NEMT On-Time Performance: Standards, Formula, and How to Improve It

What “on time” means in NEMT

On-time performance in NEMT is measured on three clocks, and a trip can pass one and fail another.

1. The pickup window. The driver has to arrive inside a window around the scheduled pickup time. Virginia’s fee-for-service NEMT handbook (Modivcare, October 2025) tells members that drivers arrive no earlier than 15 minutes before and no later than 15 minutes after the scheduled pickup time, and that a trip counts as late once those 15 minutes pass. See the pickup window entry for how windows are set.
2. Arrival before the appointment. The rider has to reach the appointment in time to be seen. The NEMT operations manual of Medi Trans, the transportation broker for Louisiana Healthcare Connections (revised February 2025), asks providers to deliver riders at least 15 minutes before the appointment and never more than two hours early. It counts a drop-off as late if it misses the scheduled time by more than 15 minutes or lands after the appointment time.
3. The return pickup. For a will-call, the clock starts when the rider says they are ready. Indiana scores its broker on completing 95% of return pickups within one hour of notification.

Early counts against you too. Indiana’s broker scorecard requires that zero trips make a rider board before the scheduled pickup time. CareOregon’s transportation provider manual (February 2024) bars drivers from picking up before the scheduled time or window. The Medi Trans manual says a rider with an 8:00 AM appointment cannot be picked up before 6:00 AM.

On-time standards in current contracts

There is no national on-time percentage. Federal rules require a state’s NEMT broker to have oversight procedures that ensure transportation is timely (42 CFR 440.170(a)(4)), and each broker turns that into its own scorecard for providers.

States enforce these standards at the broker level as well. Mississippi’s PEER Committee (Report #705, October 2024) found that, under the state’s 2018 broker contract, Mississippi assessed its former broker $76,200 in liquidated damages for 381 instances of missing the on-time arrival standard between June 2022 and August 2023. That pressure flows down to the providers the broker contracts with.

How to calculate on-time performance

The formula is simple. The discipline is in deciding which trips count.

On-time pickup rate = pickups inside the window ÷ eligible scheduled pickups × 100

On-time arrival rate = legs delivered on time for the appointment ÷ legs with an appointment time × 100

Take out trips that never had a pickup: cancellations and documented rider no-shows. Take out delays the rider caused only when they are written on the trip record. Keep late trips you caused, even when the rider did not complain.

Here is a worked example for one hypothetical week.

Against SafeRide’s 95%, this fleet is short on pickups. Against Indiana’s one-hour, 95% standard for returns, it is further behind on will-calls. The next step is to find out where the late trips cluster.

Why NEMT trips run late

Late trips have a small number of causes, and the fix depends on which one you have:

• Pickup times built on free-flow travel times. For example, a 20-minute drive at 10 AM can take 35 minutes at 7:30 AM.
• No boarding time in the plan. Securing a wheelchair or loading a stretcher takes minutes that a map does not show.
• A late first run. A driver who starts late or far from the first pickup pushes every leg after it.
• Will-calls cutting into planned runs. A return pickup pulls a van off its route, and the next scheduled rider waits.
• Same-day trips assigned too late to make.
• Address problems. Wrong entrances, gate codes, and large campuses eat the pickup window.
• Riders who are not ready. Virginia’s handbook asks members to be ready 15 minutes before the scheduled pickup, and the Medi Trans manual excuses rider-caused delays that are documented on the trip sheet.

How to raise on-time performance

1. Schedule backward from the appointment using travel time for that time of day, plus boarding time for the rider’s level of service. A wheelchair or stretcher rider needs more than an ambulatory rider.
2. Protect the first run. Start drivers close to their first pickup, finish pre-trip inspections before the first scheduled time, and avoid stacking early pickups on one van.
3. Keep slack for will-calls. Leave a vehicle, or gaps in two or three routes, near the facilities that generate return calls. The will-call guide covers how to size it.
4. Act at the first sign of a late trip. Swap the leg to a closer driver or call ahead. Indiana’s broker must require providers to warn riders of late pickups and warn medical providers of late drop-offs. The Medi Trans manual requires providers to contact waiting riders when a delay reaches 30 minutes.
5. Fix address data once. Save entrances and pickup notes on the rider’s profile so every driver gets them.
6. Turn back what you cannot make. Returning a trip early, for a reason your broker accepts, gives the broker time to cover it. Watch your turnback rate while you do, since brokers score that too.
7. Give every late trip a cause. Record whether it came from traffic, a late first run, a rider who was not ready, or a will-call that pulled the van away. A cause on each trip turns a vague on-time number into a list of fixes.
8. Review late trips weekly by cause, driver, hour of day, and facility. Fix the most common preventable cause first, then measure again.

Route planning ties most of these together. The route optimization guide explains how a good plan builds in travel time, boarding time, and ride-time limits for the whole fleet at once.

Keep the proof

On-time performance only helps you if you can prove it. For every leg, keep the scheduled pickup, the actual arrival at pickup, the actual drop-off, the appointment time, and the reason for any delay. Brokers, plans, and facilities will quote their own numbers at contract time, and your trip log is how you answer. The NEMT KPIs guide shows how on-time performance fits with the other numbers brokers score.

Tracking it in HealthRide

HealthRide’s live map shows every vehicle and flags trips that are running late, so dispatch can act before the pickup window closes. On-time performance is tracked automatically on every leg, overall and per driver, in the on-time report.