What is a standing order in NEMT?
A standing order is a recurring NEMT ride booked once for a rider who travels to the same place on a fixed schedule, such as dialysis three days a week. Every future trip is created from that single booking. Some brokers call it a subscription trip. Louisiana requires its broker to allow standing orders for dialysis, chemotherapy, opioid treatment, and wound care.
On this page
How a standing order works
A standing order stores a ride pattern instead of a single ride. One booking holds:
- The rider, pickup address, and destination
- The days of the week and the appointment and pickup times
- The return type, either a set time or a will-call
- The service level, equipment, and any escort
- A start date and, ideally, an end date
From that pattern, each service day gets its own outbound and return legs. Brokers name it differently. CareOregon’s manual calls these subscription trips, “recurring trips scheduled for a member to the same location,” and lists drug and alcohol treatment, dialysis, behavioral health, and physical, occupational, and speech therapy. Virginia’s fee-for-service member handbook lists “demand and standing order” trips side by side in its member app.
| Standing order | Demand trip | |
|---|---|---|
| Booked | Once, for many dates | Each ride on its own |
| Typical use | Dialysis, chemotherapy, therapy | Specialist visits, one-time care |
| Main risk | Trips that keep coming after care changes | Short notice |
What one state requires of brokers
Louisiana’s Medicaid manual, with sections issued July 14, 2025, spells out standing orders in detail:
- The broker must let riders with recurring treatment, such as dialysis, chemotherapy, opioid treatment programs, or wound care, set up a standing order. The treating facility can too.
- Providers are assigned on a least-costly basis. When several providers qualify, the broker should keep the same provider for continuity of care and to prevent missed treatments.
- The order must stay flexible. The rider or facility can change pickup and drop-off times, add recurring appointments, or change the end date, and the broker may not deny transport tied to those changes.
- The broker reviews every standing order at least once a month to confirm the assigned provider is still the most cost-effective choice.
That last point matters to providers. A standing order is steady revenue, but in Louisiana it is not guaranteed forever. Performance can cost you the work too. Under MTM’s 2026 Virginia provider handbook, a provider that reaches 8 infraction points gets a 10-day suspension and loses any assigned recurring trips.
Standing orders on a dispatch day
Standing orders are the most predictable part of a NEMT schedule because they are known weeks ahead. Some brokers also set rules for running them. MTM’s 2026 Virginia handbook asks providers to use the same driver for standing-order trips whenever they can, and to document when someone else has to cover.
They still go wrong in predictable ways:
- Drift. Dialysis chair times move, and the pickup time on the order does not.
- Hospital stays. The rider is admitted, and the van still shows up.
- Holidays. The clinic closes, and nobody pauses the series.
- Treatment ends. The order keeps generating trips that turn into dry runs.
- Duplicates. A broker sends a trip the series already created, and two drivers head to the same door.
Most fixes follow one pattern: change one date without breaking the series, pause the series when care pauses, and end it when care ends. For duplicates, check new broker trips against the series before you dispatch. Our guide to NEMT standing orders goes deeper on managing a full book of them, and the dialysis contracts guide covers the recurring work dialysis centers send.
Doing it faster
In HealthRide, you book a recurring trip once, choose the days it repeats, and HealthRide creates the actual trips weeks in advance. You can change a single day without touching the series, and pause it during a hospital stay.
Frequently asked questions
- Is a standing order the same as a recurring trip?
- Yes, in practice. The names vary by broker and by software. Virginia's fee-for-service member handbook calls them standing orders, CareOregon calls them subscription trips, and dispatch software may call them recurring trips. All of them mean one booking that repeats on a schedule.
- Who can set up a standing order?
- It depends on the program. Louisiana extends the right to request one to the facility providing the recurring treatment. For broker work, the provider receives the trips. For private-pay and facility clients, the provider sets up the series directly.
- Do standing orders expire?
- Some need regular review or fresh paperwork. Louisiana's broker must review every standing order at least once a month for cost. In Colorado, the verification form for trips over 25 miles one way is valid for 90 days for recurring appointments such as dialysis and cancer treatment, so a long standing order needs a new form every 90 days.
