What is hand-to-hand service in NEMT?
Hand-to-hand is the NEMT assistance level with a custody handoff at both ends. The driver receives the rider from a caregiver or staff member at pickup and hands them to a named caregiver, family member, or facility staff member at drop-off. The rider is never left alone. It is used for riders with dementia, developmental disabilities, and similar needs. Programs such as Virginia's require medical necessity.
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What hand-to-hand means
Hand-to-hand service is a chain of custody. NEMTAC’s Levels of Service Standard (October 2024) defines it as a trip where the rider requires a handoff at both the pickup and drop-off locations, and the rider must be received by an appropriate caregiver. It comes after door-through-door in the standard’s list of levels.
The driver never leaves the rider alone. Someone hands the rider to the driver at pickup, and the driver hands the rider to someone at drop-off.
How programs define the handoff
The core idea is shared, but the details differ:
| Source | Pickup | Drop-off |
|---|---|---|
| NEMTAC standard (2024) | Help from inside the pickup location | Rider received by an appropriate caregiver inside the drop-off location |
| Virginia Medicaid handbook (June 2026) | Driver receives the rider from a person at the main door | Driver hands the rider to a caregiver or facility staff at the main door, without losing sight of the vehicle |
| Virginia provider manual (2024) | From a person at the pickup point | Into the hands of facility staff, a family member, or another responsible party |
| CareOregon NEMT manual (2024) | Full escort, rider never left unattended | Rider handed to a specific person and checked in at the appointment |
Virginia requires medical necessity for hand-to-hand service. Its provider manual names riders with dementia or developmental disabilities as examples of who may need it.
Who needs hand-to-hand
Hand-to-hand fits riders who would be unsafe if left alone for even a few minutes:
- Riders with dementia who may wander.
- Riders with developmental or intellectual disabilities who need a caregiver at all times.
- Riders whose care plan requires a responsible adult to be present at each end.
- Minors riding without a parent in programs that require someone to meet them. Colorado lets riders 13 to 17 travel alone only when an adult is present to receive them at the destination and at the return location.
Hand-to-hand is separate from escort and attendant rules. An escort rides along. Hand-to-hand describes what the driver does at each end.
Running a clean handoff
The handoff works only if everyone knows who will be waiting. A simple routine helps:
- When the trip is booked, record who will receive the rider at each end and how to reach them.
- Call ahead a few minutes before arrival so that person is at the door.
- Confirm the receiver’s identity before letting go of the rider.
- Record the name of the receiver and the handoff time on the trip.
- If nobody is there, keep the rider with you and call dispatch. Never leave the rider at a door.
Build extra time into the schedule for each handoff. Where your payer pays waiting time, it bills under T2007. Otherwise the base code for the trip’s mode, such as A0130, covers the whole trip.
Keeping a record
A written record protects the rider and your company. In HealthRide, signatures are captured on screen in the driver app at pickup or drop-off and saved to the trip automatically.
Frequently asked questions
- What should a driver do if nobody is there to receive the rider?
- Do not leave the rider. Keep them with you and call dispatch, which contacts the broker or the facility. CareOregon's manual tells drivers to call the member or the brokerage for instructions when the rider is not at the door or desk. Record the wait and every call.
- Is hand-to-hand the same as an escort?
- No. Hand-to-hand is what the driver does at each end of the trip. An escort is a family member, friend, or facility employee who rides along and stays with the rider. A rider booked hand-to-hand may also travel with an escort, and the handoff still happens at drop-off.
- Is waiting time paid on a hand-to-hand trip?
- Only if your payer pays waiting time. HCPCS T2007 covers waiting time in half-hour increments where a program allows it. Medi-Cal pays it for wheelchair and litter vans after the first 15 minutes, up to 90 minutes, at $11.30 per half hour in its rate table (page updated September 2023). Florida's Medicaid policy excludes time spent waiting on a recipient to receive a service. Check your contract before you plan around a wait.
