Can a rider stay in a transport chair during a NEMT ride?
A transport chair is a lightweight wheelchair with small rear wheels, pushed by a companion because the rider cannot roll it alone. Unlike a crash-tested WC19 wheelchair, a typical transport chair is not built to be a seat in a moving vehicle. Makers tell users to move to a vehicle seat for the ride. If a rider cannot transfer, tie the chair down and use vehicle belts.
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What a transport chair is
A transport chair is a folding wheelchair built to be pushed by someone else. Its wheels are small at both ends, and many models put the wheel locks where the companion can work them. Drive Medical’s current catalog shows the pattern: steel and aluminum transport chairs with 8-inch casters all around or 12-inch rear wheels, one steel model at 26 pounds, and weight limits of 250 to 300 pounds, or 450 pounds on its bariatric models. One Drive Medical combo chair becomes a transport chair once its 24-inch rear wheels come off.
Medicare draws the line in its coding. A standard manual wheelchair must have wheels large enough, and placed so, that the user could propel it. Transport chairs have their own codes, E1037 to E1039, and Medicare covers one only as an alternative to a standard manual wheelchair when the patient has a caregiver who is available, willing, and able to help with it.
Why it is not built as a vehicle seat
Most wheelchairs were never designed to sit in a moving vehicle. Their frames and seats are not built for crash forces, and they often lack strong places to hook tiedowns. A WC19 wheelchair solves that with four easy-to-reach securement points, a 30 mph frontal crash test, and the option of a crash-tested lap belt.
Transport chair makers are blunt about their own products. Medline’s manual tells users not to ride in its transport chair in any vehicle and to transfer to an approved vehicle seat. Invacare’s labels state that no transport chair has been approved as a seating surface in a motor vehicle.
Handling a rider who arrives in one
The safest plan is a transfer. Research from the University of Michigan’s wheelchair transportation safety program calls moving to the vehicle seat best practice whenever the rider can do it.
- Ask when the trip is booked. Learn whether the rider can stand and pivot into a seat, with or without help, and note it on the trip. See safe passenger transfers for technique.
- Transfer and belt. Help the rider into a vehicle seat and fasten the lap and shoulder belt.
- Stow the chair. Fold it and secure it so it cannot fly forward in a hard stop. Broda gives the same advice for its chairs: secure an empty wheelchair in the cargo area with its brakes on.
- If the rider cannot transfer, treat the chair like any other wheelchair. Under the ADA, a transport chair still counts as a wheelchair: any mobility aid on three or more wheels that works indoors, whether pushed by hand or powered. Hook the four tiedowns to solid frame points, never to footrests or armrests, and use the vehicle’s lap and shoulder belt. Do not count on the chair’s own seat belt, because positioning belts are not made to take crash forces.
Riders who cannot transfer and cannot sit safely in a small chair for the whole ride may need a different chair or a different level of service. Some programs expect the van to bring a chair of its own. Virginia’s fee-for-service rules, for example, require a wheelchair van that accepts hospital discharges to carry a secured wheelchair, in good condition, whose seat is at least 20 inches wide.
Note the rider’s mobility need on the trip, and HealthRide’s dispatch board warns you before a wheelchair trip goes to a van without a lift.
Frequently asked questions
- How is a transport chair different from a standard wheelchair?
- The wheels and who pushes. A standard manual wheelchair has large rear wheels the rider can push. A transport chair has small wheels, often 8 or 12 inches, and needs a companion behind it. Medicare codes transport chairs separately (E1037 to E1039) and covers one only when a caregiver is available, willing, and able to help with it.
- Can a driver insist that a rider move out of a transport chair?
- Where the ADA vehicle-use rules apply, no. 49 CFR 37.165 lets a provider suggest that the rider move to a vehicle seat, but the provider cannot insist, and it bars denying a ride "on the ground that the device cannot be secured or restrained satisfactorily." Explain why a vehicle seat is safer, and secure the chair as well as possible if the rider stays in it.
- Should a transport chair rider be booked as a wheelchair trip?
- It depends on whether the rider can transfer and what your program pays for. Colorado Medicaid, for example, pays wheelchair van codes only when the rider's medical professional states in writing that the rider is wheelchair-confined. Otherwise the trip bills at the ambulatory level. Record at intake whether the rider can stand, pivot, and sit in a vehicle seat.
