Special Mobility Services provider guide: Apple Health rides in eastern Washington

Special Mobility Services at a glance

Special Mobility Services (SMS) is a nonprofit that has spent more than 40 years moving people with special transportation needs. It holds the Washington Health Care Authority (HCA) broker contract for Apple Health rides in ten eastern Washington counties, run from a call center in Spokane Valley. HCA splits the state among six brokers serving 13 regions, and each broker arranges rides for the clients who live in its counties.

The brokerage is only one part of SMS. The organization also runs weekday Community Shuttles that link Deer Park, Davenport, Reardan, Newport, Ritzville, and Sprague with Spokane, a Dial-A-Ride in the Deer Park area, travel training, and a mobility management project in Spokane County. Grants from the Washington State Department of Transportation and the Spokane Transit Authority pay for those programs. A Medicaid subcontract is a separate agreement with the brokerage. Our Washington state guide lists all six brokers and their counties.

Who SMS contracts with

SMS places Medicaid trips with many kinds of carriers, and its rider FAQ names them: public transit systems, fuel voucher vendors, commercial providers such as taxi and cabulance companies, nonprofit organizations, and intercity bus and train lines. It also works with organizations that supply volunteer drivers, and it manages a small group of its own volunteers who drive their own cars for mileage reimbursement.

A for-profit fleet fits the commercial slot. For organizations interested in carrying Medicaid riders, SMS points to its Regional Manager, reachable at 509-534-9760 or 800-892-4817. HCA gives new service providers the same general direction: start with the regional broker that covers the counties you want to serve. Bring these to the conversation:

• Licensing. Anyone who drives passengers for pay in a taxi, cabulance, or other for-hire vehicle needs a for-hire license from the Department of Licensing (DOL). It appears as an endorsement on your state business license. The application also needs a vehicle certificate for each vehicle, a For Hire Addendum signed by your local jurisdiction, and liability insurance with a combined single limit of at least $325,000 (split limits of $300,000/$100,000/$25,000 also qualify). A private nonprofit that carries riders with special transportation needs in a vehicle licensed by the Utilities and Transportation Commission is exempt from the DOL license.
• Your footprint. The counties, days, and hours you can cover, and your vehicles with their seating and wheelchair positions.
• Driver files. Licenses, driving records, and background check results for every driver. Our driver file checklist lists the usual paperwork.

Ask which counties, hours, and trip types are hardest for SMS to place. A company that fills a real gap gives the broker a reason to add one more subcontract. For the rest of the pitch, see winning NEMT broker contracts.

How SMS chooses the ride

Price comes first on every trip: SMS has to book the least expensive option the rider can actually use. WAC 182-546-5200 makes the broker decide the level of assistance each rider gets (curb-to-curb, door-to-door, door-through-door, or hand-to-hand) and settle on the cheapest mode the rider can get into that also suits their health and abilities. SMS explains this rule to riders and lists what it can arrange:

• Bus tickets or passes, since local transit is usually the least costly choice
• Fuel vouchers for riders who have a car or a driver
• Volunteer drivers
• Intercity bus or train, on routes such as the Gold Line between Kettle Falls and Spokane
• Taxi, nonprofit van, or Dial-A-Ride service, individually or as a shared ride
• Cabulance

Riders who say they cannot ride the bus can be asked to send a note from their primary care provider explaining why. WAC 182-546-6200 also rules out a paid ride when:

• The clinic is less than three-quarters of a mile from the pickup, unless the rider cannot manage that walk or the route is inaccessible or unsafe.
• The rider has a car, a relative, or a friend available and suited to the trip.
• A fixed bus route runs within a three-quarter-mile walk, unless the broker records a medical need for more specialized transport, for example a walker, a quad cane, or a portable ventilator.

The trips left for vehicle providers are the ones cheaper modes cannot cover: wheelchair riders, people whose doctor documents that transit will not work, pickups out of reach of bus service, and groups that one vehicle can carry more cheaply than several. HCA’s sample contract also requires every broker to set a shared-ride rate structure that allows a lower fee for each added passenger. Price your shared and grouped trips with that in mind. Our guides to the least costly mode rule and loading more than one rider go deeper.

State terms behind an SMS subcontract

SMS writes its own subcontracts, but HCA’s rules and its published sample broker contract set the floor for provider terms across the state.

• Signed subcontract first. Brokers may pay only transportation providers they have subcontracted, ambulance and non-ambulance alike (WAC 182-546-6200). Licensed ambulance companies can also be subcontracted for nonemergency trips in ground ambulances (WAC 182-546-5200).
• Exclusion checks. SMS has to check your company and employees for federal exclusions before signing and on an ongoing basis, and it tells HCA right away about any exclusion it finds. Our page on the OIG exclusion list explains the check.
• Licensed and legal. Providers must be licensed, equipped, and operated under every applicable federal, state, and local law, and drivers and riders must obey the law during transport.
• Ten-day pay. Your payment is due within 10 calendar days of the broker getting its monthly HCA payment.
• Open competition. Brokers are expected to recruit openly and sign enough carriers of each type to keep prices competitive.
• Trip reviews. Every provider gets a desk audit every two years, and in it the broker pulls a minimum of 10 trips at random to check paperwork, timeliness, coding, and medical justification. Every other year it also visits your office to make sure client files and manifests are locked down.
• Tribal agreements. Where a federally recognized tribe’s contract health service delivery area overlaps the broker’s region, the broker has to bargain in good faith for a transportation contract if the tribe asks. Once HCA signs off, members may travel on the tribe’s own transportation, with the broker handling coordination and payment. Our guide to tribal transportation covers those arrangements.

Our guide to passing a broker audit shows how to keep trip records ready for that review.

Timing on SMS trips

The promises SMS makes to riders become the service standard your drivers are measured against.

SMS gives riders three reasons for early pickups: the driver may have other passengers, weather and traffic vary, and wheelchairs and other equipment take time to secure. Riders are also told to ask their driver for a card with the company’s phone number, so your dispatch line will get the where-is-my-ride calls.

HCA’s sample contract adds its own standards. Pickups for appointments should average 15 minutes of waiting or less, and no single wait should pass 30. Nobody should be dropped off more than half an hour before an appointment unless they asked for that. Scheduled returns should average half an hour of waiting or less, and a shared ride should keep a rider aboard no more than 45 minutes beyond a direct trip. Will-call trips are exempt from these clocks.

Brokers can record exceptions in the rider’s file when a trip begins or ends beyond the rider’s home region, or when rural distances are unusually long. Late arrivals are handled separately. When a rider gets to the clinic too late to be treated, neither the broker nor the provider is paid for that trip. The broker may still consider paying when the delay was not the provider’s fault, for example an unforeseen accident that blocked every lane. Slowdowns in construction zones do not count. Our guide to on-time performance covers building schedules around those limits.

Out-of-area and cross-border trips

Rural riders cross county lines routinely, as HCA noted in its report to the Legislature dated December 1, 2024. Four rules shape the longer runs in SMS territory.

• Out-of-area care needs a referral. WAC 182-546-5700 limits riders to nearby providers, with listed exceptions: the service is not offered in the rider’s community, the rider needs continuity of care (active cancer treatment is one example), and a few others. SMS gives the rider a referral form for their primary care physician, and the finished form must reach SMS two full business days before the appointment.
• Five Idaho cities count as in-state. Washington recognizes Coeur d’Alene, Moscow, Sandpoint, Priest River, and Lewiston as bordering cities where Apple Health clients receive care on the same basis as at home (WAC 182-501-0175). Trips there skip the out-of-state review, though the local-provider rule still applies.
• Farther out of state goes to HCA. HCA reviews rides to any other out-of-state provider itself, and the request has to arrive no fewer than seven business days ahead of the trip (WAC 182-546-5800).
• Meals and lodging. For care outside the rider’s community, the broker can approve meals and lodging based on the rider’s needs, for up to a calendar month at a time and priced against the state per diem (WAC 182-546-5900). Any trip, meal, or lodging reimbursement needs the broker’s prior authorization at least two business days before travel (WAC 182-546-6200).

Our guides to rural NEMT, out-of-state trips, and long-distance pricing cover how to staff and cost these runs.

Standing orders and after-hours work

SMS books ongoing care in bulk. Riders going to dialysis, chemotherapy, or other regular treatment can set up a month of appointments in one call or with a ride request form. For your company, that becomes a standing order on fixed weekdays and times. A company that can hold the same pickup slot and driver week after week is well placed for that work.

SMS takes calls on weekdays until 4 p.m. only. Weekends are off, and so are the holidays on its list, Thanksgiving Day and the Friday after among them. Outside those hours, the call center voice mail connects riders to an answering service.

WAC 182-546-5200 covers urgent care visits and rides home from a hospital discharge that come up while SMS is closed and cannot approve them in advance. A subcontracted provider either carries that rider following SMS’s after-hours directions and seeks retroactive approval within two business days, or turns the trip down. A company that can staff evenings and weekends should say so early. Our after-hours guide covers pricing and staffing that shift.

Contacts

The Community Shuttle numbers (877-264-RIDE and 509-534-7171) and the shuttle dispatch email handle shuttle business only, not Medicaid rides.

Running SMS trips in HealthRide

SMS books dialysis and chemotherapy rides a month at a time. With recurring trips in HealthRide, you schedule each ride once and HealthRide keeps it going on your board. Will-call returns stay on the board until the rider calls, then activate right away, so your dispatcher can assign them inside SMS’s 60-minute window.