Rehab center transportation contracts: addiction treatment rides, Part 2 privacy, and patient brokering laws

Addiction treatment programs buy rides from outside companies for the trips their own staff can’t drive: getting a new patient to admission, daily runs to outpatient groups, a resident’s dental appointment, a court date, and the trip home or to recovery housing at discharge. These contracts come with two rules most ride contracts don’t have. Federal law bars any payment tied to bringing patients in, and the center’s patient records fall under their own federal privacy rule, 42 CFR Part 2. For the patient’s side of the trip, including which programs Medicaid covers, see Medicaid rides to drug and alcohol rehab.

What rehab centers buy from a ride company

A treatment center buys rides at each point where a patient moves between home, the program, and the rest of their obligations. Federal law draws the category wide. Under 18 U.S.C. 220(e), a clinical treatment facility is any state-licensed or certified setting, hospitals excepted, offering detox, risk reduction, outpatient or residential care, or rehabilitation for substance use. Each setting produces its own trips:

• Admission rides from home, a hospital, or a detox unit to a residential program, often one way and long.
• Outpatient runs to day and evening group sessions several days a week. Daily methadone and other opioid treatment runs work on the clinic’s dosing hours; the opioid treatment program guide covers them.
• Appointment rides for residents to doctors, dentists, pharmacies, and labs.
• Legal and work rides to court, probation, drug testing, and job interviews.
• Discharge rides home, to a family member, or to a recovery residence.

Rides the patient’s coverage leaves out fall to the center or the patient. PrimeWest Health in Minnesota, for example, lists transportation to treatment court among the rides its benefit does not cover, so a court ride for a resident becomes the center’s expense or the patient’s.

Who pays for the rides

Four sources pay for treatment rides, and a center may use all of them:

1. The center’s own budget. Rides the patient’s coverage does not pay for, such as court dates and outings, are invoiced to the center under your contract.
2. The patient’s Medicaid ride benefit. For treatment the member’s Medicaid covers, rides are booked through the state’s broker or health plan, not paid by the center. That is a separate trip under the broker’s rules, not part of your center contract.
3. Opioid settlement funds. Item B.7 of Exhibit E in the national opioid distributor settlement, its list of approved uses, reads “Provide or support transportation to treatment or recovery programs or services” for persons with OUD and co-occurring conditions. The state and local governments that receive the money decide what to buy, so a county settlement office is a buyer worth calling.
4. State Opioid Response grants. SAMHSA’s 2024 notice (TI-24-008) limited applicants to each state’s single state agency for substance use services, and it names transportation among the recovery support services the grants fund. For rural areas it points to voucher models, where riders pay participating carriers with tickets or coupons. The same notice bars using the money for direct payments to people to enter or stay in treatment.

Price the ride, never the patient

Every price in a treatment center contract should stay the same whether the passenger is admitted or not. Under 18 U.S.C. 220, the Eliminating Kickbacks in Recovery Act (EKRA), it is a federal crime to solicit or receive anything of value in return for referring a patient to a recovery home or clinical treatment facility, and it reaches private insurance as well as public programs. The penalty is up to $200,000 and 10 years in prison for each occurrence. The Medicaid rehab rides guide covers the patient-side warning signs and a 2025 sentencing under this law.

For a ride company, the line runs through the statute’s exception for contractors (section 220(b)(2)). It covers contractor pay only when three things play no part in setting it: how many people are referred, how many tests or procedures are done, and how much is billed to the patients’ insurance. In contract terms:

• Fine: a rate per ride, per mile, or per hour, the same for every passenger.
• Not fine: a bonus for each admission, a higher rate when the passenger stays past a certain day, a fee based on the patient’s insurance, or payments from a recovery residence for the people you drop off.
• Drivers stay out of placement. A driver who recommends a program or a residence to a passenger is doing referral work, and that is where the pay question starts.

Under section 220(d), EKRA does not apply to conduct that the federal Anti-Kickback Statute prohibits, which covers Medicare and Medicaid business. The same subsection leaves state laws in force, and some states go further. Florida’s patient brokering statute, section 817.505, makes it a crime for anyone to pay or take a commission, bonus, kickback, or split fee for sending patients to, or bringing them from, a Florida health care provider or facility. Florida’s section 397.4873 also bars licensed treatment providers from referring patients to recovery residences that lack a state certificate of compliance, and under that section, just telling a patient where a residence is or what it is called is a referral. On discharge rides, take the destination the center booked in writing and nothing else.

Part 2 and the qualified service organization agreement

Expect a treatment center to hand you a qualified service organization agreement (often called a QSOA) to sign before it sends you patient names. Part 2, the federal confidentiality rule for substance use disorder treatment records, covers federally assisted programs. Under section 2.12(b), that includes programs that participate in Medicare, are registered with the DEA to dispense controlled substances for treatment, receive federal money in any form, or hold a tax exemption. A licensed center that bills Medicare, dispenses controlled-substance medication for treatment, or is a tax-exempt nonprofit meets at least one of these tests.

A qualified service organization is defined in section 2.11 as an outside person that provides services to a Part 2 program and signs a written agreement that:

1. Acknowledges that Part 2 binds it fully whenever it receives, stores, processes, or otherwise handles the program’s patient records.
2. Agrees, if necessary, to resist in judicial proceedings any effort to obtain patient identifying information except as Part 2 permits.

With that agreement signed, section 2.12(c)(4) lets the program share the information you need to provide the service without asking each patient for consent. Patient identifying information under Part 2 includes a name and an address, which is exactly what a ride needs. Where the program is also covered by HIPAA, the definition takes in a business associate, so the center may hand you one agreement that does both jobs.

The rule changed recently. The February 16, 2024 final rule (89 FR 12472) set February 16, 2026 as the date to comply, and violations now carry the civil and criminal penalties of HIPAA’s enforcement sections (42 CFR 2.3). If someone serves a subpoena for a center patient’s trip records, section 2.61 bars releasing them unless a court has also entered a Part 2 authorizing order; the records requests guide walks through it.

On the road with treatment patients

Plan for the two things that make these rides different. The first is a possible overdose on board. Decide whether your vans carry naloxone and how drivers are trained to use it; the naloxone guide covers storage in a parked van, training, and the van policy. The second is a passenger who wants to get out early or go somewhere else. Drivers do not restrain anyone. Agree with the center on a phone number to call, a safe place to stop, and who decides what happens next; the behavioral health rides guide covers where van work ends.

Pricing and terms for a center contract

Match the price to the ride type:

• Admission rides: a one-way base rate plus loaded miles, quoted per trip. If the center offers to cover a patient’s long trip in, check state limits on travel offered by treatment programs; the Medicaid rehab rides guide explains California’s rule for licensed facilities.
• Outpatient runs: a rate per rider-day for standing schedules, or a reserved van billed by the hour when the center’s runs fill a shift (see dedicated vehicle contracts).
• Court and appointment rides: a flat price per trip, plus a wait charge once a free waiting period runs out.

Then write down the terms that keep both sides clear of the rules above:

1. Rates that do not change with admission, length of stay, or the patient’s insurance.
2. The signed QSOA, plus a business associate agreement when the center is a HIPAA covered entity.
3. Who books each ride and sets each destination, in writing.
4. What the center tells you about a patient: pickup, destination, mobility needs, and an emergency contact, and nothing more.
5. The procedure for an overdose, a medical emergency, or a passenger who leaves the vehicle.
6. How you will handle subpoenas and records requests for center patients.
7. A monthly invoice that lists rides by trip number and initials rather than full names, if the center asks for it.

Keeping a center’s rides confidential in HealthRide

HealthRide is HIPAA compliant. Every change to a trip is recorded, what each person on your team can see depends on their role, and phone lock screens never show rider details. Each completed ride keeps its timestamps, its GPS-recorded miles, and the signature captured on screen, which is the record a center invoice rests on. See invoicing.