Behavioral Health Transportation in 2027: Secure Ride Rules, Crew Training, and Who Pays

Rides to behavioral health care are part of ordinary Medicaid NEMT. Members ride to counseling, psychiatric visits, day programs, and substance use treatment. Other riders are in crisis and need a secure ride, for example from an emergency department to a psychiatric unit, and that work runs under its own rules in the states that pay for it.

What behavioral health transportation covers

CMS set the federal starting point in its Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023). States must consider a member’s behavioral health needs when they pick the ride. CMS also encourages states to cover rides tailored to these riders, and says a state may require the providers who give them to be trained and credentialed for behavioral health needs.

That splits the work into two kinds of rides.

	Routine behavioral health rides	Secure or crisis rides
Who rides	Members going to therapy, psychiatric visits, day programs, or substance use treatment	People in a mental health or substance use crisis who may harm themselves or others
Who books	The member, a case manager, or a standing order through the broker	A crisis team, emergency department, peace officer, county official, or magistrate
Vehicle	Any vehicle that fits the member’s level of service	A secured vehicle, usually partitioned, under a state or county license or approval
Crew	Your regular drivers	Staff trained in de-escalation, and in restraint where the state allows it
Paid by	Medicaid NEMT, through the state, broker, or health plan	A separate Medicaid benefit, a county, a state agency, or a hospital

Federal rules mention secured rides too. The NEMT brokerage rule lists “secured transportation containing an occupant protection system that addresses safety needs of disabled or special needs individuals” among the services a broker may arrange (42 CFR 440.170(a)(4)). The national provider taxonomy code 343800000X, Secured Medical Transport (VAN), describes vehicles “specially equipped to provide enhanced safety, security and passenger restraint,” staffed by people “trained to work with patients in crisis situations.” If you add secure rides, add that code to your NPI record, and check your state’s list for the code it expects. See NEMT taxonomy codes.

Watch the names

States use different words for secure rides, and one uses the word for something else entirely.

State	Its term	What it means
Colorado	Secure transportation	Urgent rides for people in a behavioral health crisis, licensed by counties
Oregon	Secured transport	Involuntary rides for members in danger of harming themselves or others, by providers the state approves
Minnesota	Protected transport	One of seven NEMT modes, in a vehicle with a partition, safety locks, and a video recorder
Virginia	Alternative transportation	Custody and transport of people under a temporary detention order by someone other than police, most often a contractor of the state behavioral health agency
South Dakota	Secure medical transportation	Wheelchair and stretcher van rides. It has nothing to do with behavioral health.

South Dakota’s manual, updated August 2026, limits secure medical transportation to recipients confined to a wheelchair or needing a stretcher. Read the definition in your state’s manual before you assume what a word means.

Routine behavioral health rides: how they work and how they are paid

Routine behavioral health trips are ordinary NEMT trips. They use the same codes, rates, and trip logs as a ride to a primary care doctor. MTM Health’s Virginia handbook, approved August 10, 2026, lists behavioral health and substance use treatment among the trip types it covers. It adds that many fee-for-service trips are recurring, such as daily or weekly rides to day support.

Two parts of this work need extra planning.

• Daily treatment rides. Louisiana’s Medicaid manual, in sections issued July 14, 2025, counts opioid treatment program visits as urgent transportation the broker may not deny for short notice. It also requires the broker to cover rides to any opioid treatment location, not only the clinic a member is linked to. See NEMT methadone rides for scheduling and records.
• Attendants and service changes. Louisiana lets the broker require an attendant for behavioral disorders or a risk of elopement. An employee of a mental health facility may serve as that attendant when the member is a danger to themselves or others or at risk of elopement. In Oregon, CareOregon’s February 2024 manual says a brokerage may modify a member’s service after a safety threat, for example by assigning a specific provider or requiring an attendant. It may not deny the ride.

Your drivers will meet riders who are anxious, confused, or upset. That calls for calm handling and clear reporting, not force. See handling difficult or unsafe riders for de-escalation steps and when a driver may end a ride.

Secure transport rules in five states

Where a state pays for secure rides, it licenses or approves the provider first. These five show the range.

State	Who approves you	How long it lasts	Restraint	Who pays
Colorado	The county where your service is based	License 3 years, vehicle permits 1 year	Class A may use physical restraint. Class B may not. No chemical restraint.	Health First Colorado, through its Regional Accountable Entities
Oregon	Oregon Health Authority, with county director letters	2 years	Mechanical restraint in emergencies only	The member’s CCO, or the brokerage for fee-for-service members
Minnesota	Certification as a protected transport provider, with MnDOT checking the vehicle	Yearly vehicle inspection	Not set in the statute	Medicaid fee-for-service, $75 a trip plus $2.40 a mile
Virginia	A contract with the Department of Behavioral Health and Developmental Services	Contract term	Allowed for trained contractors when less restrictive steps fail	The state agency
Florida	A county contract under its transportation plan	A yearly contract	Not set in the statute	The county, which then seeks repayment from the rider’s insurance

Colorado

Colorado’s secure transportation rules, 6 CCR 1011-4, took effect August 14, 2022. Each county licenses the services based in it and may add its own requirements. The license lasts three years and cannot be sold or transferred. Every vehicle needs its own permit, renewed each year after an inspection. A Type 1 permit covers a vehicle with a safety partition between the driver and the rider. A Type 2 permit covers a vehicle without one.

Staffing depends on the vehicle. In a Type 1 vehicle carrying one client, one trained staff member is enough, and that person may be the driver. A Type 2 vehicle carrying one client needs two staff, and the one who is not driving must hold every required training. With more than one client, each client gets one trained staff member. In a Type 1 vehicle, one of them may be the driver. In a Type 2 vehicle, the driver does not count toward that ratio.

Health First Colorado covers these rides under 10 CCR 2505-10, section 8.019, in the version effective July 10, 2026. A member qualifies when in a behavioral health crisis, as established by an intervening professional, a crisis professional, an independent professional person, a certified peace officer, or an EMS provider. The benefit covers rides from the community to a facility for evaluation, to an approved treatment facility or walk-in crisis center, and between facilities when a client moves to a higher or lower level of care. The rule requires no prior authorization. Rides by law enforcement are not covered.

Since July 1, 2025, the state’s Regional Accountable Entities (RAEs) pay for these rides as part of their capitation, so you must contract with the RAEs to be paid. You also enroll with Health First Colorado as provider type 97, Behavioral Health Secure Transportation, specialty 773, once your county license and vehicle permits are in hand. A state law effective August 12, 2026 (HB26-1063) requires the Medicaid agency and the Behavioral Health Administration to publish lists of contracted secure transportation providers with a working phone number or website. See the Colorado state guide for enrollment.

Oregon

Oregon approves secure transport providers under OAR 309-033-0432. You send the Oregon Health Authority a letter of application. The director of the county where you are located writes to the county’s governing body naming you, and the county where you will work sends a letter of recommendation. Approval lasts two years, under rules last amended December 20, 2022. To carry anyone to a Psychiatric Emergency Services facility, you also need an ambulance license.

The Oregon Health Plan pays secured transports through each member’s coordinated care organization (OAR 410-141-3940) and through the brokerage for fee-for-service members (OAR 410-136-3120, effective January 1, 2024). The ride must go to a Medicaid-enrolled facility that can treat the member’s crisis. One extra attendant may ride at no extra charge when medically appropriate. Rides home are assumed not to need security unless the treating professional documents why they do. CareOregon’s February 2024 manual adds one exception of its own: a member who is not on a hold may ride secure with informed consent and a written statement from the treating professional. See the Oregon state guide.

Minnesota

Minnesota Statutes 256B.0625, subdivision 17, makes protected transport one of seven Medicaid NEMT modes. It is for a client whose prescreening found other rides inappropriate. The vehicle cannot be an ambulance or police car, and it needs safety locks, a video recorder, and a clear thermoplastic partition between rider and driver. The provider must be certified as a protected transport provider, and MnDOT checks those features at its vehicle inspections (Minnesota Statutes 174.30). A protected transport provider may also carry a patient under civil commitment to treatment (253B.10, subdivision 2).

The statute’s fee-for-service rates pay protected transport more than any other mode:

Mode	Base rate	Per mile
Assisted transport	$14.30	$1.43
Lift-equipped or ramp transport	$19.80	$1.70
Stretcher transport	$60.00	$2.40
Protected transport	$75.00	$2.40

A 20-mile protected ride pays $75.00 plus $48.00, or $123.00, before the fuel adjustment and any rural add-on. The statute’s rates were set to expire July 1, 2026 for fee-for-service. A law signed May 27, 2026 (Laws 2026, chapter 121) keeps them until the state’s new NEMT administrator starts, and the state must give counties and health plans six months’ notice first. Location matters too: as of September 2026, the Department of Human Services is not enrolling new NEMT providers based in the seven-county Twin Cities metro area until January 27, 2027. See the Minnesota state guide.

Virginia

Virginia pays for crisis rides through its Department of Behavioral Health and Developmental Services (DBHDS), not Medicaid NEMT. Under Code of Virginia 37.2-810, a magistrate can name an alternative transportation provider in a temporary detention order. Police then hand custody to that provider, which keeps custody until the facility takes the person. A provider counts as available if it can take custody within six hours of the order, and the law treats DBHDS contractors and hospital employees as able to transport safely. A contractor’s staff who complete DBHDS-approved restraint training may use restraint only when it is needed for safety or to prevent escape, and only when less restrictive steps have not worked.

The work runs through large contracts. DBHDS reported a base budget of $18,673,707 for fiscal year 2026, including a $14.1 million contract with one private security company for custody and transport in two of its regions. In the same January 2026 summary, it asked for $15 million more for fiscal year 2027 to expand statewide. DBHDS also says a provider can take custody only if it can also do the transport.

Florida

Florida Statutes 394.462 requires each county to adopt a transportation plan for people taken for involuntary examination or admission, and the plan may rely on private transport companies. The designated police agency may decline a transport only if the county has a yearly contract with a transport company and both agree police do not need to be present. A contracted company must carry at least $100,000 in liability insurance for patient transport. The county seeks payment first from the rider’s insurance. Contracted companies also get preference for transports from nursing homes, assisted living facilities, and adult day care centers.

What a secure transport vehicle needs

Vehicle rules are specific, and they differ by state. Build or buy to the strictest rule you will work under.

Feature	Colorado	Oregon	Minnesota
Driver separation	Permanent safety partition in a Type 1 vehicle, plus one for any cargo area	Secured rear seat behind a safety shield	Clear thermoplastic partition
Rider area	Four doors, child and window safety locks, ligature risk reduction, and nothing loose that could cause harm	No inside locks or door handles, washable and unbreakable, guarded windows	Safety locks
Watching the rider	GPS tracking, and a mirror or another way to see the client	A cell phone or other device for use in transit	Video recorder
Restraints	Soft non-metal restraints and a spit or bite guard, if you restrain	Wrist and ankle restraints, preferably soft	Not listed
Other equipment	First aid kit, fire extinguisher, two-way communication, biohazard bag, protective equipment, service area map, and an AED if you restrain	Flashlight, first aid kit with gloves, traction devices when needed	The equipment Minnesota requires of every special transportation service
Inspection	Yearly, by the county	No set schedule in the rule. Approval is renewed every 2 years.	Yearly, by MnDOT

If you record video inside the van, protect the footage the way you protect trip records. Colorado also gives riders the right to be told about any video or audio recording. See NEMT dash cameras for state camera rules and HIPAA for NEMT for storage.

Crew training for behavioral health rides

In Colorado and Oregon, every secure crew member trains before the first ride or soon after hire, and again each year.

Who	Required training	How often
Colorado, all staff with client contact	Cultural competency, verbal de-escalation, trauma-informed care, evade and escape strategies, internal policies, client rights, and privacy law, including the federal rules for substance use treatment records (42 CFR Part 2)	Before the first ride, then yearly or as the training organization recommends
Colorado, staff who support clients	Also adult and youth mental health first aid, basic first aid and CPR, and care of clients with substance use disorders	Before the first ride, then yearly or as the training organization recommends
Colorado, Class A staff	Also when restraint is allowed and how to apply it safely	Before the first ride, then yearly or as the training organization recommends
Oregon, staff who carry people in custody or on diversion	Four hours on supportive interaction, redirection, de-escalation, managing aggressive behavior, and proper use of mechanical restraint, plus job duties, policies, infection control, and abuse reporting	Every year
Oregon, same staff	Current first aid and CPR, and a nationally recognized safe driving course	First aid and CPR kept current. Safe driving within 90 days of hire.
Virginia, contractors who restrain	Restraint training approved by DBHDS	As DBHDS requires

Oregon also bars staff from using threats, intimidation, coercion, or the display of batons, mace, or weapons to gain compliance. Both states require background checks and quick reports when a rider is hurt. Colorado wants a report to the county within 24 hours of a serious injury or a restraint injury, and Oregon wants immediate written notice of any injury from mechanical restraint.

For routine rides, your standard driver training is the base. Add de-escalation and mandatory reporting, and write down what a driver does when a rider becomes unsafe. See the NEMT driver training plan.

When a behavioral health rider needs an ambulance

Secure vans are not ambulances. Colorado allows a secure ride only when the client needs no medical treatment or ongoing monitoring on the way, and any client who needs chemical restraint must go by ambulance. Louisiana’s manual covers emergency ambulance transport for a rider who is psychiatrically unmanageable or needs restraint. Oregon requires an ambulance license for secure rides into a Psychiatric Emergency Services facility.

Hospital transfers add a federal rule. Under EMTALA, an emergency medical condition includes “psychiatric disturbances and/or symptoms of substance abuse.” When an emergency department transfers a patient whose condition is not stabilized, the transfer must use “qualified personnel and transportation equipment” (42 CFR 489.24). That duty sits with the sending hospital, so let it choose the mode for these transfers, and write down who chose it. See NEMT vs ambulance for where the line falls on other rides.

Who pays for behavioral health rides

Payer	What it buys	How you get the work
Medicaid NEMT, through the state, broker, or health plan	Routine rides to behavioral health and substance use treatment	Your existing broker or plan contract
A state Medicaid secure benefit	Secure rides in Colorado, secured transports in Oregon, protected transport in Minnesota	A county license or state approval, then Medicaid enrollment and a contract with the plan, RAE, or brokerage
A county	Rides under the county’s transportation plan, as in Florida	A county contract, often yearly
A state behavioral health agency	Custody and transport under detention orders, as in Virginia	A state procurement
Hospitals, crisis centers, and treatment facilities	Transfers and discharges the facility pays for	A facility contract

Emergency departments and psychiatric units also discharge patients who need a calm, reliable ride that is not a secure one. See hospital discharge transportation and NEMT facility contracts.

How to add behavioral health rides to your company

1. Read your state’s rule. Search your state Medicaid manual and administrative code for “secure transport,” “protected transport,” and “alternative transportation.” If there is no such rule, ask your Medicaid agency and county behavioral health office how crisis rides run today before you spend money.
2. Choose routine, secure, or both. Routine rides need only your current enrollment. Secure rides need a license or approval, a converted vehicle, and a trained crew.
3. Get approved before you advertise. Colorado requires a county license and a permit for each vehicle. Oregon requires the Oregon Health Authority’s certificate. Oregon also requires providers who carry minors to state in their advertising that the Oregon Health Authority authorizes them.
4. Build or buy the vehicle to code. Match the partition, locks, window guards, and equipment your state lists.
5. Train every crew member first. Keep dated certificates and rosters, because Colorado counties can ask to see them.
6. Write the policies. Cover client rights, restraint and its documentation, complaints, abuse reporting, and privacy for substance use treatment records.
7. Check your insurance. Colorado requires general liability of at least $1,000,000 per claim and $3,000,000 for all claims, and Florida sets $100,000 in liability for county transport contracts. Ask your agent to confirm in writing that your auto and general liability policies cover secure rides and restraint. See NEMT insurance requirements.
8. Enroll and add the taxonomy code. Add 343800000X to your NPI record, then enroll or amend your Medicaid, plan, or brokerage contract for the new service.
9. Meet the people who call for rides. Emergency department case managers, crisis centers, county behavioral health directors, and the plans that pay for secure rides decide who gets the work.