How to Improve NEMT On-Time Performance in 2027: What Brokers Measure and What to Fix First

On-time performance is the share of your trips that reach riders when the broker says they should. It is the first metric in the performance tables of MTM Health’s Virginia and Rhode Island provider handbooks, and a handful of late trips a week can put a small company under the line.

This guide covers how brokers count it, the targets they set, how to work out your own rate, and the fixes that move it. The fixes come in the order lateness happens, starting the day before.

How brokers measure on-time performance

Most broker handbooks draw a window around the scheduled pickup time. A driver who arrives inside it is on time. Here is how seven programs define it.

Program	A pickup is on time when	Also scored or required
MTM Health, Virginia (August 10, 2026)	The driver arrives 15 minutes before to 15 minutes after the scheduled pickup, on the first leg	Drop-off no later than the appointment time
MTM Health, Rhode Island (July 1, 2026)	It is within 15 minutes of the stated time	Will-call van within 45 minutes
Georgia Medicaid (July 1, 2026)	It is within 15 minutes of the stated pickup time	Return within 1 hour of the call
MAS, New York (October 1, 2023)	It is at the scheduled time or up to 15 minutes before or after. Later is a late pickup.	Return within 1 hour of the ready call
Modivcare, Kansas and Oklahoma (September 2026)	The van arrives 15 minutes before to 15 minutes after the pickup time	Return within 60 minutes of the call
Texas Medicaid health plans (August 1, 2021)	Scored at the appointment: arrival at least 15 minutes and no more than 1 hour early	Return within 1 hour of the request
MediTrans, Louisiana (September 2026)	The driver arrives inside the pickup window	Dialysis, chemotherapy, and surgery trips must not be late

Four details decide your score.

• Which leg counts. Virginia’s window applies only to the first pickup of the trip, not to the drop-off. The rider must still be dropped off no later than the appointment time. A van inside the pickup window can still deliver a rider late.
• Which clock counts. Windows run from the scheduled time, not from when the driver shows up. In Virginia, Rhode Island, Georgia, and New York, a rider never has to board before the scheduled time. CareOregon bars picking a member up early unless the member chooses.
• Which record counts. MTM Health’s Virginia handbook requires location tracking on every trip, active for the whole ride, to capture arrivals, pickups, and drop-offs. Its trip log carries the scheduled pickup time, actual pickup time, departure time, and arrival time. MediTrans asks drivers to mark En Route and Arrived in its portal. If tracking is off, or a driver taps Arrived late, an on-time pickup can look late.
• Which trips are excused. CareOregon’s manual (February 2024) says that when the brokerage asks you to take a same-day trip that is already late, the pickup time stays the same but you are not penalized, and the brokerage records that the trip was assigned late. Ask each broker which trips it leaves out of your score and how to dispute one.

See pickup window for how windows work in more programs.

The targets, and what missing them costs

Program	Standard	If you miss it
MTM Health, Virginia (August 10, 2026)	On time above 95 percent	A performance improvement plan, liquidated damages, or removal from the network
MTM Health, Rhode Island (July 1, 2026)	Late trips under 4.99 percent is green, 5 to 6.99 percent is yellow, 7 percent or more is red	A performance improvement plan, liquidated damages, or removal from the network
CareOregon (February 2024)	No chronic or unexcused lateness	Suspension or termination, including over complaints of arrivals more than 30 minutes after a return request or scheduled return time

MediTrans in Louisiana (September 2026) expects 95 percent or more of trips on time, alongside 98 percent or more completed, complaints on under 2 percent of trips, and provider no-shows under 1 percent.

Brokers are graded too, and their targets reach you through your agreement. Rhode Island’s contract with MTM Health (effective July 1, 2025) says no more than 4 percent of trips should be late or missed in a month. In any month above that, MTM must send the state a root cause analysis and a corrective action plan. The contract also requires its pickup standards to be written into every transportation provider agreement.

Texas holds its Medicaid health plans to four delivery standards in its NEMT handbook (effective August 1, 2021):

Texas standard	Target
Accepted trips completed, not counting member cancellations and no-shows	99 percent
Members arriving at least 15 minutes and no more than 1 hour before the appointment	95 percent
Return trips picked up within 1 hour of the request	95 percent
Hospital discharges picked up within 3 hours of the request	95 percent

Riders notice. Wisconsin’s statewide report counted 92 substantiated complaints about timeliness in May 2026, up from 57 in January, and 197 where no vehicle could be found or the provider never arrived. In Philadelphia County, timeliness grew from 8.96 percent of consumer complaints in 2023 to 19.12 percent in 2025, according to Pennsylvania’s broker study (June 25, 2026). CMS says states have ultimate responsibility to make sure transportation is timely (SMD 23-006, September 28, 2023).

The Virginia on-time bonus

MTM Health pays for good timing in Virginia. Its On-Time Performance Incentive runs each calendar quarter. Providers at 95 percent or higher share a pool made up of the liquidated damages collected across the network. Shares are weighted by trip volume, and higher on-time results earn a larger share. The handbook’s example weights providers at 96.2, 98.6, and 100 percent on time at 1.0, 1.25, and 1.5 times their share of trips. Providers under 95 percent get nothing from the pool.

For every metric brokers grade, not just timing, see NEMT broker scorecards and broker penalties.

How to work out your own on-time rate

Keep your own count. It shows a problem before the broker’s monthly report does.

On-time rate = on-time pickups ÷ pickups counted × 100

Count each first-leg pickup against the broker’s window, using the same arrival times the broker sees. Count drop-offs after the appointment time and returns outside the will-call window as separate numbers.

Small fleets feel each late trip. Here is an example with hypothetical counts:

Pickups in the month	Late pickups	On-time rate	Late pickups allowed at 95 percent	Each late pickup costs
200	12	94.0 percent	10	0.5 points
400	22	94.5 percent	20	0.25 points
800	36	95.5 percent	40	0.125 points

Rhode Island scores it the other way, as the share of trips that were late, so lower is better. The 400-pickup example above is 5.5 percent late, which falls in Rhode Island’s yellow band.

Then split the late pickups to find where they come from:

Split late pickups by	What it tells you
Driver	Whether lateness follows one person or the whole fleet
Hour of the day	Whether first runs, the midday return rush, or rush hour are the problem
First leg or later leg	Whether runs start late or lose time as the day goes on
Facility or address	Which clinics and homes cost the most time at the door
Reason logged	Traffic, rider not ready, a late assignment, a breakdown, or a tight schedule

The NEMT KPIs guide shows how on-time rate fits with the other weekly numbers.

Why NEMT trips run late

Lateness starts in one of a few places. Knowing where tells you which fix to use.

Where it starts	What goes wrong	Fix
The schedule	A pickup time too tight for the drive at that hour	1
The schedule	No room between legs for boarding and a full wait at the last door	1
The morning	The first van leaves late, or a van fails its inspection	2
Midday	Will-call returns and discharges bunch up	3
On the road	Traffic, a detour, or a breakdown	4
At the door	The rider is not ready, or the entrance is hard to find	5
The records	Tracking is off, or Arrived is tapped late	6

The fixes, in order

Work from the top. A late first pickup can make every later leg on that run late, so the earliest fixes do the most.

1. Schedule pickups you can make

This fix happens the afternoon before, while there is still time to change the plan.

• Work back from the appointment. Pickup time is the appointment time minus the arrival cushion, the drive time at that hour, and boarding time. NEMT scheduling walks through the method.
• Leave slack between legs. Each gap needs the drive to the next pickup, boarding time, and the full wait the payer allows at the last door: up to 10 minutes in Georgia and Rhode Island, at least 15 in New York and CareOregon’s network, and 20 at a facility with MediTrans.
• Check the broker’s times the day before. If a pickup time on the manifest cannot be made, call the broker then. CareOregon and MAS do not let you change it yourself.
• Accept only trips you can run on time. MediTrans tells providers to accept trips they can complete on time and to decline within 30 minutes if they cannot.
• Keep shared rides inside the ride-time limit. Extra time on board is capped at 45 minutes over the average direct trip in Virginia, Rhode Island, and Georgia, and one hour in Texas.

2. Protect the first run of the day

• Inspect vans before the first pickup time, with time left to swap a van that fails. Use the vehicle inspection checklist.
• Fuel and charge the night before. A stop for gas at 6 a.m. makes the first pickup late.
• Check in every driver at a set time, and name a backup driver and van for a sick call or breakdown.
• Send the first van out to arrive at the start of the window. The rider does not have to board early, but you start the day with minutes in hand.

3. Hold room for will-calls and discharges

Returns have their own clocks: 45 minutes from the call with MTM Health in Virginia and Rhode Island, one hour in Georgia, Texas, and New York, and 60 minutes with Modivcare in Kansas and Oklahoma. Discharges often allow three hours, and Virginia charges liquidated damages when a discharge pickup takes longer.

When returns crowd the afternoon, morning vans get pulled off their runs. Keep a van free near the busiest clinics at the hours they usually call, from your own records. See managing will-call trips and will-call trip.

4. Have dispatch watch the next hour

Late trips get worse the longer nobody acts. Every half hour, dispatch checks each van against its next two pickups. MediTrans tells drivers to call dispatch before they miss the pickup window, not after.

When a van will be late:

1. Call the rider or facility with a new arrival time. Virginia, Rhode Island, and Georgia require it.
2. Tell the broker. Texas requires drivers to report a late arrival right away, so the health care provider can confirm it can still see the member.
3. Move the trip to a van that can make it, or ask the broker to reassign it.

Brokers step in at set points. Georgia’s manual counts a vehicle 20 minutes late as excessively late, and its broker must have a backup in place within 30 minutes. Texas uses more than 30 minutes past the pickup time, or 30 minutes after the call for a return ride. A call at 10 minutes late gives the broker time to act. The late driver playbook covers who to call first, and NEMT dispatch covers the rest of the dispatcher’s day.

5. Build driver habits at every stop

• Arrive at the start of the window, not the middle of it.
• Tell the rider you are outside. Rhode Island asks drivers to call or text if the member is not ready, and Kansas and Oklahoma members are asked to be ready 15 minutes before pickup.
• Learn each regular address: the right door, the gate code, and where to park safely. Virginia requires parking where riders can reach the entrance without crossing the street when possible.
• Practice securement until it is quick and right every time.
• Follow the wait rule exactly, then the no-show steps. In Virginia, a member not ready within the window is documented as a no-show after the driver tries to reach them by phone or text. See how to reduce NEMT no-shows.
• Never speed to make a window. Virginia’s handbook says safety must never be compromised to meet schedules. It also bars phone use while driving, except with a Bluetooth headset, so send changes before the van pulls out.

6. Keep records that show the truth

• Keep location tracking on for every trip. Virginia scores GPS compliance above 90.01 percent. Rhode Island marks it red below 75 percent.
• Mark Arrived at the door, not down the street or after the rider boards.
• Log a reason for every late pickup, such as traffic, a late assignment, or a rider not ready.
• Check the broker’s monthly numbers against your own. In Virginia a field monitor, and in Rhode Island a vendor account manager, reviews each metric with you regularly. Bring your records to that meeting and dispute errors.

7. Review the numbers every week

Pick one hour each week and go through the splits from the table above. Then change one thing:

• One driver is late often: ride along or retrain before it becomes a complaint.
• First runs are late: move the start time or the inspection earlier.
• Midday is late: hold a van for will-calls, or accept fewer midday trips.
• One clinic is always slow: add minutes to every pickup there, or ask the broker to adjust the times.
• Late assignments pile up: raise them with your broker contact with dates and trip numbers.

Late trip, turnback, or missed trip

Sometimes you can see a day ahead that a trip will not fit. Broker scorecards count each outcome, so choose knowingly.

Outcome	How brokers score it
On time	Counts toward the 95 percent
Turned back before the deadline	Virginia holds turnbacks under 0.5 percent. Rhode Island’s green level is under 3.99 percent, with turnbacks due 24 hours before the appointment and none on the same day.
Late	Counts against your on-time rate. Report it early so the broker can act.
Provider no-show	Virginia holds these under 0.25 percent. Rhode Island’s green level is under 0.29 percent. CMS says federal Medicaid funds do not pay for a provider no-show.

A turnback made in time lets the broker place the trip with another provider. A provider no-show leaves a rider without a ride to care. Never let a trip reach the day of service without a van assigned.