Evacuation Transportation Agreements in 2027: Nursing Homes, Hospitals, and Counties

When a hurricane, flood, or wildfire forces a nursing home or a coastal county to move people out, someone has to drive them. Facilities and counties line up that help in writing before the season starts. A small NEMT company with wheelchair vans can be that help, if it signs only an agreement it can keep on the worst day of the year.

Who needs an evacuation transportation agreement

Federal rules make nursing homes (42 CFR 483.73), hospitals (42 CFR 482.15), intermediate care facilities for people with intellectual disabilities (42 CFR 483.475), and PACE programs (42 CFR 460.84), among other Medicare and Medicaid providers, plan evacuation transportation. Each must have policies for safe evacuation that cover transportation, evacuation locations, and backup ways to reach outside help. Nursing homes review those policies at least once a year. Hospitals, ICF/IID homes, and PACE programs do it at least every 2 years.

Once you sign with a nursing home, its emergency rules reach you too: expect to go on its contact list and into its emergency training, and the home tests its plan with exercises at least twice a year. The nursing home transportation guide explains those duties.

CMS surveyor guidance (State Operations Manual Appendix Z, Rev. 204, April 16, 2021) says arrangements for moving patients between facilities should be in writing, such as memorandums of understanding and transfer agreements, and suggests reviewing them on the same schedule as the policies. Surveyors ask facility leadership to explain the transportation arrangements for an evacuation. The guidance also says the transportation should fit the patients: a facility that cares for patients on ventilators needs transport equipped for them.

Some states add assisted living. Texas and Florida make assisted living facilities plan evacuation transportation, as the assisted living transportation guide explains.

Counties need help too. Florida keeps a registry of people with special needs who would need help during evacuations and sheltering (section 252.355, Florida Statutes 2026). The state’s emergency management division keeps it with each county’s emergency management agency, to plan resources for the people on it. Clients of state or federally funded service programs who need help evacuating must register. Those are the riders a county will ask you to move.

What Florida and Louisiana nursing homes must show

Federal rules set the floor. Florida and Louisiana ask for more, and their rules spell out what paper a facility needs from you. The Florida state guide and Louisiana state guide cover licensing and Medicaid in each state.

Florida: agreements attached to the county plan

Florida nursing homes write a comprehensive emergency management plan to the criteria in AHCA Form 3110-6006 (April 2025), adopted by Rule 59A-4.126 (effective January 25, 2026, with a technical change on May 18, 2026). The home submits the plan to the county emergency management agency every year, and the county has the final say on it. On transportation, the criteria ask the home to:

• Name its transportation arrangements, facility-owned or contracted with a carrier, and attach the agreements in Appendix D. Agreements must be reviewed and updated annually as needed.
• Describe how transportation companies are notified of emergencies and evacuation decisions.
• Describe how records, medications, treatments, supplies, and medical equipment travel with residents.
• Explain how residents get back from the receiving facility or shelter to the home.

Each item is a question the facility will ask you. Answer it in your agreement, and the facility can attach one document instead of writing around you.

Timing matters too. Under the rule, a change to a contract or agreement in the plan that alters how the plan is carried out is a significant modification, and the home must submit it within 30 days. If you replace another carrier partway through the year, the home has a filing to make, so hand it a signed agreement it can attach right away.

Louisiana: a primary and a backup agreement

Louisiana law makes every nursing home’s emergency plan include proof of transportation or a contract with a transportation company, verified by a written agreement (R.S. 40:2009.25). The law covers nursing homes in all 64 parishes, in two lists, and each home reviews its plan by October 31 every year. The state health department sends each plan to the state fire marshal, the Governor’s Office of Homeland Security and Emergency Preparedness, the Department of Transportation and Development, the Louisiana Emergency Response Network, and the parish emergency offices for review. Each reviewer has 90 days to respond.

The licensing rule adds detail (LAC 48:I.9767, as last amended in November 2023):

• Two signed agreements. The plan holds a copy of the primary and the secondary written transportation agreements, signed and dated by all parties.
• Climate control. The vehicles that evacuate residents must have temperature controls. Vehicles owned by or at the disposal of the facility need signed and dated written usage agreements with a copy of each vehicle’s title or registration, the number and type of vehicles, the capacity of each, and statements that each has temperature controls and is in good working condition.
• Triage by color. Red residents need an advanced life support ambulance. Yellow residents cannot ride in normal vehicles and may need a basic life support ambulance, with buses, vans, or cars as a last resort. Green residents can ride in a car, van, bus, or wheelchair accessible vehicle. Green riders are the ones a NEMT company’s vans can carry.
• A nurse on large loads. Licensed nursing staff ride on any bus or vehicle carrying 15 or more residents. A BLS-certified licensed therapist or a paramedic may substitute.

State surveyors check that the agreement is signed by all parties and dated within the last 12 months, per the health department’s survey checklist (form HSS-NH-6, updated April 2021). A self-renewing agreement needs a signed and dated statement from the administrator verifying it. The checklist also asks for a list of residents triaged by transport type (ambulance with life support, ambulance, wheelchair vehicle, or regular transport), with totals that equal the current census, so expect the home to ask how many of each kind of seat you can supply.

How often each agreement is reviewed

The review cycle sets your calendar, and the main rule is simple: plan on re-signing every nursing home agreement each year.

Facility and rule	Review cycle
Nursing homes, federal (42 CFR 483.73)	At least once a year, and CMS suggests the same for agreements
Hospitals, ICF/IID, and PACE, federal	At least every 2 years
Florida nursing homes (Rule 59A-4.126)	Plan filed with the county yearly; a changed agreement within 30 days
Louisiana nursing homes (R.S. 40:2009.25)	Plan reviewed by October 31 yearly; agreement dated within 12 months

What a county evacuation contract looks like

Monroe County, Florida, shows how a county buys these rides. Its social services transportation contract for October 1, 2026 to September 30, 2027, on the county commission’s September 9, 2026 agenda, sets aside up to $65,536.70 of a $489,468.81 contract for emergency evacuation transportation. The contractor moves people on the county’s special needs registry, with a caregiver, service animals, and household pets, to staging areas and shelters.

The contract activates only after a declared local state of emergency and a request from county emergency management. Out-of-county evacuations may start 96 hours before tropical storm force winds, and in-county evacuations must finish within 24 and a half hours of them. The county can call the contractor any time between 96 and 36 hours before the winds arrive.

The county pays per passenger for each one-way trip, and the price includes a caregiver, pets, and reasonable belongings:

Evacuation trip	Price per passenger
Home to a local staging area	$26.16
Staging area to an in-county shelter	$26.16
Key Largo staging area to an out-of-county shelter	$128.83
Key West staging area to an out-of-county shelter	$373.32

A return trip is paid at the same rate as the trip out. The unit prices are all-inclusive: no separate mileage, staging, overtime, or wheelchair charge. Any trip the contract does not list needs the county’s written approval and price before it happens.

Three more clauses show what a county expects in a storm:

1. First priority. Before, during, and after an emergency, the contractor serves the county and other governments ahead of private customers, at a fair and reasonable price, and keeps a 24-hour phone number.
2. A breach penalty. Breaking the contract during an emergency recovery period costs $5,000 plus damages. Section 252.505 of the Florida Statutes requires that clause in every state or local government contract for emergency response goods or services signed, renewed, or amended on or after July 1, 2025. The recovery period runs one year from the Governor’s first declaration.
3. Insurance. $1,000,000 combined single limit auto liability covering owned, non-owned, and hired vehicles, $1,000,000 of general liability, workers’ compensation, and the county named as additional insured.

Registry records are confidential under Florida law and go only to the emergency response agencies the local emergency management director chooses (section 252.355(5)). Treat the list the county hands you the way you treat any rider record.

Who pays for evacuation rides

Three payers cover most evacuation work, and the agreement should say which one pays for each ride.

• The facility or the county. Most agreements are paid by whoever signed them, at the rates in the agreement. See how to get NEMT facility contracts for pricing facility work.
• Medicaid. CMS says NEMT is available to move a Medicaid member from a nursing facility or other medical facility a disaster made unsafe to another facility, even out of state, and states must cover it (SMD 23-006, September 28, 2023). It does not cover moves between community settings for personal reasons. If you drive for the area’s broker, ask before the season how it wants those trips booked.
• FEMA, through the county. After a declared disaster, FEMA Public Assistance reimburses eligible applicants, not you. Its guide (Version 5.0 Amended, for incidents declared on or after January 6, 2025) lists paratransit for seniors, people with disabilities, and nursing home and assisted living residents as eligible evacuation work, along with standby time for drivers and contracted vehicles waiting to transport. For-profit companies are not eligible applicants, but counties may hire them to do eligible work. Nonprofit hospitals and nursing homes can claim their own patient evacuation costs.

FEMA’s procurement rules shape a county’s contract with you. A time-and-materials contract is reimbursed only if no other type fit, it has a ceiling price the contractor exceeds at its own risk, and the county oversees it closely. FEMA does not reimburse the percentage on a cost-plus-percentage-of-cost contract. When a county skips bidding because of an emergency, FEMA covers that sole-source contract only for the work tied to the emergency and only while the emergency lasts. A contract signed before the storm is reimbursed if it was procured under federal rules, its scope covers the work, and its term covers the dates. Expect the county to check that you are not suspended or debarred, and to add federal clauses on termination, equal employment, and lobbying. The government NEMT contracts guide covers registering and bidding.

What to put in an evacuation transportation agreement

Your general facility contract covers rates, invoices, privacy, and insurance. An evacuation agreement needs terms for the day everything goes wrong at once. Build each of these into it, or into an evacuation schedule attached to your facility transportation agreement:

• Capacity by vehicle type. The number of ambulatory seats, wheelchair positions, and stretchers you commit, and how many round trips per day. Louisiana surveyors look for a count of residents by transport type, and your numbers have to cover the residents you take.
• Vehicle condition. Working heat and air conditioning in every vehicle you commit. Louisiana requires temperature controls on the vehicles that evacuate nursing home residents.
• Activation. Who may activate the agreement, how (a phone call confirmed in writing), and how many hours’ notice you need. Match the county’s or state’s timeline, such as Monroe County’s 96 to 36 hours.
• Priority among your clients. List every facility and county you have promised, in order. OIG’s November 20, 2024 nursing facility guidance tells facilities to make sure their transportation company can move residents in time during a disaster that hits a wide area. A facility that learns you promised the same vans to three others will choose another company.
• Drivers and call-back. How you reach off-duty drivers, which drivers have agreed in advance to work an evacuation, and what happens if fewer show up. Drivers evacuate their own families too.
• Fuel. Fill every tank before activation and know which stations have backup power. Power outages can close gas stations (Ready.gov, updated June 4, 2026).
• Who rides along. Which residents travel with facility staff, and how many staff seats you hold for them. CMS guidance says critically ill evacuees should travel with staff who can treat them when the transportation service has no trained medical professionals, and Louisiana puts a nurse on any vehicle with 15 or more residents.
• What travels with each rider. Records, medications, equipment, and a short health summary. Appendix Z suggests a hard copy that travels with each patient.
• Communication. A primary contact and a backup for each side, and what you use when phones fail. Appendix Z names satellite phones as an alternate way to reach evacuation help.
• Rates for storm work. Per trip or per hour, standby time, long-distance runs to the receiving facility, and return trips. If a county may claim FEMA reimbursement, avoid open-ended hourly terms without a ceiling.
• Return trips. Who books them, when, and at what rate. Florida’s planning criteria ask facilities how residents get home.
• Insurance. Limits, additional insured status, and coverage for vehicles you rent or borrow during the storm. See NEMT insurance requirements.
• Force majeure and breach. What counts as an event you cannot control, how fast you must give notice, and any penalty. Monroe County’s contract requires a force majeure claim within 72 hours of the start of the delay.
• Renewal. A signature date each year, so the facility can show surveyors a current agreement.

Write your own side of these promises into your NEMT emergency plan, and keep your rules for cancelling routine trips in your bad weather policy. Getting riders out of a stalled van is a different drill, covered in wheelchair van evacuation.

How to become an evacuation transportation provider, step by step

1. Count what you can really send. List vehicles by type and the drivers who will work a storm. Subtract what your Medicaid dialysis and other urgent riders need during the same days.
2. Start with facilities you already serve. Ask each nursing home administrator who is in its evacuation plan now, and whether it has a primary and a backup carrier.
3. Call your county emergency management office. Ask how it moves people on its special needs registry and when it next bids that work. In Florida, ask whether it runs through the county’s transportation disadvantaged or social services transportation contract.
4. Offer one page that answers the plan’s questions. Vehicles and capacity by type, activation steps, contacts, return trips, and what records travel with residents.
5. Sign before the season. The Atlantic hurricane season runs June 1 to November 30 (National Hurricane Center). Get agreements signed and dated in the spring, so they are current for the facility’s annual plan review.
6. Join the drills. Ask to take part in each facility’s exercises. Showing up builds the relationship that wins the contract.
7. Keep a ranked list and stick to it. When the call comes, serve clients in the order your agreements set, and tell anyone you cannot reach in time as early as you can.