Complaint and grievance procedure template for NEMT companies: intake to closed file
Overview
A complaint resolution policy is the written procedure for every complaint: who takes it, how fast you acknowledge and answer it, how you investigate, which broker deadlines you meet, and how the person can appeal or go to an outside agency. The ADA transportation rules (49 CFR 37.17) require one of every covered company, and Medicaid-funded companies with 15 or more employees also need a Section 1557 grievance procedure.
On this page
Which rules require a written procedure
Every NEMT company covered by the ADA transportation rules needs a written complaint procedure, and several other rules add to it as the company grows or bills electronically. The procedure is the policy. The complaint log is where each case is recorded, and answering a broker about a specific complaint is covered in answering rider complaints a broker sends you.
| Rule | Who it covers | What the procedure must do |
|---|---|---|
| ADA, 49 CFR 37.17 | Every company covered by DOT’s ADA rules, any size | Due process, prompt and fair resolution, a named contact the public can find, access for riders with disabilities, a documented reasoned answer |
| Section 1557, 45 CFR 92.8(c) | Companies paid with HHS money, such as Medicaid, with 15 or more employees | Prompt and fair resolution of discrimination grievances, records kept 3 years, complainant identity kept confidential |
| Section 504, 45 CFR 84.7 | HHS-funded companies with 15 or more employees | A coordinator and grievance procedures with due process for disability complaints |
| HIPAA, 45 CFR 164.530 | HIPAA covered entities, such as providers that bill electronically | A contact for privacy complaints, every complaint and outcome documented, records kept 6 years, no retaliation |
| Medicaid managed care, 42 CFR 438.402 to 438.408 | Managed care plans, and so the brokers working for them (not rides-only brokers paid by the state) | Grievances taken orally or in writing at any time, receipt acknowledged, resolved within the state’s deadline |
A company under 15 employees can still adopt the full grievance procedure, and HHS encourages it. The template below covers every row, so one document handles a late pickup, a privacy worry, and a discrimination claim. Disability complaints that reach a federal agency are explained in our guide to ADA complaints against a transportation company.
The template
[Company name] complaint and grievance procedure
Effective date: [date] | Approved by: [owner name] | Next review: [date]
1. Who this covers
Complaints from riders, family members, representatives, facilities, brokers, health plans, and the public about any service [Company name] provides, and the employees and contractors who receive or investigate them.
2. What counts
- Complaint. Any expression of dissatisfaction with our service, spoken or written, whether or not the person uses the word “complaint.”
- Civil rights grievance. A complaint that we treated someone differently because of race, color, national origin (including language), sex, age, or disability, or did not provide language help, communication aids, or a change to our usual practice that a person with a disability needed.
- Privacy complaint. A complaint about how we handled a rider’s personal or health information.
- Incident. An injury, accident, alleged abuse, or property damage. Incidents follow our incident report procedure as well as this one.
3. How to complain
Anyone may complain by phone at [number], text at [number], email at [address], our website form at [link], mail to [address], in person at [office], or by telling any driver, dispatcher, or office employee. A representative may complain for a rider. We accept complaints in any language and in accessible formats, offer free interpreters and help filling out forms, and accept anonymous complaints. This process is posted on our website and inside each vehicle.
4. Who handles each type
| Type | Handled by | Contact |
|---|---|---|
| Service complaints (lateness, conduct, vehicle, billing) | [Complaint lead, usually the operations manager] | |
| Disability complaints and modification requests | [ADA coordinator] | |
| Other civil rights grievances | [Section 1557 coordinator, if 15 or more employees; otherwise the owner] | |
| Privacy complaints | [Privacy official] |
Any employee who hears a complaint passes it to the right person the same day, with the date, the person’s contact details, the rider and trip, and what was said.
5. Riders sent by a broker or health plan
- Drivers and dispatchers give the rider the broker’s or plan’s complaint number. Complaints the broker never hears about cannot be counted or resolved on its side.
- We report the complaint to the broker within its deadline, using its form or portal: [broker name, deadline, method].
- The broker’s or plan’s process decides the rider’s grievance. We investigate our part, send our records, and answer by the broker’s deadline.
6. Timeline
| Step | Our standard | Broker or plan deadline, if shorter |
|---|---|---|
| Urgent service problem (rider waiting, missed pickup) | Fixed on the same call where possible | |
| Acknowledge the complaint | [1 business day] | |
| Report to the broker or plan | [Same business day] | |
| Finish the investigation | [5 business days] | |
| Send the written answer | [10 business days] | |
| Civil rights grievance decision | [30 calendar days] | |
| Appeal decision | [30 calendar days after the appeal] |
If we will miss a deadline, we tell the person, and the broker where one is involved, before it passes, with the reason and a new date.
7. Investigating
- Pull the records the same day: trip times, GPS route, signatures, recorded waits, messages, and any camera footage.
- Get written statements from the driver and anyone else involved. Record what people saw, heard, or measured, not opinions.
- Contact the person who complained if anything is unclear.
- A person who was not involved in the event, and does not report to someone who was, makes the decision.
- Decide whether the complaint is substantiated, not substantiated, or cannot be determined, and record the cause.
- Decide the corrective action: retraining, a schedule change, a repair, discipline, or a change to this or another policy.
8. The answer
The written answer gives our finding, the reasons for it, what we are doing about it, how to appeal, and the outside agencies the person may contact. It goes out in the person’s language and format. A copy goes in the file (49 CFR 37.17(b)(3)).
9. Appeals
A person who disagrees may appeal in writing or by phone to [owner or general manager] within [15 calendar days] of our answer. Someone other than the first decision-maker reviews the file and any new information and decides within the time in section 6.
10. Outside options
Using this procedure never stops anyone from going elsewhere, at any time:
- The broker or health plan, through its member services line.
- The state Medicaid agency.
- The U.S. Department of Health and Human Services, Office for Civil Rights, for discrimination or privacy complaints, generally within 180 days.
- The U.S. Department of Justice, for disability complaints.
- [The Federal Transit Administration or the state DOT, if we carry riders under a transit contract.]
11. No retaliation and confidentiality
No one at [Company name] may threaten, punish, or treat anyone worse for complaining, helping with an investigation, or refusing to drop a complaint. Drivers may not discourage a rider from complaining. Complaint files are kept where only the people handling them can see them, and the identity of anyone who files a civil rights grievance is shared only as the law or the investigation requires.
12. Records
Each complaint gets a numbered entry in the complaint log. The file holds the complaint, the person’s contact details if given, what was alleged and on what basis, the dates filed and resolved, the evidence, the answer, and any appeal. Civil rights grievance files are kept at least 3 years after resolution, privacy complaint files at least 6 years, and every file at least as long as [our longest broker or state rule: __ years].
13. Review
The complaint lead reviews the log every month for repeat types, drivers, and vehicles, and reports to [owner]. This procedure is reviewed every [year] and after any finding by a broker, plan, or agency.
Where the deadlines come from
Your deadlines are set by the shortest clock above you. A Medicaid managed care plan must resolve a standard grievance within a time its state sets, which can never exceed 90 calendar days from receipt (42 CFR 438.408). Those grievance rules do not reach a broker that contracts with the state for rides alone (42 CFR 438.402(a) and 438.9), which follows its state contract instead, but a broker running rides for a health plan works to the plan’s clock. The plan can add up to 14 days only if the member asks or if it shows the state the delay is in the member’s interest. It must also acknowledge every grievance and have it decided by someone who was not involved earlier (438.406), which is why section 7 hands the decision to someone outside the event.
The broker’s deadline for your side can be much shorter. CareOregon expects a provider’s response to a routine grievance within 3 business days, may shorten that to 1 business day for a serious one, and wants notice if a response will be late. The complaint log collects more broker and state deadlines, so copy the ones you work under into section 5.
Complaints also count against drivers quickly. WellTrans’s Indiana manual says a driver or attendant with two or more rider complaints within five business days may not drive its trips until a corrective action plan it approves is in place, and valid complaints become part of that person’s permanent record. A procedure that gets each complaint investigated within days, not weeks, is how a company protects a good driver from an unfair pattern and catches a real one.
Running civil rights grievances inside the same procedure
Most complaints a NEMT company gets are about service, but the procedure has to recognize a discrimination claim when one arrives inside an ordinary complaint. A rider who says “the driver refused my service dog” or “nobody would speak Spanish with me” has made a civil rights grievance as well as a service complaint. Route it to the coordinator in section 4 and keep the record section 12 describes.
HHS’s 2024 rule allows one combined procedure for Section 1557, Title VI, Section 504, Title IX, and Age Act grievances, as long as Section 1557 is clearly addressed (45 CFR 92.8(g)). In the rule’s preamble, HHS said it had posted a sample grievance procedure on its Section 1557 web pages, suited mainly to smaller covered entities. It also said that companies already running a HIPAA complaint process would still need to revise it and train staff before it handled civil rights grievances, so adding a line to an existing privacy procedure is not enough. The ADA policy template and the language access plan template name the coordinator and the services the grievance would be about.
Giving investigators the facts from HealthRide
Step 1 of the investigation goes faster when the records already exist. HealthRide keeps each trip’s timestamps, GPS-recorded miles, signatures, and recorded no-show waits, and every change is recorded, so the person deciding a complaint starts from what happened rather than from memory. Each person on your team sees only what their role allows, so trip details stay with the people who need them. The trip log exports from reports as a CSV or PDF for the complaint file.
Frequently asked questions
- Does a NEMT company with a few employees need a written complaint procedure?
- Yes, for disability complaints at least. DOT's ADA rule requires every public or private entity it covers to adopt complaint procedures with due process, a named contact, and a reasoned answer, with no size cutoff (49 CFR 37.17). The Section 1557 and Section 504 grievance procedure rules start at 15 employees, and HIPAA covered entities of any size need a way to take privacy complaints.
- How fast do we have to answer a complaint?
- There is no single federal deadline for a transportation company; your contracts set it. Medicaid managed care plans must resolve a standard grievance within a time the state sets, never more than 90 calendar days, and the brokers running their rides ask providers for their side within days. CareOregon, for example, wants a provider response within 3 business days, or 1 business day for serious grievances. Set your own deadlines inside the shortest one you work under.
- Should a driver take a complaint at the curb?
- The driver should listen, pass it to the office the same day, and tell the rider how to file. On broker trips, also give the broker's complaint number. WellTrans's Indiana manual points out that complaints made only to drivers cannot be tracked by the plan's transportation line, and it asks providers to send members there. A driver should never argue the complaint or try to talk the rider out of filing.
- How long do we keep complaint files?
- Keep each file as long as the longest rule that applies. A Section 1557 grievance file must be kept at least three calendar years after the grievance is resolved, with the complaint, the complainant's contact details, the alleged action and basis, the filing and resolution dates, and the outcome. A HIPAA covered entity keeps complaint records six years. Broker contracts may ask for longer.
- Can a complaint be anonymous?
- Yes, accept it and investigate what you can. You may not be able to send an answer, so record that in the file. For civil rights grievances, the rule also asks you to keep the identity of anyone who files confidential, sharing it only as the law requires or as the investigation needs, which is a reason to limit who can open complaint files.
- Can one procedure cover privacy, discrimination, and service complaints?
- Yes, if each type's rules are met inside it. The Section 1557 rule lets you combine its grievance procedure with your Title VI and Section 504 procedures, as long as Section 1557 is clearly addressed. HHS noted in the 2024 rule that companies with a HIPAA complaint process would still need to revise it and train staff before it handles civil rights grievances.
