# What Is Door-Through-Door Service in NEMT? What the Driver Does Inside

Canonical URL: https://nemtguide.com/glossary/door-through-door/ · Updated 2026-09-29

Door-through-door service means the NEMT driver goes inside: they meet the rider inside the pickup building, walk them to the vehicle, and at the destination walk them inside to the lobby, front desk, or waiting room. It goes one step past door-to-door. Brokers such as MTM Health allow it only with prior approval based on the rider's medical need.

- Door-through-door help starts inside the pickup building and ends inside the destination, not at the outside door.
- Programs differ on homes: Rhode Island drivers go inside the residence, while Washington stops at a home's exterior door.
- It still leaves out lifting, personal care, and going into the exam room.
- MTM Health requires prior approval based on medical need, and bars drivers from charging riders for help getting in or out of the vehicle.
- A driver who goes inside leaves the van, so plan these trips as single loads or send a second person.

## What door-through-door service means

Door-through-door is a level of help where the driver's assistance starts inside the pickup building and ends inside the destination. The rider is met in a lobby, hallway, or apartment instead of at the curb or the front door, and walked in at the other end to the front desk or waiting room.

It sits one step above [door-to-door](https://nemtguide.com/glossary/door-to-door/), where help stops at the outside door, and one step below [hand-to-hand](https://nemtguide.com/glossary/hand-to-hand/), where the driver must hand the rider to a responsible person. Programs draw the line in different places:

| Source | What door-through-door covers |
|---|---|
| Rhode Island Medicaid contract with MTM (effective July 1, 2025) | From inside the residence to inside the medical office, and back. The driver enters the residence and the medical facility with the member. |
| New York Medicaid, ambulettes (manual effective August 25, 2023) | Ambulettes must give personal assistance, which the manual also calls door through door. It runs from the rider's own front door, including an apartment door or nursing home room, to the door of the medical practitioner, with no limit on stairs or floors. |
| Washington sample broker contract (amendment term July 1, 2023 to June 30, 2025) | Listed as a level, but at a residence it applies only to the exterior door, and at a health care facility it runs to the street-level main reception desk |
| MTM Health standard agreement (January 1, 2023) | A level MTM must approve in advance, above the curb-to-curb standard |

Some programs do not list it. Virginia's handbook and member manual name curb-to-curb, door-to-door, and hand-to-hand, and the member manual (June 2026) says drivers may not go beyond the main entrance lobby or main door. Rhode Island offers door-through-door to Medicaid members but only curb-to-curb and door-to-door in its non-Medicaid Elderly Transportation Program.

## What the driver does on a door-through-door trip

1. **Check the level on the manifest.** Give the level the broker approved, no less. Virginia warns that carrying a rider in a way that does not match the authorized level may lead to nonpayment or corrective action.
2. **Secure the vehicle and any other riders.** MTM's standard agreement says no driver or attendant may leave a member unattended in the vehicle (section 2.JJ).
3. **Identify yourself at the entrance.** Rhode Island drivers show identification and announce their presence at the entrance of the facility or residence, and follow the facility's rules when entering and leaving.
4. **Go in to the rider.** Enter a private home only where your program allows it. Rhode Island's level includes the residence. CareOregon bars drivers from going inside a private home or a rider's room in a care facility unless they are licensed, trained, and authorized by the brokerage.
5. **Walk the rider to the vehicle and secure them.** Open doors, guide them over steps and thresholds, fasten the seat belt, and secure any wheelchair or walker.
6. **At the destination, walk them inside** to the front desk or waiting room. Minnesota's statute describes driver-assisted service as including help with getting the rider admitted to the medical facility (256B.0625, subd. 17).
7. **Never leave a rider at a locked door.** New York's broker MAS says that when you are responsible for door-through-door service, a rider must never be left at a closed or inaccessible facility. If they cannot get in safely, MAS says to return them to the pickup location. Then tell the broker.
8. **Write it down.** Note the times and anything unusual on your [trip log](https://nemtguide.com/templates/nemt-trip-log-template/).

## What door-through-door service does not include

Going inside does not turn the driver into a caregiver. The same limits as other levels apply:

- **No lifting or transfers.** CareOregon's manual (February 2024) bars drivers from moving a rider into or out of a wheelchair or bed, or giving full-weight support while walking, unless licensed, trained, and authorized. New York says lifting a wheelchair user onto an exam table is the job of the rider's aide or the medical staff, not the driver.
- **No carrying on stairs.** CareOregon drivers may help riders find their way on stairs but may not physically assist or carry them up or down. A rider who must be carried needs a [stair chair](https://nemtguide.com/glossary/stair-chair/) or stretcher crew.
- **No exam room and no personal care.** CareOregon drivers do not go into the exam room or attend the appointment, and do not dress or feed riders.
- **No handoff promise.** If the rider cannot be left alone once inside, book [hand-to-hand](https://nemtguide.com/glossary/hand-to-hand/) service instead.

## Who approves it and how it is paid

The broker or state sets the level for each trip, based on the rider's needs. MTM Health's standard agreement makes curb-to-curb the standard and requires MTM's prior approval for door-to-door and door-through-door, based on the member's medical necessity (section 2.GG). If a rider needs more help than the manifest shows, call the broker before the ride. See [NEMT level of service](https://nemtguide.com/glossary/level-of-service/).

Check how each payer handles it:

| Payer | How door-through-door help is paid |
|---|---|
| New York Medicaid, ambulettes | Included in the ambulette rate. Personal assistance and door-to-door service come at no additional or enhanced charge. |
| MTM Health standard agreement | Drivers may not charge riders for general assistance such as opening doors, offering an arm, or holding a bag (section 2.HH) |
| Other brokers | Ask whether the rate changes with the level of assistance, and get the answer in writing |

## The training and insurance it takes

**Training.** A driver who goes inside homes and clinics needs more than driving skills. Virginia requires PASS passenger assistance training for all drivers before they carry riders. Ohio ambulette drivers repeat passenger assistance training at least every three years, covering transfer techniques, wheelchair handling, lift operation, and emergency procedures (Ohio Adm. Code 4766-3-13). See [PASS certification](https://nemtguide.com/glossary/pass-certification/) and [NEMT driver training](https://nemtguide.com/guides/nemt-driver-training/).

**Insurance.** Door-through-door work happens off the vehicle, so your general liability and workers' compensation matter as much as auto coverage. MTM's standard agreement requires all three (section 9):

| Coverage | Minimum in MTM's agreement (January 1, 2023) |
|---|---|
| Commercial general liability | $500,000 per occurrence and $500,000 aggregate, including bodily injury and property damage |
| Commercial auto liability | $500,000 combined single limit for every vehicle used |
| Workers' compensation | Statutory amounts for your state |

MTM also requires "broad form" coverage that includes loading and unloading. Ask your agent in writing whether your policies cover a driver helping a rider inside a home or clinic, and a driver hurt while doing it. See [NEMT insurance requirements](https://nemtguide.com/guides/nemt-insurance-requirements/).

## Scheduling door-through-door trips

Each of these stops takes longer than a curbside pickup, and the driver leaves the van. DOT's paratransit examples in Appendix E to 49 CFR Part 37 say a paratransit driver should generally open a building's outside door for a rider, as long as it does not leave the vehicle unattended or out of sight for a long time. A request for door-through-door help generally need not be granted, because it could fundamentally change the service.

For NEMT, that means:

- **Run these riders alone,** or first or last on a shared run, so no one waits alone in the van.
- **Send an attendant** when you must pair a door-through-door rider with others.
- **Add minutes at both ends** so the trip stays inside its [pickup window](https://nemtguide.com/glossary/pickup-window/).
- **Check the destination's hours.** MAS bars dropping ambulette riders off before the office opens.

Hospital discharges often need this level or more. CareOregon sends drivers to the nurses' station on the rider's unit with a full escort. See [hospital discharge transportation](https://nemtguide.com/guides/hospital-discharge-transportation/) and [safe passenger transfers](https://nemtguide.com/guides/safe-passenger-transfers/).

## Frequently asked questions

### What is the difference between door-to-door and door-through-door service?

Door-to-door help stops at the outside door of each building. Door-through-door help goes past it: the driver comes inside to get the rider and walks them inside at the destination. Rhode Island's Medicaid contract (effective July 1, 2025) defines door-through-door as transport from inside the residence to inside the medical office, with the driver entering both.

### Can the driver go into the rider's home?

Only where the program allows it. Rhode Island's door-through-door level has the driver enter the residence. Washington's sample broker contract applies the level only to a home's exterior door. CareOregon bars drivers from going inside a private home or a rider's room in a care facility unless they are licensed, trained, and authorized by the brokerage. Virginia drivers may not go beyond the main entrance lobby.

### Do I get paid more for door-through-door trips?

It depends on the payer. New York requires ambulettes to give personal assistance from the rider's apartment door or nursing home room to the doctor's door at no extra charge. MTM Health's agreement bars drivers from charging riders for general help such as opening doors or offering an arm. Ask each broker whether its rate changes with the level of assistance.

### Can I leave other riders in the van while I walk someone inside?

Not on MTM Health trips. MTM's standard agreement says no driver or attendant may leave a member unattended in the vehicle. Run door-through-door riders alone, put them first or last on a shared run, or send an attendant. DOT's paratransit examples also warn against leaving a vehicle unattended or out of sight for long, and say door-through-door help generally need not be given.

### What if the clinic is closed when we arrive?

Do not leave the rider. New York's broker MAS says that when you are responsible for door-through-door service, a rider must never be left at a closed or inaccessible facility. If the rider cannot safely get inside, MAS says to return them to the pickup location. Then tell the broker. MAS also bars dropping ambulette riders off before the office opens.

## Official resources

- [Rhode Island EOHHS: NEMT contract with MTM (levels of service)](https://eohhs.ri.gov/sites/g/files/xkgbur226/files/2025-07/MTM_2023-03_executed_fully%20executed_20250623.pdf)
- [CareOregon: NEMT Transportation Provider Manual](https://careoregon.org/docs/default-source/nemt/nemt-provider-manual.pdf)
- [eMedNY: New York Medicaid Transportation Policy Manual](https://www.emedny.org/ProviderManuals/Transportation/PDFS/Transportation_Manual_Policy_Section.pdf)
- [eCFR: Appendix E to 49 CFR Part 37, reasonable modification examples](https://www.ecfr.gov/current/title-49/subtitle-A/part-37/appendix-Appendix%20E%20to%20Part%2037)