# Hospital Discharge Transportation in 2027: How to Become the Ride Case Managers Call

Canonical URL: https://nemtguide.com/guides/hospital-discharge-transportation/ · Updated 2026-09-28

Hospital discharge transportation is the ride home, or to another facility, when a patient leaves the hospital. Case managers and social workers book it as part of the discharge plan, and Medicaid programs take these requests on short notice. To get their calls, credential with the brokers and health plans that serve the hospital, carry the right equipment, and arrive within the pickup window, often three hours.

- Hospitals must plan discharges, and CMS expects them to know the local service providers, including transportation, their patients rely on.
- Three hours is a common discharge pickup window. New York partner companies get 60 minutes.
- Original Medicare pays only for ambulances, so wheelchair and stretcher van rides for Medicare-only patients need another payer.
- Carry a spare wheelchair, know your stretcher rules, and only promise hours you can staff.
- Price hospital-paid rides by distance or a fixed rate, never per patient, and never pay staff for referrals.

A discharge ride cannot be booked a week ahead. The patient leaves when the care team says they are ready, and someone has to get them home safely that day. A company that answers those calls fast, with the right vehicle, solves a real problem for the hospital.

## How hospital discharge planning works

Every hospital that takes Medicare must run a discharge planning process under 42 CFR 482.43, last amended November 27, 2024. The rule requires the hospital to:

- **Find patients early.** Identify, early in the stay, patients likely to suffer without a discharge plan, and evaluate their needs.
- **Plan beyond medical care.** The evaluation covers non-health care services and community based care providers, and whether those services are available and the patient can get to them.
- **Plan on time.** Finish the evaluation early enough to arrange care before discharge and avoid unnecessary delays.
- **Use qualified staff.** A registered nurse, social worker, or other qualified staff develops the plan or supervises it.
- **Check its own work.** Review a sample of discharge plans, including those of patients readmitted within 30 days.

Since July 1, 2025, the hospital rule also requires written policies for transferring patients to the right level of care, with yearly staff training. Critical access hospitals follow a nearly identical discharge planning rule under 42 CFR 485.642.

CMS's guidance for hospital surveyors spells out what that means. In the State Operations Manual, Appendix A (tag A-0807, revised March 20, 2026), transportation services are named among the non-health care services a patient may need after discharge. Hospitals are expected to know the capabilities and capacities of the service providers in the area where most of their patients get care after the hospital. The hospital's evaluation includes coordination with insurers, including the state Medicaid agency. Under tag A-0806, a hospital can be cited if it does not identify patients who need discharge planning at least 48 hours before discharge and a patient's discharge is delayed as a result.

Acute care hospitals paid under Medicare's inpatient payment system also have money on the line. Since October 1, 2012, Medicare has cut payments to those hospitals when they have too many readmissions within 30 days. The program now tracks six conditions and procedures: heart attack, heart failure, pneumonia, COPD, hip or knee replacement, and bypass surgery. The cut is capped at 3 percent of base payments under the Hospital Readmissions Reduction Program, and CMS publishes each hospital's results. The surveyor guidance also notes that all patients are likely to need some follow-up care, such as a visit with their surgeon or primary care doctor.

For you, this means discharge planners must think about how each patient gets home and back for follow-up care. A company that answers fast and shows up on time makes that part of the plan work.

## Who books the ride and who pays

The hospital must start carrying out the discharge plan, including referrals to community resources that help with transportation (tag A-0808). That job falls to the staff who run discharge planning: nurses, social workers, and discharge planners. In Delaware, Modivcare does not let patients call in their own discharge rides (as of September 2026). Who pays depends on the patient's coverage:

| Patient's coverage | Who pays | What to know |
|---|---|---|
| Medicaid | The state, its broker, or the member's health plan | Discharges can be booked the same day. Modivcare in Delaware takes discharge requests 24 hours a day, 7 days a week. |
| Original Medicare only | Medicare, for an ambulance only | Medicare pays for an ambulance from a hospital to home or to the nearest capable skilled nursing facility only when any other vehicle would be unsafe (42 CFR 410.40). It does not pay for wheelchair van, stretcher van, or car rides. |
| Medicare Advantage | The plan, if it offers rides as an extra benefit | The plan must arrange or provide the rides itself (Medicare Managed Care Manual, chapter 4). |
| No program pays | The hospital, under a written agreement | The federal safe harbor has no mileage limit for rides home after an inpatient stay or at least 24 hours in observation (since January 19, 2021). |
| Private pay | The patient or family | Agree on the price before the ride. See [private pay NEMT](https://nemtguide.com/guides/private-pay-nemt/). |

The Medicare gap matters. A Medicare-only patient who needs a wheelchair van home has no Medicare benefit for that ride, so the hospital or family has to cover it. That is where a hospital agreement or a clear private pay price can win you the call. For more, see does Medicare cover NEMT and Medicare Advantage transportation.

## How fast discharge pickups must be

Discharge pickup windows are short, and many programs write them into their contracts:

| Program | Discharge rule |
|---|---|
| Texas Medicaid managed care (UMCM 16.4, August 1, 2021) | Discharge rides can be booked with less than 48 hours' notice. At least 95 percent of discharge pickups within 3 hours of the member or advocate asking for the ride. No 24-hour confirmation call needed. |
| MTM Health, Virginia fee-for-service (starting October 1, 2026, handbook approved August 10, 2026) | The vehicle arrives within 3 hours of notice that the member is ready. Missing that window brings liquidated damages. |
| Medical Answering Services, New York (manual of October 1, 2023) | Same-day discharges picked up within 3 hours of receiving the reservation |
| New York Preferred Provider Opportunity partners (policy manual, August 25, 2023) | At the hospital within 60 minutes of trip assignment |
| Modivcare, Delaware (as of September 2026) | Requests taken 24 hours a day, with a goal of a ride within 3 hours |

Notice when each clock starts. MTM Health counts from notice that the member is ready. MAS counts from when you receive the reservation, and Texas from the member's or advocate's request. So confirm the patient is truly ready before a van rolls. For the dispatch side of short-notice work, see same-day NEMT trips.

## What case managers need from you

### The right vehicle

| Patient | Vehicle | Rules to know |
|---|---|---|
| Walks, or uses a cane or walker | Sedan or ambulatory van | Confirm the patient can climb in safely after a hospital stay. |
| Sits in a wheelchair | Wheelchair van ([A0130](https://nemtguide.com/glossary/a0130/)) | MTM Health in Virginia requires wheelchair van providers that take discharges to carry a wheelchair in good condition, with a seat at least 20 inches wide. |
| Must lie flat, needs no care on the way | Stretcher van ([T2005](https://nemtguide.com/glossary/t2005/)) where your state allows and pays for it | MTM Health's Virginia standards call for a stretcher meeting GSA KKK-A-1822E, a mattress at least 3 inches thick, chest, hip, knee, and upper torso restraints, a crash tested mount, and loading headfirst. |
| Needs monitoring or care on the way | Ambulance | Medicare treats a patient as bed-confined when they cannot get up from bed without help, cannot walk, and cannot sit in a chair or wheelchair. That is one factor, not the only test. |

Stretcher pay varies widely. Arizona's fee-for-service rates effective October 1, 2026 pay $49.09 per stretcher van trip plus $1.54 a mile in the Phoenix and Tucson metro areas, and $86.70 plus $1.66 a mile elsewhere. In Illinois, a customer qualifies for an ambulance only if they cannot travel safely in a personal vehicle, taxi, or wheelchair van (HFS handbook, March 11, 2024). See NEMT vs ambulance, stretcher van requirements, and bariatric transportation for patients who need larger equipment.

### The right paperwork

- **Illinois.** Every non-emergency ambulance, wheelchair van, or service car trip from a hospital or long-term care facility needs an HFS 2270 Physician Certification Statement, completed by the hospital. A discharge planner, nurse, social worker, or caseworker may sign it. For a discharge, it is valid only for that date. If it is missing at pickup, the hospital must send it within 10 calendar days of your request, at no charge.
- **Illinois crisis program discharges.** For patients in the state's Screening, Assessment and Support Services (SASS) program, approval is required at any level of transport, and the request can go in 24 to 48 hours before discharge.
- **Delaware.** Modivcare needs a medical necessity form for wheelchair and stretcher reservations.
- **Every ride.** Log the request time, arrival time, pickup, drop-off, and the handoff at home on a [trip log](https://nemtguide.com/templates/nemt-trip-log-template/).

### The right level of help

MTM Health's trip manifests list the level of help for each ride: curb-to-curb, door-to-door, or hand-to-hand. A patient just out of the hospital may need help with steps, a door, or a transfer to a chair. MAS says a rider who cannot safely get into a closed location should go back to the pickup location. For a discharge, the pickup is the hospital, so call the case manager before you leave a patient anywhere unsafe. See door-through-door service and transporting riders with oxygen.

## How to get on a hospital's call list

1. **Credential with the programs first.** Get into the networks of the brokers and health plans that serve the hospital's patients. See [NEMT broker credentialing](https://nemtguide.com/guides/nemt-broker-credentialing/) and the [broker directory](https://nemtguide.com/brokers/).
2. **List the hospitals you can reach fast.** CMS's hospital list (updated July 2026) covers 5,419 Medicare-registered hospitals, including 3,107 acute care and 1,382 critical access hospitals, with addresses, hospital types, and phone numbers.
3. **Find the case management department.** Ask who books discharge rides, which brokers and plans their patients use most, and which rides are hardest to get: nights, weekends, stretchers, or large wheelchairs.
4. **Leave a one-page sheet.** List your service area, hours, vehicle types and counts, a phone number someone answers, your usual response time, the brokers and plans you work with, and your private pay rates. Only list hours you can staff.
5. **Ask to be named where your program allows it.** The table below shows how four programs handle a hospital's choice.
6. **Offer an agreement for rides no program pays for.** See the next section.
7. **Prove it.** Record the request time and arrival time for every discharge, and send the hospital a short report each month.
8. **Keep it clean.** Never give case managers gifts or payments for referrals. Knowingly and willfully offering anything of value to induce referrals paid by a federal health care program is a felony, with fines up to $100,000 and up to 10 years in prison (42 U.S.C. 1320a-7b(b)). Protect patient information too. See [HIPAA for NEMT providers](https://nemtguide.com/guides/hipaa-for-nemt/).

| Program | Can the hospital pick your company? |
|---|---|
| New York ([Medical Answering Services](https://nemtguide.com/brokers/medical-answering-services/)) | Yes, in a set order. MAS assigns trips first to Preferred Provider Opportunity partners, then to the member's choice, then to the medical provider's choice when it booked the ride. PPO partners cannot refuse or reassign PPO trips and must attend regular meetings with the hospital and the state. |
| Virginia fee-for-service ([MTM Health](https://nemtguide.com/brokers/mtm-health/), starting October 1, 2026) | Yes. A facility that has a designated sole source provider relationship gets its trips sent to that provider automatically. |
| Delaware ([Modivcare](https://nemtguide.com/brokers/modivcare/)) | A request only. Modivcare notes the facility's pick but may use another provider. |
| Illinois fee-for-service | Yes. Members may choose any enrolled provider with the right level of transport. Transdev, which approves the rides, uses random selection only when a member asks for help. |

### When the hospital pays you directly

A free ride home from the hospital is something of value to a patient, so the hospital will want it to fit the federal local transportation safe harbor (42 CFR 1001.952(bb)). Its main conditions:

- A written policy the hospital applies the same way to every patient, not tied to how much business the patient brings
- Rides only for the hospital's established patients, to get medically necessary care
- No air, luxury, or ambulance-level rides
- The hospital does not advertise the rides, and nobody markets health services during a ride
- Drivers and anyone arranging the rides are not paid per patient carried
- Rides within 25 miles, or 75 miles for rural patients, with no mileage limit for a patient going home after an inpatient stay or at least 24 hours in observation
- The hospital pays the cost and does not shift it to Medicare, Medicaid, other payers, or the patient

The pay rule shapes your price. When OIG created the safe harbor in 2016, it said a provider hiring a transport company cannot pay it per patient carried, but may pay based on the total distance the vehicle travels. It also agreed with a commenter that pay on a mileage or other fixed-rate basis works (81 FR 88387). Price hospital-paid runs by distance or at a fixed rate, and ask the hospital's compliance office to approve the terms. Put them in writing with the facility transportation agreement template, and see [NEMT facility contracts](https://nemtguide.com/guides/how-to-get-nemt-facility-contracts/).

## How to run discharge rides day to day

1. **Keep capacity open.** MTM Health's Virginia handbook expects providers to keep enough vehicles and drivers to respond to short-notice trips, and it assigns an urgent trip only with the provider's okay. Hold a van and driver free during the hours your hospitals discharge most.
2. **Confirm the patient is ready.** Before the van leaves, ask the nurse or case manager whether the discharge order is signed and the patient is dressed and packed.
3. **Check the ride details.** Confirm the mobility device, any oxygen, bags and belongings, who will be home, the steps at the home, and how the patient will get in.
4. **Bring what the patient lacks.** Carry a spare wheelchair, a blanket, and the right securement for the patient's chair. See [wheelchair securement](https://nemtguide.com/guides/wheelchair-securement/).
5. **Report delays right away.** MTM Health requires providers to tell the members or facilities affected, and MTM Health itself, about any delay.
6. **Hand off, then document.** See the patient inside, or into the care of whoever is home, before you leave. Log the handoff time and who received the patient.
7. **Offer the follow-up ride.** Most discharged patients need a follow-up visit. Ask the case manager to book it through the broker or plan and to name your company where the program allows it, so the patient rides with a driver they already know.

## Frequently asked questions

### Who pays for a ride home from the hospital?

It depends on the patient's coverage. Medicaid pays through the state, its broker, or the member's health plan. Original Medicare pays only for an ambulance, and only when any other vehicle would be unsafe. A Medicare Advantage plan pays if it offers rides as an extra benefit. Otherwise the hospital or the family pays you directly, so agree on the payer and the price before the ride.

### How fast do I have to pick up a hospital discharge?

Often within three hours. Texas Medicaid managed care wants 95 percent of discharge pickups within 3 hours of the call. MTM Health's Virginia handbook (approved August 10, 2026) requires arrival within 3 hours of notice that the member is ready, and Medical Answering Services in New York sets 3 hours for same-day discharges. New York partner companies in a Preferred Provider Opportunity must reach the hospital within 60 minutes of trip assignment.

### Can a hospital choose my company for its discharge rides?

Sometimes. In New York, Medical Answering Services sends trips first to partner companies and then to the company a medical provider picks when it books the ride. MTM Health's Virginia program, which starts October 1, 2026, sends a facility's trips to its designated sole source provider. Modivcare in Delaware treats a hospital's pick as a request only. For rides no program pays for, the hospital can hire you directly.

### Does Medicare pay for a wheelchair van home from the hospital?

No. Original Medicare pays for ground transportation only by ambulance, and only when any other vehicle would be unsafe for the patient (42 CFR 410.40). A wheelchair van or stretcher van ride for a Medicare-only patient is paid by the hospital, the family, or a Medicare Advantage plan that offers rides.

### Do I need a stretcher van to do hospital discharges?

Not to start. You can take ambulatory and wheelchair discharges first, and MTM Health in Virginia requires wheelchair van providers that take discharges to carry a spare wheelchair. A stretcher van serves patients who must lie flat but need no medical care on the way. Your state must allow and pay for stretcher vans, and the equipment rules are strict. Patients who need monitoring go by ambulance.

### Can I give case managers gifts to get more discharge rides?

No. Knowingly and willfully offering anything of value to induce referrals of patients whose rides a federal health care program pays for is a felony under 42 U.S.C. 1320a-7b(b), with fines up to $100,000 and up to 10 years in prison. Medical Answering Services says offering anything of value to a medical provider to steer trips is illegal. Earn the calls with fast, reliable pickups.

## Official resources

- [eCFR: 42 CFR 482.43, Hospital discharge planning](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-482/subpart-C/section-482.43)
- [CMS Provider Data Catalog: Hospital General Information (every Medicare hospital, with phone numbers)](https://data.cms.gov/provider-data/dataset/xubh-q36u)
- [CMS Provider Data Catalog: Hospital Readmissions Reduction Program results by hospital](https://data.cms.gov/provider-data/dataset/9n3s-kdb3)
- [eCFR: 42 CFR 1001.952(bb), Local transportation safe harbor](https://www.ecfr.gov/current/title-42/section-1001.952)
- [Medicare.gov: Ambulance services coverage](https://www.medicare.gov/coverage/ambulance-services)
- [Texas HHSC: Uniform Managed Care Manual (chapter 16.4, NEMT)](https://www.hhs.texas.gov/services/health/medicaid-chip/managed-care-contract-management/texas-medicaid-chip-uniform-managed-care-manual)