, whether or not anyone was carried.

A finished package, written out

Here is the same five lines filled in for a wheelchair rider on dialysis, as the clinic would read it.

Mode and crew. Wheelchair-accessible vehicle. One driver, no attendant.

Assistance level. Door-to-door. The driver meets the rider at the building entrance, helps them to the vehicle and into the securement, and does the same at the destination. The driver does not go inside.

Trip pattern and booking window. Standing order for the same days each week, booked in advance through the clinic. The return is a standing return, not a will-call. Changes are accepted with the notice the contract states.

Included and excluded. The base trip covers the ride and the door-to-door assistance. Wait time, extra stops, a companion and a hand-to-hand handover are add-ons billed separately.

Cancellation and notification rule. The clinic cancels by the cut-off in the contract. A trip cancelled after the cut-off is billable.

Add-ons that are really separate services

Some things get bundled in casually and should be priced and staffed as their own thing.

Whether you can offer any of these, and under what conditions, depends on the accessibility rules that apply to you, including the Americans with Disabilities Act, on your equipment manufacturers' instructions, your insurer, your contract and your state program. Never assume the answer, and never let a booking clerk agree to one of these on the phone without a rule to apply.

Keeping the records the service implies

Each service level implies a record. Door-through-door means you know who received the patient. Will-call means you know when the call came and when the vehicle arrived. Cancellations mean you know the time the notice was given, because that determines whether it is billable under your own contract terms.

General recordkeeping obligations for a business are set out in the Internal Revenue Service guidance on business records. The trip-level records your payer requires are a separate and stricter matter, and come from the contract and the state program rather than from any federal tax page.

Staffing the labor you actually supply

Every rung of the assistance ladder is somebody's paid time. When you decide what to offer, the binding question is not whether you can do it once, it is whether you can staff it repeatedly at the pay level your market supports.

Published wage data by occupation and metropolitan area is available from the Bureau of Labor Statistics occupational wage tables and is the honest starting point for that question. It will not tell you what a driver in your county will accept for a role that includes lifting, waiting and paperwork. Local candidates will.

The wider framing of these decisions sits in your own cost per staffed vehicle hour and in the trips you can actually complete with the fleet you have.

Common questions

Should I offer everything to look credible?

No. A short list you deliver reliably beats a long list with exceptions. Facilities remember the failed trip, not the brochure.

Can I upgrade a curb-to-curb booking to door-to-door on the spot?

Your driver will want to, because refusing feels wrong. Decide the rule in advance and write it down, because the alternative is that every driver decides differently and your timings become unpredictable.

How do I price door-through-door?

By the minutes it adds, measured on your own routes, applied to your own cost per staffed vehicle hour. Anyone quoting you a national uplift figure is guessing.

What should I do about will-call if I only have one vehicle?

Either decline will-call work, or accept it only in a window where you have deliberately left nothing else scheduled. There is no third option that works.