NEMT Standing Orders: How Recurring Rides Work and How to Run Them
A NEMT standing order is one approval that covers a rider's repeating trips to the same provider for the same treatment, such as dialysis three times a week. Brokers approve them for set periods. MTM schedules recurring dialysis in Wisconsin for up to six months at a time and other standing orders for up to three, and they must be renewed or changed when treatment changes.
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What a standing order is
A standing order is one approval that covers a series of repeating rides. The NEMT operations manual of Medi Trans, the transportation broker for Louisiana Healthcare Connections (revised February 2025), defines it as transportation to or from multiple recurring appointments for covered services, for the same member, with the same healthcare provider, for the same treatment or condition. It also calls this a subscription order. CareOregon’s transportation provider manual (February 2024) uses the word subscription for recurring trips scheduled for a member to the same location.
| One-time trip | Standing order | Will-call return | |
|---|---|---|---|
| Booked | Once, for one date | Once, for a series of dates | As part of a trip, with no pickup time |
| Pickup time | Set at booking | Set for each recurring day | Set when the rider calls |
| Typical use | A specialist visit | Dialysis, therapy, treatment programs | Appointments with an unknown end time |
| Main risk | Wrong details at intake | Expired or outdated series | Late response |
The two often overlap. A dialysis standing order can have will-call returns on the days treatment runs long.
Which trips become standing orders
Standing orders cover treatment that repeats on a schedule. The manuals name the same kinds of care:
- Medi Trans, Louisiana: dialysis, behavioral health, and chemotherapy, plus recurring treatment such as wound care.
- CareOregon: alcohol and drug treatment centers, dialysis clinics, behavioral health appointments, and physical, occupational, and speech therapy.
Dialysis drives much of this work. A 2022 CMS report to Congress found that slightly more than half of Medicaid beneficiaries with end-stage renal disease used NEMT in 2019, averaging 5.9 ride days a month. In Mississippi, the state’s broker at the time reported that 58% of all NEMT trips in 2021 were for dialysis, according to the PEER Committee’s October 2024 review. The same review shows 28.4% of trip legs in April 2024 going to dialysis appointments, with return rides home counted separately at 48.6%.
The math explains why standing orders anchor a schedule. A rider on a Monday, Wednesday, Friday dialysis schedule rides 3 days a week. Each day is 2 legs, so that is 6 legs a week and about 312 legs a year from one rider. Ten such riders fill a meaningful part of a van’s week before any other trip is booked. The dialysis transportation contracts guide covers how to win that work directly from centers.
How long standing orders last
Every standing order has an end date or a renewal date. Current examples:
| Broker or program | Duration and renewal |
|---|---|
| MTM, Wisconsin | Recurring dialysis trips scheduled for up to six months at a time. Other standing orders for up to three months at a time |
| Medi Trans, Louisiana (February 2025) | Recertified every six months for dialysis, every three months for behavioral health, and every three months for all other services. Every standing order is reviewed at least once a month to confirm the assigned provider is the most cost-effective option |
| Rhode Island (210-RICR-20-00-2) | A licensed medical or behavioral health provider must request or modify the standing order. Riders with frequent no-shows can lose it and ask for it back after 60 days, subject to state approval |
Medi Trans approves standing orders to match the series of appointments. Its example: a six-month series of appointments gets transportation approved for each trip, including all legs, for those six months. It still checks the member’s eligibility before each pickup.
Who requests and changes them
On broker work, the rider or the treating facility asks the broker for the standing order. You receive the resulting trips.
- Riders and facilities. The Medi Trans manual extends the right to set up a standing order to the facility providing the treatment. The member or facility can revise pickup and drop-off times, add recurring appointments, and change the completion date, and Medi Trans may not deny transportation because of those changes.
- Clinicians. Rhode Island requires a licensed medical or behavioral health provider to request or modify the standing order, and Medi Trans may require the treating provider to certify the appointment series in writing.
- Facility portals. MTM in Wisconsin lets facilities schedule recurring trips through its MTM Link Facility Portal or by phone.
For private-pay riders and facility contracts, you set the rules yourself. Write down who can start, change, and end a series, and how much notice you need.
Running standing orders day to day
On broker work, the approval is the broker’s job. Your job is keeping the trips it produces accurate week after week.
- Keep the same driver and time. Riders and facilities learn who is coming and when. Medi Trans keeps standing orders with the same provider, when it is among the least costly options, for continuity of care.
- Build the recurring days first. Plan standing-order legs before one-off trips, then fill around them.
- Separate series changes from one-day changes. A permanent move to a new chair time updates every future leg. “Just this Wednesday at 2 PM” changes one date. Mixing them up is how riders get stranded.
- Track end and renewal dates. Keep a list of every series and its end date, and ask the facility or broker about renewal two weeks ahead.
- Pause for hospital stays. A rider in the hospital with rides still running becomes a string of no-shows. Pause, then resume at discharge.
- Plan for holidays. Dialysis centers and clinics may shift treatment days around holidays. Confirm holiday weeks in advance.
- Reconcile every week. Compare your schedule against the trips each broker has assigned you. Every broker leg should be on your board, and nothing should be on your board that the broker has not approved. When a broker trip matches a recurring ride you already have, keep one and attach the broker’s trip number to it, so the rider does not get two vans.
- Look for riders who share a schedule. Two riders from the same area with the same chair time at one dialysis center can share a run where your contract allows it. Ride-time limits still apply, such as the Medi Trans rule that no rider in a multi-load vehicle rides more than 45 minutes longer than the direct trip.
What to record for every standing order
Keep one record per series with everything a dispatcher needs to run it without calling anyone:
| Field | Why it matters |
|---|---|
| Rider and contact numbers, including a caregiver or facility contact | Reaching someone before a missed pickup |
| Treatment days and chair or appointment times | The basis for every pickup time |
| Pickup address and entrance notes | Avoiding false no-shows at the wrong door |
| Facility name, address, and a direct phone number | Confirming changes and will-call returns |
| Level of service, equipment, and escort | Matching the right vehicle every time |
| Return type: scheduled or will-call | Planning afternoon capacity |
| Broker authorization or trip numbers | Billing and reconciliation |
| Start date, end date, and renewal date | Catching expirations before they cause a gap |
| Preferred driver, if any | Continuity for riders who need it |
For private-pay and facility contracts, add the rate, the billing contact, and your cancellation terms. The same record is what you hand a new dispatcher on their first day.
When a standing order ends
Series end for ordinary reasons: treatment finishes, the rider moves, eligibility lapses, or the rider’s condition changes and a different level of service is needed. The Medi Trans manual notes that a member’s condition can change over time and require a different mode of transportation. When a series ends, remove its future legs so they do not linger on the schedule as phantom trips, and keep the history for your records.
Recurring rides in HealthRide
Schedule it once, and HealthRide keeps it going. You book the ride once, choose the days it repeats, and HealthRide creates the actual trips weeks in advance. You can change one day without breaking the series, pause it during a hospital stay, and end it cleanly when care changes. See recurring trips for details.
Frequently asked questions
- What is the difference between a standing order and a will-call?
- A standing order is the approval for a series of repeating trips. A will-call is a single return leg with no set pickup time. They often go together, since a dialysis standing order can have will-call returns on days when treatment runs long.
- How long does a NEMT standing order last?
- It depends on the broker and the treatment. MTM schedules recurring dialysis trips in Wisconsin for up to six months at a time and other standing orders for up to three months. The Medi Trans manual in Louisiana recertifies dialysis standing orders every six months and behavioral health and all other standing orders every three months.
- Who can request a standing order?
- Usually the rider or the facility providing the treatment. The Medi Trans manual extends the right to the treating facility, and MTM in Wisconsin lets facilities schedule recurring trips through its facility portal or by phone. Some states require a clinician. Rhode Island's rule says a licensed medical or behavioral health provider must request or modify the standing order.
- What happens to a standing order when the rider is in the hospital?
- Pause the rides, not the series. Tell the broker or facility the rider is admitted so upcoming legs are cancelled or held, and restart them when the rider is discharged. Leaving the rides running turns a hospital stay into a string of no-shows on your record.
- Can I change one day of a standing order without changing the whole series?
- Yes, and you should keep the two separate. A one-day change, like a single Wednesday moving to 2 PM, applies to that date only. A series change, like a permanent move to a new chair time, updates every future trip. For broker trips, both kinds of change go through the broker.
- Does a standing order guarantee me those trips?
- No. The Medi Trans manual keeps a standing order with the same provider as long as the provider complies with its agreement, but reserves the right to reassign it. CareOregon states that contracted providers are not guaranteed a specific volume of trips. Reliable, on-time service on recurring riders is the best way to keep them.
