Paying drivers on overnight medical trips: travel time, sleep time, and per diem

Three kinds of time on an overnight run

A transplant evaluation four hours away, a two-day treatment out of state, or a one-way transfer to a facility across the country can keep a driver away overnight. Federal wage rules split that trip into three kinds of time:

• Driving and riding. Time behind the wheel is always work. So is time a second employee spends riding along because you require it, as a relief driver or helper (29 CFR 785.41).
• Waiting. Time spent ready to load the rider is work. Time after you have fully released the driver until a set hour is not.
• Sleeping. Sleep is unpaid when the driver is off duty, or on a tour of 24 hours or more under an agreement that meets the federal rules. Sleep while on a shorter duty period is paid.

The rest of this page goes through each kind, then the per diem that pays for the hotel and meals. The pricing side, including whether to stay over or send the van home, is in the long-distance pricing guide.

Waiting at the destination

Most overnight pay disputes come down to the hours between drop-off and the return trip.

The Labor Department’s rule is in 29 CFR 785.16. Time is off duty only when the employee is completely relieved, is told in advance that they may leave, knows they will not have to start work until a definite time, and has enough time to use it for their own purposes. The regulation gives a driver’s example. A truck driver sent from Washington, DC to New York City who arrives at noon and is completely relieved until 6 p.m. is not working during those six hours. The same section says a driver who must take care of the employer’s property while awaiting the return trip is working while waiting.

For a NEMT run, that means:

• Released in writing until a set time. “You are off until 8:30 tomorrow morning” makes the evening unpaid.
• Told to wait for a call. A driver who has to stay at the hospital, ready to load when the rider is discharged, is engaged to wait and on the clock (29 CFR 785.15).
• On call at the hotel. If the only requirement is to keep a phone on and be reachable, 29 CFR 785.17 says the driver is not working. The more you restrict where they can go and how fast they must respond, the closer the time comes to work.
• Guarding the van or equipment. If you tell the driver to stay with the vehicle because a rider’s power chair or oxygen is inside, that is work.

The Labor Department’s handbook adds a point from its truck driver guidance (section 31b09). Whether a layover breaks a continuous tour of duty is a question of fact, and no rule of thumb such as a two-hour or four-hour break decides it. A two-hour stop in a remote place with no restaurants or other facilities was its example of a layover that stays paid.

Sleep time: a hotel room versus the van

Two regulations decide whether sleep is paid.

When a driver is on duty for less than 24 hours, the time is work even if the employee is allowed to sleep when not busy (29 CFR 785.21). A driver who dozes in the van in a hospital lot while waiting for a midnight discharge is working.

When a tour of duty lasts 24 hours or more, employer and employee may agree to exclude bona fide meal periods and a regularly scheduled sleep period of up to 8 hours, but only if you furnish adequate sleeping facilities and the driver can usually get an uninterrupted night’s sleep (29 CFR 785.22). Calls to duty during the night are paid. If interruptions keep the driver from getting at least 5 hours of sleep, the whole period counts as work.

The Labor Department treats truck sleeper berths as adequate facilities, and only on tours of 24 hours or more away from home. Nothing in that guidance extends the treatment to a van seat. Book a room for any driver who will be away overnight. A room paired with a written release keeps the night unpaid, lets the driver rest before the return drive, and makes the trip qualify for tax-free per diem, as explained below.

Relief drivers and the trip home

Long transfers often use two drivers or send one driver home by another route.

• The relief driver riding along. Under 29 CFR 785.41, a second employee you require in the vehicle as a helper is on the clock for the ride. Bona fide meal breaks come off, and so does sleep, but only in proper sleeping quarters you furnish, which a passenger seat is not. Plan to pay both drivers for the whole drive.
• Flying or taking a bus home. Travel that keeps an employee away overnight is work when it cuts across the employee’s workday, and that includes the same hours on days they do not normally work (29 CFR 785.39). If a driver normally works 6 a.m. to 2:30 p.m. and flies home on a Saturday from 9 a.m. to noon, those three hours count. As an enforcement policy, time spent as a passenger outside regular working hours is not counted, and regular meal periods are excluded.
• A driver who asks to drive their own car instead. If you offered public transportation and the driver asks to drive, you may count either the actual driving time or the hours that would have counted on the public option (29 CFR 785.40). Mileage for a personal car is covered in the guide to reimbursing drivers who use their own car.

Example: a two-day transplant evaluation

This example uses round times and is for illustration only. A driver with a regular schedule of 6 a.m. to 2:30 p.m., Monday to Friday, takes a rider 280 miles to a transplant center.

1. Thursday. The driver leaves the garage at 5:00 a.m., takes a 30-minute meal break on the road, and arrives at 10:30 a.m. The rider is admitted for testing. At 11:00 a.m. dispatch texts the driver that they are off until 8:30 a.m. Friday. Paid time: 5:00 to 11:00, minus the meal break, is 5.5 hours.
2. Thursday night. The driver checks into a hotel the company booked. The 21.5 hours from 11:00 a.m. Thursday to 8:30 a.m. Friday are unpaid, because the release was in advance, to a set hour, and long enough to use.
3. Friday. The driver arrives at the center at 8:30 a.m. and waits in the lobby until the rider is discharged at 10:15 a.m. That waiting is paid. They drive home with a 30-minute meal break and reach the garage at 3:45 p.m. Paid time: 8:30 to 3:45, minus the meal break, is 6.75 hours.

The trip adds 12.25 paid hours to the week. Change one fact and the answer changes. If the center had said “we’ll call when the rider is ready, maybe tonight” and the driver had to stay nearby ready to leave, much of Thursday evening could become work time. The overtime guide shows how those hours affect the week.

Per diem for the hotel and meals

A per diem is a daily allowance for lodging, meals, and incidentals. Paid within federal rates under an accountable plan, it is not wages for tax purposes and does not raise the regular rate used for overtime (29 CFR 778.217 treats travel reimbursements within the Federal Travel Regulation or IRS limits as reasonable).

The federal rates from October 1, 2026

GSA’s FY 2027 rates cover travel between October 1, 2026 and September 30, 2027. Across most of the continental US, the standard lodging rate is $113 per night, and meals and incidental expenses come to $68 per day. Another 295 locations have their own non-standard rates, and the meals and incidentals amount runs from $68 to $92 depending on the location. Look up the destination’s rate before the trip.

Departure and return days are partial days. GSA sets the first and last day at 75 percent of the meals and incidentals rate, and IRS Publication 463 allows the same three-quarters method:

In the example above, at a standard-rate destination, the per diem would be up to $113 for Thursday night’s lodging plus $51 for Thursday and $51 for Friday. If the company pays the hotel directly, pay only the $102 in meals and incidentals.

The IRS high-low method

The high-low method in Rev. Proc. 2019-48 is simpler, and Notice 2026-60 sets its rates for travel from October 1, 2026. It uses two rates for the whole continental US: $329 a day for listed high-cost localities and $230 for everywhere else. Of those amounts, $86 and $74 are treated as meals for the 50 percent deduction limit. If you pay meals and incidentals only, the high-low rates are $86 and $74.

Two rules come with it. A company that uses high-low for an employee must use it for all of that employee’s travel in the continental US for the calendar year. For October through December, it must either keep the rates it used for the first nine months or switch to the new ones, applied consistently.

Rules that keep per diem tax-free

• The trip has to be an overnight. Publication 463 treats a driver as traveling away from home only when the duties keep them away substantially longer than an ordinary day and they need sleep or rest before working again. Napping in the car does not count. Meal money on a long same-day run is wages.
• The driver accounts for the trip. Under 26 CFR 1.62-2, the driver must report the dates, the place, and the business purpose of each trip promptly, with 60 days as the safe harbor, and hand back any advance for days not traveled.
• Do not tie it to hours. A per diem computed like wages, on hours worked or miles driven, generally fails the business connection rule, so pay it per day or night away.
• Owners are different. The lodging per diem and the high-low method are not available to an employee related to the company, which includes owning more than 10 percent. Owner-drivers can use actual receipts or the meals-only per diem.

The company’s deduction for the meal portion is generally limited to 50 percent. The limit is 80 percent for drivers on duty under the Department of Transportation’s hours-of-service rules, which reach only some NEMT vehicles. The hours-of-service guide covers which ones.

A written policy for overnight trips

Put the rules in writing before the first long run, so dispatch and drivers apply them the same way:

1. When a trip becomes an overnight, based on driving time and your company’s longest allowed day. The driver fatigue guide covers setting that limit.
2. That the company books and pays for the room, one room per driver.
3. That every release is sent in writing with the time work resumes.
4. What on-call means, if you use it, and that time at the hospital waiting to load is paid.
5. The per diem method and amounts, and what the driver turns in afterward.
6. How relief drivers are paid, and who approves overtime before the trip leaves.

For the rider’s side of the same trip, such as meals, medications, and rest stops, see the long-distance rider care guide. Crossing state lines adds approvals and insurance questions covered in the out-of-state trips guide.

Driver hours on long trips in HealthRide

In HealthRide, each driver clocks in and out of a shift, and every leg of the trip keeps its scheduled and actual times. The driver activity and timecard reports show the hours each driver worked in any week, so the time on a two-day run can be checked against your release messages before the week closes.