NEMT driver attendance policy: call-outs, no-call no-shows, and protected sick leave

Measure call-out deadlines from the first pickup

A call-out rule written around a fixed shift start misses how NEMT days work. First pickups move with each day’s manifest: a 5:30 a.m. dialysis chair on Monday, an 8:15 a.m. clinic visit on Tuesday. Tie the deadline to the first scheduled pickup on the driver’s manifest instead, such as at least 90 minutes before it. Add a second deadline the evening before for anything the driver already knows about, so nobody with a 5:30 start is calling at 3 a.m. about something they knew at dinner.

The reason is what an uncovered leg costs. MTM Health’s Virginia handbook (approved August 2026) defines a vendor no-show as failing or refusing to complete an assigned trip, and expects providers to keep those under 0.25 percent of trips. In the Rhode Island handbook (updated July 2026), a vendor no-show rate under 0.29 percent of trips is green, and anything from 0.5 percent up is red. For a hypothetical fleet running 2,000 trips a month, 0.25 percent is five trips. One driver who misses a 12-leg day without a word, discovered after the first pickup has passed, can use up the month in a morning.

Rhode Island also lists a driver’s habitual no-shows or lateness among the Tier 2 issues a provider reports to MTM in writing within 24 hours. A pattern at your company becomes a pattern on the broker’s file. Rebuilding the day once a driver calls out is covered in what to do when a driver calls out sick. This page is about the written rule that comes before it.

The call-out procedure, step by step

Spell the procedure out so a driver can follow it half awake:

1. One number. Name the line drivers call, such as the dispatch phone or the on-call supervisor’s cell, and say that a voicemail on it counts. A text to a coworker or a message in a group chat does not. The FMLA rules back this up: 29 CFR 825.303(c) lets an employer require workers to call a designated number or a specific person, absent unusual circumstances.
2. Two deadlines. For a sudden absence, a set time before the first pickup. For anything known the night before, a set evening hour. For planned days off, a request window (more on state limits below).
3. What to say. That the driver is out, for how long, and when they expect to return. Nothing about symptoms.
4. Who else may call. A spouse or adult family member can report the absence when the driver cannot, which 29 CFR 825.303(a) expressly allows for FMLA leave. Put that in writing for every absence.
5. A confirmation. Whoever takes the call writes down the time and replies to the driver. That one line settles later arguments about whether a call ever came in.

If you operate in Illinois, the written policy is required, not optional. The Paid Leave for All Workers Act lets an employer require notice for unforeseeable leave only if it has a written policy with the procedure, hands it to employees, and gives written notice within 5 calendar days of any change. The same section bars making a driver find their own replacement as a condition of taking the leave.

No-call no-shows: define them before the first one

Write the definition so nobody argues about it later. One version: a no-call no-show is missing a scheduled shift without contacting the call-out number before the first scheduled pickup. Then decide what it costs.

No federal statute defines job abandonment, so the point at which silence becomes a resignation is a policy choice. Three consecutive scheduled shifts with no contact is one workable line, and a stricter policy might use two. Whatever you choose, apply it to every driver, and keep one exception: a driver who could not reasonably call. Under 29 CFR 825.303(c), a worker who needs emergency medical treatment does not have to follow the call-in procedure until their condition is stable and they can use a phone. A driver who never misses and then vanishes for a day may be in a hospital bed.

So before you treat silence as a resignation, call the driver and their emergency contact, and write down when you tried. If it does end in separation, the steps for final pay, the badge, keys and broker roster are in firing a NEMT driver.

A points scale drivers can follow

A points system works when every event has a fixed value and points expire on a date the driver can work out. Brokers score providers on this model too. MTM Health’s Virginia handbook keeps each infraction point for one year from the date it was assessed, and 10 points means termination from MTM’s network. A scale for drivers might look like this (an example, not a legal standard):

Pair it with thresholds, such as a coaching talk at 4 points, a written warning at 6, a final warning at 8, and separation at 10, with each point dropping off 12 months after the event. Count consecutive days of the same absence as one occurrence. Give every protected absence an excused code that carries zero points, and have the person who logs it decide which code applies before the points total updates.

An attendance bonus layered on top of the scale has its own FMLA rule, explained in the driver bonus guide.

Absences that can never earn points

A points scale only works on absences the law lets you count. These are the main exceptions, with the employer size at which each starts.

State paid leave: Illinois and New York as examples

• Illinois. The Paid Leave for All Workers Act, in effect since January 1, 2024, gives workers in the state at least 40 hours of paid leave a year, earned at one hour per 40 worked and usable 90 days after hire. Drivers may use it for any reason and cannot be required to give a reason or documentation. An employer may set a minimum increment of no more than 2 hours a day. Section 25 makes it unlawful to treat the leave as a negative factor in discipline or to count it under a no-fault attendance policy. A violation costs the employer the driver’s damages plus a penalty of $500 to $1,000, and the state can add a civil penalty of $2,500 for each separate offense. Employers covered by a city or county paid leave ordinance in effect when the act started follow that ordinance instead.
• New York. Labor Law 215 defines retaliation to include assessing any demerit, occurrence, point, or deduction from a bank of time, when it could lead to discipline, for a legally protected absence under federal, state, or local law. The civil penalty runs from $1,000 to $10,000, and up to $20,000 for a repeat within six years. How much sick leave a New York driver earns depends on headcount; the sick call-out guide has the tiers.

California works the same way in practice: Labor Code 246.5(c) bars punishing an employee for using accrued paid sick days. Many other states and some cities set rules of their own, so check yours before the scale goes into the handbook.

FMLA leave at 50 employees

The FMLA reaches employers with 50 or more employees on each working day in at least 20 workweeks of this year or last. A driver qualifies after 12 months on the job and 1,250 hours in the prior year, at a worksite with 50 or more employees within 75 miles. For those drivers, 29 CFR 825.220(c) says FMLA leave may not be counted under a no-fault attendance policy or used as a negative factor in discipline. You can still require them to call in the usual way.

ADA and pregnancy accommodations at 15 employees

The ADA applies at 15 employees. The EEOC’s guidance on employer-provided leave (May 2016) says unpaid leave can be a reasonable accommodation even when the driver is too new for your leave policy or has used up FMLA leave. Attendance policies may have to bend for disability-related absences unless that causes undue hardship, and an employer may not penalize a driver for leave taken as an accommodation. In one of the guidance’s examples, a cap of four unscheduled absences a year calls for an interactive discussion about whether an exception is feasible.

The Pregnant Workers Fairness Act also starts at 15 employees. Its regulation lists time off to attend health care appointments related to pregnancy among possible accommodations, and the statute bars adverse action against a worker for using one. The pregnant drivers guide covers the rest of that law.

Military duty and jury service

USERRA covers every employer regardless of size, even a company with one employee. A driver leaving for Guard or Reserve duty must give notice, which can be verbal and informal, but does not need your permission. Federal law also bars discharging, threatening, or coercing a permanent employee over service on a federal jury, and each violation can draw a civil penalty as high as $5,000. State jury service is protected under state law.

Applying the policy the same way every time

A policy only holds up if it is applied evenly. Five habits keep it consistent:

• Signed at hire. Put the procedure and the scale in the driver handbook and keep each signed acknowledgment in the driver file.
• Every call logged. Time of the call, who took it, and the time of the driver’s first pickup.
• Thresholds in writing. Tell the driver in writing each time a threshold is reached, using the steps in disciplining NEMT drivers.
• Same rules for everyone. Dispatchers and the owner’s favorite driver included. If two drivers with the same points get different outcomes, you will have to explain why.
• New hires told early. If you use an introductory period, say how attendance is judged during it; see the probationary period guide.

Look at the pattern as well as the person. If call-outs bunch up on the earliest starts, a different shift pattern may fix more than points will; building driver shifts covers that.

Tracking attendance in HealthRide

Drivers clock in and clock out of every shift in the HealthRide driver app. HealthRide’s reports build each driver’s hours from those real clock-ins, and timecards export in one click. When a late start or an early exit comes up in a coaching talk, the clock times are already on record.