How to get NEMT facility contracts with hospitals, nursing homes, clinics, and senior living
NEMT facility contracts are written agreements to transport a facility's patients or residents, paid by the facility or arranged for riders whose rides are covered elsewhere. Hospitals, nursing homes, dialysis clinics, PACE programs, and assisted living communities sign them. You win them by meeting the staff who book rides, proving you arrive on time, and offering a clear agreement with rates, response times, and reporting.
On this page
What a facility contract is, and why it matters
A facility contract is a written agreement to transport a facility’s patients or residents. The facility may pay for the rides itself, or it may send you riders whose rides are paid by Medicaid, a Medicare Advantage plan, or the family. When the facility pays, its staff decide which company to call.
Facility work balances broker work. Broker volume moves when a health plan changes vendors or a broker changes its rules. A facility that trusts you keeps calling, and some facility work pays at rates you set.
The market is large. The CDC counts about 14,700 nursing homes and 32,200 residential care communities, such as assisted living, as of 2022. The American Hospital Association counts about 6,100 hospitals. The 18 ESRD Networks served 7,556 dialysis centers as of March 31, 2025, and the National PACE Association counts 204 PACE programs.
The facility types and what each one needs
Each facility type buys transportation differently. Match your pitch to the one in front of you.
| Facility | Who to ask for | What they need most | Our guide |
|---|---|---|---|
| Hospital | Case managers, social workers, discharge planners | Same-day discharges, fast response, stretcher and wheelchair service | Hospital discharge transportation |
| Dialysis clinic | The clinic social worker | On-time arrival for chair times and fast pickups after treatment | Dialysis transportation contracts |
| PACE program | The contractor liaison each program must designate | Recurring center routes, trained drivers, complete staff records | PACE program transportation |
| Nursing home or skilled nursing facility | Whoever schedules resident appointments | Wheelchair and stretcher rides to appointments, escorts, reliable returns | |
| Assisted living and senior communities | Whoever arranges resident outings and appointments | Appointment rides for residents, often paid by the resident or family | Assisted living transportation |
| Clinics and specialist practices | The front desk or care coordinator | Patients who arrive on time and a provider they can call |
The details come from the rules each facility works under. Hospitals must plan discharges “to avoid unnecessary delays in discharge” under 42 CFR 482.43. Medicare tells dialysis patients to ask the facility social worker for help with non-ambulance rides. PACE programs must have a written contract with every outside service provider under 42 CFR 460.70.
The rules that shape every facility deal
Two federal rules decide what you can and cannot offer a facility.
The Anti-Kickback Statute. The HHS Office of Inspector General describes it as a criminal law that “prohibits the knowing and willful payment of ‘remuneration’ to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs.” Penalties include fines, jail terms, and exclusion from Medicare and Medicaid. For a NEMT company, that means no referral fees, no kickbacks to staff, and no gifts meant to steer Medicaid or Medicare riders your way. Win on service.
The local transportation safe harbor. When a facility pays for patients’ rides, it is giving patients something of value. The OIG safe harbor at 42 CFR 1001.952(bb) protects free or discounted local rides when the facility meets its conditions:
- A set policy, applied uniformly and consistently, not tied to how much federal program business a patient brings.
- No air, luxury, or ambulance-level transport.
- No public advertising of the rides, and no marketing by drivers.
- Drivers, and anyone arranging the rides, are not paid per patient transported.
- Rides for established patients to get medically necessary care, within 25 miles, or 75 miles in rural areas. Rides home after an inpatient stay, or after at least 24 hours in observation, have no mileage limit.
- The facility bears the cost and does not shift it to payers or patients.
The facility’s compliance team decides how its program fits the rules. You make it easy with a written agreement, a rate sheet, and invoices that show each trip.
Patient privacy matters in the sale too. Under the HIPAA Privacy Rule, a covered entity needs written authorization to use protected health information for marketing (45 CFR 164.508(a)(3)). Never use a rider’s name, story, or photo in a pitch without written permission.
How to win the contract
- Build a target list. Use Medicare Care Compare to list nursing homes, dialysis facilities, and hospitals near your garage. Use the National PACE Association’s program finder for PACE. Start with the ones your vans can reach fastest.
- Find the person who books rides. Ask the front desk who arranges transportation, and use the table above as a guide.
- Ask what goes wrong today. Listen for late pickups, long waits after appointments, no-shows, and staff chasing rides. In a UC Davis Health study of four dialysis clinics, reported in April 2026, patients described late pickups and rides that never came, and social workers spent large parts of their days on hold with transportation companies instead of counseling.
- Offer a trial on the hard trips. Ask for the trips their current provider struggles with, such as early chair times, stretcher discharges, or weekend returns. Then run them perfectly.
- Put it in writing. Offer a short agreement with the terms in the next section.
- Report every month. Send on-time performance, completed trips, and any incidents. Numbers keep the contract when a competitor calls.
In some Medicaid programs, facility requests also count with the broker. Rhode Island’s broker contract lists “a facility request for a TP based on previous professional working relationship” as one of its trip assignment criteria. Good service at a facility can bring you broker trips too. Our marketing guide covers outreach beyond facilities.
What the agreement should include
| Section | What to spell out |
|---|---|
| Services | Levels of service (ambulatory, wheelchair, stretcher), escort or door-through-door help, and service area |
| Requests | How staff book rides, how much notice you need, and same-day response times |
| Rates | Base and mileage rates by level of service, wait time after a free window, no-show and late cancellation fees, after-hours rates |
| Who pays | Which riders the facility pays for, and how Medicaid, plan, or private pay riders are handled |
| Billing | Invoice timing, what each invoice shows, payment terms, and accepted payment methods |
| Records and reports | Trip records you keep and the monthly report you send |
| Insurance and incidents | Your coverage, certificates on request, and how you report incidents |
| Privacy | How you protect patient information |
| Term | Start date, renewal, and how either side can end the agreement |
Pricing a facility contract: a worked example
Price facility work from your own costs. The numbers below are illustrative, not market rates.
An assisted living community asks for a quote on about 40 wheelchair appointment rides a month, all within 10 miles, booked a day ahead.
| Input | Amount |
|---|---|
| Your cost per van hour | $46 |
| Average van time per one-way ride, including deadhead and a 10 minute wait | 50 minutes |
| Cost per one-way ride | $46 × 50 ÷ 60 = $38.33 |
| Target margin | 25% |
| Price per one-way ride | $38.33 ÷ 0.75 = about $51 |
Now test the terms. If riders often run 30 minutes late coming out of appointments, each late return adds $23 of van time. A wait fee after 15 minutes protects you. If the community cancels rides the same morning, a late cancellation fee covers the empty slot. If it offers a monthly minimum in exchange for a lower rate, check that the minimum covers your committed van hours.
Keep the result on a written rate sheet and run your own numbers in the trip price calculator.
Serving facilities in HealthRide
Facilities get their own portal in HealthRide, where staff request rides, follow vehicles live, and view and pay their invoices. Completed trips gather into one invoice for each facility, priced from that facility’s rates, with a pay-online link. Checks and other payments are recorded in the same ledger, so you always know what each facility owes. See invoicing.
Frequently asked questions
- Who books transportation at a hospital or nursing home?
- The staff who plan patient care. In hospitals, federal rules require discharge plans to be developed by, or under the supervision of, a registered nurse, social worker, or other qualified staff, so case managers and social workers book most rides. At dialysis clinics, Medicare sends patients to the facility social worker for help with non-ambulance transportation. Elsewhere, ask the front desk who schedules resident or patient appointments.
- Can I pay a facility or its staff for referrals?
- No. The federal Anti-Kickback Statute makes it a crime to knowingly and willfully pay anything to induce or reward referrals of business paid by federal health care programs. Penalties include fines, prison, and exclusion from Medicare and Medicaid. Compete on service, price, and reliability, and keep gifts and perks out of your sales approach.
- Can a facility pay for a patient's ride?
- Yes. Facilities pay for rides for many reasons, and an OIG safe harbor protects free or discounted local transportation for established patients when conditions are met, including a policy applied uniformly, no public advertising of the rides, and no shifting of costs to payers. The facility decides how its program fits. Your side is a written agreement and accurate invoices.
- What should a NEMT facility contract include?
- The service levels you provide, response times for scheduled and same-day requests, rates with wait time, no-show, and after-hours terms, how rides are requested, how invoices are sent and paid, which riders the facility pays for, insurance and incident reporting, records you keep, and how either side ends the agreement.
- How many facilities are there to pitch?
- Plenty. The CDC counts about 14,700 nursing homes and 32,200 residential care communities, such as assisted living, as of 2022. The American Hospital Association counts about 6,100 hospitals. The 18 ESRD Networks served 7,556 dialysis centers as of March 31, 2025, and the National PACE Association counts 204 PACE programs.
- Should I offer facilities a discount?
- Only if the numbers still work. A lower rate in exchange for predictable volume, such as standing dialysis or PACE center routes, can make sense because it keeps vans full. A discount on scattered same-day trips is harder to justify. Price from your cost per van hour and test it before you sign.
