# After-Hours NEMT in 2027: Nights, Weekends, On-Call Drivers, and Off-Hours Rates

Canonical URL: https://nemtguide.com/guides/after-hours-nemt/ · Updated 2026-09-29

After-hours NEMT is any ride outside the broker's business hours, such as hospital discharges, urgent care returns, and Saturday or night dialysis. Brokers in Missouri and Kentucky must arrange urgent rides around the clock, so they need providers who staff those hours. Some pay more: MTM Health's Rhode Island schedule (July 1, 2023) adds $6 to the wheelchair base rate for appointments from 5 p.m. to 4:59 a.m.

- Brokers in states such as Missouri, Kentucky, and Georgia must arrange urgent rides around the clock, so they need providers whose listed hours cover nights and weekends.
- The trips that run after hours are hospital discharges, urgent care returns, late will-calls, and dialysis on Saturdays or at night.
- MTM Health in Rhode Island pays a higher base rate for appointments from 5 p.m. to 4:59 a.m. The Arizona and South Dakota fee-for-service schedules pay the same rate at any hour.
- In Washington, when the broker is closed, you may run an urgent care or discharge ride under its after-hours instructions and ask for approval within two business days.
- Federal law requires no extra pay for nights or weekends, but on-call time can be work time and any night differential raises the overtime rate.

Broker offices keep business hours, but care does not stop at 5 p.m. Hospitals discharge patients at night, urgent care clinics send people home late, and dialysis runs on Saturdays. The companies that can take those rides fill a gap brokers struggle to cover. The ones that promise hours they cannot staff pick up late marks and complaints.

## What after-hours NEMT means

After hours means outside the broker's business hours, and each program draws that line differently. CareOregon's manual (February 2024) defines it as the hours outside the brokerage's business hours, usually overnight and weekends. Brokerages there must offer NEMT 24 hours a day, 7 days a week. One that is not open all hours must offer an after-hours option for medically urgent trip requests.

| Program | Business hours | After hours |
|---|---|---|
| MTM Health, Rhode Island rate schedule (July 1, 2023) | Appointments from 5:00 a.m. to 4:59 p.m., Sunday through Saturday | Appointments from 5:00 p.m. to 4:59 a.m. |
| Paratransit Services, western Washington | Weekdays, 8:00 a.m. to 5:00 p.m. | 5:00 p.m. to 7:59 a.m. on weekdays, all day on weekends and most major holidays |
| Kentucky regional brokers (603 KAR 7:080) | Rides from 6 a.m. to 8 p.m. on weekdays and 8 a.m. to 1 p.m. on Saturday | Urgent care 24 hours a day including holidays, plus special cases such as night dialysis |
| Georgia broker (DCH manual, July 1, 2026) | Scheduling from 7:00 a.m. to 6:00 p.m. Eastern, Monday through Friday | Paging for nights, weekends, and stated holidays |
| Missouri (MO HealthNet manual, April 16, 2026) | Routine booking from 8:00 a.m. to 6:00 p.m., Monday through Friday | Staff answer 24 hours a day for urgent trips and the Where's My Ride line |

The broker's duty runs around the clock even when its office is closed. Missouri's manual says the broker must make NEMT available 24 hours a day, 7 days a week, when medically necessary. Georgia's manual requires its broker to keep a phone system and staff for paging after hours, including nights, weekends, and holidays. After hours, that broker also arranges non-routine rides and replaces broken-down or unavailable vehicles. What the broker cannot do is drive. It needs providers who will.

## Which trips run after hours

These are the trips that come up after hours. Each has its own rules.

| Trip | Why it runs after hours | Rules to know |
|---|---|---|
| Hospital discharge | Patients leave when the doctor clears them, at any hour | Virginia: the van must arrive within 3 hours of notice that the member is ready. Georgia: discharges count as urgent care, due within 3 hours. |
| Urgent care and emergency room returns | The visit ends late in the day or at night | Kentucky: urgent care runs 24 hours a day, 7 days a week, including holidays. Paratransit Services in western Washington: after-hours rides generally cover ER returns, hospital releases, and urgent care, but not rides to the ER. |
| Dialysis | Saturday is a regular treatment day, and some centers run at night | Kentucky lets brokers schedule rides after normal hours for dialysis, chemotherapy, or radiation offered only on nights and weekends. |
| Late will-call returns | Appointments run long | CareOregon asks drivers to pick members up within 15 minutes of the facility closing. |

Dialysis can put your vans on the road six days a week. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says center patients usually get a fixed slot three times a week: Monday, Wednesday, and Friday, or Tuesday, Thursday, and Saturday. Each session lasts about 4 hours. Some centers also offer treatment at night, three nights a week, while the patient sleeps. See [dialysis transportation](https://nemtguide.com/guides/dialysis-transportation/) for standing orders and chair times.

Discharges are hard to cover off-hours. Washington's Health Care Authority told the Legislature on December 1, 2024 that same-day, urgent, and no-notice trips are some of the most difficult for brokers to coordinate. It added that brokers have after-hours providers for discharges, but the resources are very limited. In Georgia, a broker that cannot meet the 3-hour discharge requirement must reimburse the hospital for its transport costs (DCH manual, section 906.7.5). The [hospital discharge guide](https://nemtguide.com/guides/hospital-discharge-transportation/) covers how to become the ride case managers call, and [same-day NEMT trips](https://nemtguide.com/guides/same-day-nemt-trips/) covers fitting short-notice rides into a day.

Some programs limit what runs after hours. Vermont's NEMT manual (updated July 28, 2025) limits unscheduled rides outside normal business hours to hospital discharges. Kentucky's rule keeps inpatient discharges inside its regular ride hours. Urgent care is the service it requires around the clock.

Holidays add their own pattern. Kentucky's brokers close for New Year's Day, Memorial Day, July 4th, Labor Day, Thanksgiving, and Christmas, and Georgia's broker may close scheduling on the same six days. See the NEMT holiday schedule for how to plan those weeks.

## How brokers send after-hours trips

Brokers send trips to providers whose profile says they can take them. MTM Health's Virginia handbook, for the fee-for-service program MTM takes over on October 1, 2026, assigns trips by capacity, hours of operation, trip distance, and credentialing status. Its provider profile asks for your days and hours. It expects providers to make reasonable efforts to take urgent trips within their approved service area and operating hours, and it assigns an urgent trip only with the provider's okay.

Your listed hours are a promise. CareOregon's manual treats a trip outside your hours of operation as an acceptable reason to ask for reassignment. A pattern of last-minute turnbacks is not, and neither is turning back urgent same-day trips you already agreed to take. The brokerage can then put you on a corrective action plan, cut your trip offers, or change the hours it lists for you. When your hours change, tell the brokerage right away.

### Washington lets you drive first and get approval after

Washington has a rule for nights when the broker's office is closed. If a broker cannot give advance approval for a ride to an urgent care appointment or after a hospital discharge, the subcontracted provider must do one of two things ([WAC 182-546-5200](https://app.leg.wa.gov/wac/default.aspx?cite=182-546-5200)):

1. **Give the ride** under the broker's after-hours instructions, and request retroactive approval within two business days.
2. **Decline the ride** if you cannot meet the rule's requirements.

The broker may grant the retroactive approval and must write down why in the trip record. So get the broker's after-hours instructions in writing before your first night, and send the approval request the next business morning.

Paratransit Services' Washington site lists the providers riders call after hours, county by county. As of September 2026, it shows no current after-hours coverage in Thurston or Pacific County. Gaps like that are openings for a provider who can staff the hours. See the [Paratransit Services page](https://nemtguide.com/brokers/paratransit-services/).

Other programs require approval first. Virginia's handbook says never to transport a member without the unique trip ID MTM issues, and MTM runs a 24/7 provider hotline at 866-810-8302. Rhode Island's 24/7 provider hotline is 888-597-1180. Save your broker's after-hours numbers in every driver's phone.

## What payers pay for off-hours trips

A few payers pay more for off-hours rides. Others pay the same rate at any hour.

MTM Health's Rhode Island schedule is one that pays more. Under Schedule A, effective July 1, 2023, the after-hours rate applies to trips with appointment times from 5:00 p.m. to 4:59 a.m., excluding specialized services. The extra money is in the base rate, which covers the first 5 miles. Mileage after that pays the same at any hour.

| Mode, pickup within 40 miles of your garage | Business-hours base | After-hours base | Difference | Each mile after 5 |
|---|---|---|---|---|
| Ambulatory | $17.75 | $21.75 | $4.00 | $1.75 |
| Wheelchair | $28.50 | $34.50 | $6.00 | $2.50 |
| Stretcher | $175.00 | $190.00 | $15.00 | $4.50 |
| Bariatric stretcher | $300.00 | $315.00 | $15.00 | $4.50 |

A 10-mile wheelchair trip pays the base plus 5 more miles. That is $28.50 + (5 × $2.50) = $41.00 for a 2 p.m. appointment and $34.50 + (5 × $2.50) = $47.00 for a 7 p.m. appointment. Pickups more than 40 miles from where your vehicles are kept pay $1.31 more on the base and on each mile, at both times of day. The [MTM Health page](https://nemtguide.com/brokers/mtm-health/) covers the rest of the schedule.

Other payers leave the number to you. Paratransit Services in Washington does not set subcontractor rates. You propose the rates your operation needs, and it negotiates if they are well above what it accepts. Its rate sheet can be filed as regular rates or after-hours rates, and asks for your office hours, service hours, and after-hours phone. So you can price nights separately.

Some fee-for-service schedules pay one rate around the clock. Arizona's rates effective October 1, 2026 have one modifier, TN for rural trips, and no rate for time of day. South Dakota's schedule effective July 1, 2026 pays more for trips outside the city and less for an extra rider, with nothing extra for nights or weekends.

For [private pay](https://nemtguide.com/guides/private-pay-nemt/) and facility rides, you set the price. Put an after-hours line on your rate sheet and say which hours it covers. When you negotiate with a broker, ask whether its rate sheet has an after-hours line and what it pays when it has no provider for those hours. See [how much to charge for NEMT](https://nemtguide.com/guides/how-much-to-charge-for-nemt/) and [how to negotiate broker rates](https://nemtguide.com/guides/negotiate-nemt-broker-rates/).

Before you add night hours, run the numbers:

**After-hours margin = after-hours trip pay − (driver pay for the call-out + running cost for the miles)**

If the margin is thin, a scheduled late shift that also covers daytime will-calls may pay better than a driver on call for one discharge.

## On-call setups that work for a small company

You do not need a night dispatcher to take after-hours work. Pick the setup that matches how many trips you expect.

| Setup | How it works | Is the waiting time paid? | Fits |
|---|---|---|---|
| Late shift | A driver works a scheduled shift into the evening | Yes, it is a normal shift | Steady evening discharges, late dialysis, and will-calls |
| On call at home | The driver is free at home and answers the phone | Generally no, until the driver takes a call (29 CFR 785.17) | A few calls a week |
| On call at the lot or near a hospital | The driver must wait at your lot or close by | Yes, it is work time (29 CFR 785.17) | Busy nights with a known window |
| Owner on call | You take the calls and the rides yourself | No payroll cost, but it is your time | One or two vans, while you test demand |
| Answering service with callback | A service or voicemail takes messages and someone calls back fast | Pay depends on who calls back | Offices that close but still get calls |

An on-call driver who keeps the van at home saves a trip to the lot. Under the Portal-to-Portal Act, commuting in the employer's vehicle, and activities incidental to that use, are not part of the driver's principal activities if the travel is within the normal commuting area and the vehicle use is covered by an agreement between you and the driver (29 U.S.C. 254(a)). Put that agreement in writing. A night call-out is different: when an employee who has gone home is called out at night to travel a substantial distance to an emergency job for a customer, the Labor Department counts all of that travel as work time (29 CFR 785.36).

Do not hand broker trips to another company to cover your night. MediTrans's operations manual for Louisiana Healthcare Connections bars providers from subletting, subcontracting, or arranging transportation for trips assigned to them unless the agreement allows it. If you cannot run a trip, give it back through the broker.

### How to set up after-hours coverage

1. **Decide the hours you can staff** every week, not just this week.
2. **Update your broker profile** with those hours, your after-hours phone, and the vehicle types you can send.
3. **Get the broker's after-hours instructions** in writing, including who to call and how approvals work.
4. **Write an on-call policy.** Set the response time, how far from base the driver may be, the phone rule, and the pay.
5. **Keep one van ready.** Fueled, inspected, and stocked with a spare wheelchair if you take discharges.
6. **Post an all-hours contact list** for incidents: your own manager and the broker's lines.
7. **Record every call-out** with the time of the call, the time the driver started, and the trip ID.

The [driver schedules guide](https://nemtguide.com/guides/nemt-driver-schedules/) shows how to build shifts around your trip counts.

## Driver pay and hours on nights and weekends

Federal law treats a night or weekend hour like any other hour. The Labor Department says the Fair Labor Standards Act does not require extra pay for night work or weekend work, and does not require pay for holidays not worked. Extra pay for those shifts is a matter of agreement between you and the driver. Overtime still applies after 40 hours in a workweek.

Three federal rules shape after-hours pay:

- **On-call time.** A driver required to stay on your premises, or so close that they cannot use the time for their own purposes, is working. A driver who only has to leave word where they can be reached is not (29 CFR 785.17). The Labor Department's Fact Sheet #22 adds that further limits on the driver's freedom could make the time paid.
- **Night differentials.** If you pay extra for night shifts, as a percent or as cents per hour, it goes into the regular rate used to figure overtime (29 CFR 778.207(b)).
- **On-call stipends.** Pay for on-call time that is work counts toward the regular rate. A payment for on-call time that is not work generally does too, unless an exclusion applies (29 CFR 778.223).

State law can add more, such as daily overtime or split-shift pay. See [NEMT driver overtime](https://nemtguide.com/guides/nemt-driver-overtime/) for the full rules and the state differences.

Watch fatigue as closely as pay. A driver who took a 10 p.m. discharge should not start the 5 a.m. dialysis run. [Rural NEMT](https://nemtguide.com/guides/rural-nemt/) covers when federal hours-of-service limits apply to NEMT and how to hold drivers to them anyway.

## Phones, incidents, and riders after dark

Someone has to answer while a van is out. MART's provider standards in Massachusetts (revised July 1, 2025) require phone coverage from 7:00 a.m. to 6:00 p.m. on weekdays plus any extra time a vehicle is still in service. They also require a 24-hour answering system that records messages and tells riders their options outside your hours. The base station must be staffed while any vehicle is in transit.

Incidents follow the same clock at night. MTM Health's Rhode Island handbook requires an immediate phone call and email to its transportation manager and vendor account manager after an accident or moving violation that injures a driver or member. If they do not answer, leave a voicemail and then call MTM's WeCare or dispatch line, and send the written report within 24 hours. MediTrans wants notice within two hours of any motor vehicle accident with members on board. Keep the [emergency plan](https://nemtguide.com/templates/nemt-emergency-plan/) and the [vehicle accident steps](https://nemtguide.com/guides/nemt-vehicle-accident/) in every van.

Respect riders' evenings too. Texas requires ride confirmations 24 hours before pickup, and never after 9 p.m. local time (UMCM 16.4, effective August 1, 2021). Make your evening calls early, and use the voicemail and callback scripts in [NEMT customer service](https://nemtguide.com/guides/nemt-customer-service/).

Bad weather adds another layer. CareOregon counts renal dialysis and chemotherapy as critical medical care that must keep running, to the extent possible, during adverse weather. It expects providers to have a backup plan for members who may be picked up very late. See the [NEMT bad weather policy guide](https://nemtguide.com/guides/nemt-bad-weather-policy/).

## Is after-hours work worth it for your company

After-hours work pays off when the demand is steady and your costs stay under control. Ask these questions before you commit:

- **Is there demand?** Ask each broker which hours, days, and counties it cannot cover. Ask the case managers at your nearest hospitals when discharges wait longest.
- **Does anyone pay more?** Check each rate sheet for an after-hours line, and price your private pay nights on their own.
- **Can you staff it every week?** An hour you list and then turn back hurts your standing more than an hour you never offered.
- **Can a scheduled shift do it?** A late shift that covers will-calls and discharges can cost less than paying someone to wait.
- **Who answers the phone?** A missed call at 9 p.m. is a missed trip and possibly a complaint.

Start with the hours closest to your day, such as Saturday dialysis and weekday evenings until 8 p.m. Add overnight coverage only when you have the trips and the drivers for it.

## Frequently asked questions

### What counts as after hours for NEMT?

Each program sets its own line. MTM Health's Rhode Island schedule treats appointment times from 5:00 p.m. to 4:59 a.m. as after hours, every day of the week. Paratransit Services' Washington site counts 5:00 p.m. to 7:59 a.m. on weekdays, plus all day on weekends and most major holidays. Kentucky's regional brokers run rides from 6 a.m. to 8 p.m. on weekdays and 8 a.m. to 1 p.m. on Saturday.

### Does Medicaid pay more for night or weekend rides?

Sometimes, and it depends on the payer. MTM Health's Rhode Island Schedule A, effective July 1, 2023, pays a $34.50 wheelchair base rate for after-hours appointments against $28.50 during business hours. Paratransit Services in Washington lets you submit a separate after-hours rate sheet. The fee-for-service schedules for Arizona (October 1, 2026) and South Dakota (July 1, 2026) have no time-of-day rate.

### Do I have to take after-hours trips?

Generally no, unless you list those hours. Brokers assign trips by the hours of operation you give them, and CareOregon's manual lists trips outside your hours as an acceptable reason to ask for reassignment. But if you keep turning back trips during hours you agreed to serve, CareOregon's brokerages can put you on a corrective action plan and change your listed hours.

### Can I give an after-hours ride before the broker approves it?

Only where the rules allow it. In Washington, when the broker is closed, a provider may give an urgent care or hospital discharge ride under the broker's after-hours instructions and request retroactive approval within two business days (WAC 182-546-5200). The broker may grant it. In Virginia, MTM Health's handbook says never to transport a member without MTM's trip ID.

### Do I have to pay drivers who are on call?

It depends on how free they are. A driver who must stay at your lot, or so close that they cannot use the time for their own purposes, is working (29 CFR 785.17). A driver who only has to answer the phone at home generally is not, though the Labor Department says added limits on their freedom can make the time paid. Time spent handling a call and running the trip is work time.

### Do I have to pay extra for night, weekend, or holiday shifts?

Not under federal law. The Labor Department says the Fair Labor Standards Act requires no extra pay for night or weekend work, and no pay for holidays not worked. Overtime after 40 hours in a workweek still applies. If you choose to pay a night differential or an on-call stipend, it goes into the regular rate used to figure overtime (29 CFR 778.207 and 778.223). State law may add more.

## Official resources

- [MTM Health: Rhode Island Schedule A rates (business hours and after hours)](https://www.mtm-inc.net/wp-content/uploads/2018/12/RI-Transportation-Provider-Rates-Schedule-A-1.pdf)
- [WAC 182-546-5200: Washington after-hours rides and retroactive approval](https://app.leg.wa.gov/wac/default.aspx?cite=182-546-5200)
- [Paratransit Services: after-hours coverage by county in western Washington](https://www.wanemt.com/after-hours)
- [U.S. Department of Labor: Fact Sheet #22, Hours Worked (on-call time)](https://www.dol.gov/agencies/whd/fact-sheets/22-flsa-hours-worked)
- [NIDDK: Hemodialysis schedules](https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis)