Service levels and vehicles
What Is Hand-to-Hand Transport? The Handoff, Who Needs It, and How to Record It
Hand-to-hand transport is the NEMT level of help where the driver takes the rider from a responsible person at pickup and hands them to another responsible person at the destination, such as facility staff or family. The rider is never left alone. It is for riders who cannot safely wait by themselves, such as some with dementia, and Virginia requires medical necessity for it.
- On a hand-to-hand trip the rider is never left alone: one responsible person hands them to the driver, and the driver hands them to another.
- The broker sets the level from the rider's needs and prints it on the manifest. Virginia requires medical necessity for hand-to-hand trips.
- If no one is there to receive the rider, keep the rider with you and call the broker. Leaving them counts as abandonment in MTM Health's Virginia network.
- Write down who handed the rider over, who received them, and the times, next to the signature your broker already requires.
- MTM Health prices Virginia trips by mileage, mode, and shared rides, not the level of help, so build the extra minutes into your schedule.
What hand-to-hand transport means
Hand-to-hand transport is the level of help with a handoff at both ends. A responsible person hands the rider to the driver at pickup. The driver stays with the rider and hands them to another responsible person at the destination. At no point is the rider on their own.
It is one of the levels of assistance, which sit on top of the vehicle mode. A wheelchair rider or a rider who walks can each be booked hand-to-hand. See NEMT level of service for how the mode and the level fit together. Programs describe the handoff in slightly different words:
| Program | At pickup | At the destination |
|---|---|---|
| Virginia Medicaid member manual (June 2026) | The driver receives the member from a person at the main door | The driver hands the member to a caregiver or facility staff at the main door, without losing sight of the vehicle |
| MTM Health, Virginia handbook (approved August 10, 2026) | The member comes from a person at the pickup point | Into the hands of facility staff, a family member, or another responsible party |
| CareOregon NEMT manual (February 2024) | A full escort, and the driver may not leave the member unattended | The member is handed to a specific person and checked in at the appointment, and again at the destination after each appointment |
| TennCare provider FAQ (Rev. 11/2025) | Help to and from the vehicle | To the provider staff member, family member, or other responsible party |
Washington’s rule shows where it sits among the other levels. Its brokers must set the level for each authorized trip, such as curb-to-curb, door-to-door, door-through-door, or hand-to-hand (WAC 182-546-5200).
Who needs hand-to-hand service
Hand-to-hand is for riders who would be unsafe if left alone, even for a few minutes at a lobby door. MTM Health, which takes over Virginia’s fee-for-service rides on October 1, 2026, gives riders with dementia or developmental disabilities as examples in its provider handbook. Virginia’s member manual says the level requires medical necessity, so it is set by the broker from the rider’s needs, not chosen by the driver.
You find it on the manifest. MTM Health’s Virginia manifests list the required level of assistance (curb-to-curb, door-to-door, or hand-to-hand), whether an escort will ride along, and whether you must supply an attendant. Read all three before the driver leaves the yard.
Children are a separate question. Virginia’s broker must provide an attendant for riders 12 and under when no family member or escort can come (DMAS requirements, May 26, 2026). CareOregon requires the parent or guardian to provide an attendant for members 12 and younger in most cases. See children in NEMT for who rides with a child and who receives them.
What the driver confirms at each end
- Before the trip. Read the manifest for the level, the escort, and any notes about who will meet the rider. If the manifest does not say who will receive the rider, ask dispatch to find out from the broker or the facility.
- Call ahead. A short call before arrival puts the right person at the door and saves minutes at both ends.
- Announce yourself at pickup. MTM Health’s Virginia handbook has drivers identify themselves, show identification, and announce their presence at the entrance or to facility staff when the pickup is not at the curb.
- Take the rider from a person. Receive the rider from the person handing them over, not from an empty doorway.
- Stay with the rider. CareOregon calls hand-to-hand a full escort that does not let the driver leave the member unattended.
- Hand the rider to a named person. At the destination, hand the rider to the staff member, family member, or other responsible party, and check them in where your broker asks for it.
- Keep your limits. Virginia’s member manual keeps drivers from going beyond the main entrance lobby or main door, and from losing sight of the vehicle on hand-to-hand trips. CareOregon bars drivers from going into a private home or a resident’s room unless they are licensed, trained, and authorized by the brokerage, and from going into an exam room.
If no one is there to receive the rider, do not leave. CareOregon tells drivers to call the member or the brokerage for instructions. Keep the rider with you, call dispatch, and follow the broker’s direction.
How to record the handoff
Your broker already requires a trip record, and the handoff belongs on it. MTM Health’s Virginia handbook requires an electronic trip log with the trip ID, the scheduled and actual pickup times, the departure and arrival times, and the member’s signature, or the claim is denied. Minnesota’s statute, as a second example, accepts the signature of the rider, an authorized party, or the medical provider. If none of them can or will sign, the driver notes on the record that signatures were requested and not given (256B.0625, subdivision 17b).
For a hand-to-hand trip, add these lines to your trip log:
| Record | Why it matters |
|---|---|
| Name and role of the person who handed the rider over | Shows the chain started with a responsible person |
| Name and role of the person who received the rider | Proves the rider was not left alone |
| Time of each handoff | Matches the pickup and arrival times on the claim |
| Calls made and minutes waited, if no one was there | Shows you followed the broker’s instructions |
| Signature, or a note that it was refused | Meets the broker’s claim rule |
If anything goes wrong at a handoff, file an incident report the same day.
What happens when the handoff is skipped
MTM Health treats a missed handoff as a safety failure. MTM Health’s Virginia handbook defines member abandonment to include dropping a member at a location other than the one scheduled and failing to give the correct level of service, naming hand-to-hand. It sits in the handbook’s most serious group of violations, which carry an immediate suspension of at least 5 days and possible permanent removal of the driver or vehicle from MTM Health’s network.
The same handbook warns that carrying a member in a way that does not match the authorized level of assistance may lead to nonpayment or corrective action. It also requires PASS passenger assistance training for every driver before they carry members, taxi drivers on door-to-door and hand-to-hand trips included. See PASS certification and NEMT driver training.
A dispatch example
A rider with dementia lives in a memory care home and has a dialysis appointment at 9:00. The manifest shows a wheelchair van, hand-to-hand, and no escort. Dispatch calls the home the day before to learn who will bring the rider to the front door, and calls the clinic to learn who will receive her.
The driver arrives, announces himself at the entrance, and takes the rider from the aide. At the clinic he hands her to the front desk nurse and writes down both names and times. On the way home, no one answers at the memory care door. The driver keeps the rider with him, calls dispatch, and waits for the broker’s direction rather than leaving her in the lobby.
The level of help did not change the rate: MTM Health’s Virginia handbook pays from its rate sheet by mileage, mode, and shared rides. Plan the extra minutes at both ends so the next pickup stays on time, and see T2007 wait time for the programs that pay waiting.
Frequently asked questions
What is the difference between hand-to-hand and door-to-door service?
Who the driver hands the rider to. On a door-to-door trip the driver walks the rider between the vehicle and the door, front desk, or waiting area, and CareOregon's manual (February 2024) says the driver does not need to check the rider in or escort them to a specific person. On a hand-to-hand trip the driver stays with the rider and hands them to a named person, such as facility staff or a family member, and CareOregon also has the driver check the rider in.
What should the driver do if no one is there to receive the rider?
Stay with the rider and call. CareOregon's manual tells drivers to call the member or the brokerage for instructions when the member is not at the door or desk. MTM Health's Virginia handbook (approved August 10, 2026) treats leaving a rider without the required level of service, such as hand-to-hand, as member abandonment. Log every call and the time you waited.
Does a hand-to-hand trip pay more?
Not as a rule. MTM Health's Virginia handbook prices each trip from its rate sheet by mileage, mode of transportation, and shared rides, and the level of help is not on that list. Where a payer covers waiting time, it may bill as T2007, and a second paid person on the trip may bill as T2001 where the program allows it. Check your broker agreement before you promise anything to a facility.
Is hand-to-hand the same as an escort or attendant?
No. Hand-to-hand describes what the driver does at each end of the ride. An escort or attendant is a person who rides along with the rider, such as a parent or a caregiver. A rider can have both. MTM Health's Virginia manifests show the level of assistance and, separately, whether an escort will ride or the provider must supply an attendant.
Who decides that a rider needs hand-to-hand service?
The broker or state, from the rider's needs. Washington requires its brokers to set the level of assistance for each authorized trip (WAC 182-546-5200). MTM Health's Virginia handbook assigns the level from medical needs, functional ability, and safety, and Virginia's member manual (June 2026) says hand-to-hand requires medical necessity. If a rider needs more help than the manifest shows, call the broker before the ride.