# NEMT Bad Weather Policy in 2027: When to Cancel, Who Rides First, and How to Tell Riders

Canonical URL: https://nemtguide.com/guides/nemt-bad-weather-policy/ · Updated 2026-09-29

A NEMT bad weather policy says who makes the go or no-go call, which weather alerts slow or stop your trips, which riders go first, and how fast you tell the broker and each rider. MTM Health's standard agreement requires immediate notice to the rider and MTM when weather makes a trip unsafe. CareOregon requires a written weather policy and wants dialysis and chemotherapy rides kept running wherever possible.

- Tie your go or no-go levels to National Weather Service alert names, and name one person who makes the call each morning.
- Keep dialysis and chemotherapy rides running as long as roads allow, and know each center's storm plan before the season starts.
- Tell the broker the moment you know a trip cannot run. Late turnbacks count against you, early ones usually do not.
- Call every affected rider and facility with a new time or a clear cancellation, and never leave a rider waiting outside in heat or cold.
- A trip weather cancels is not billable, so record the reason and ask the broker to code it as weather.

A storm day tests every part of a small NEMT company at once. Roads get worse by the hour, riders still need dialysis, the broker's phone lines are jammed, and your drivers want to know if they should leave home. A written weather policy settles those calls before the forecast turns, so no one has to guess at 5 a.m.

## What a NEMT bad weather policy has to cover

Most weather rules come from your broker contracts, and some brokers ask to see your policy. CareOregon, which administers ride benefits for three Oregon coordinated care organizations, defines adverse weather as weather that may limit transportation, including extreme heat, extreme cold, flooding, tornado warnings, heavy snowfall, and icy roads (manual version 1.3, February 2024). Its providers must keep written policies for adverse weather and disasters that cover staff training, how people are notified, and member education, and hand over copies on request.

These are the clearest written rules as of September 2026:

| Broker or program | What it requires in bad weather |
|---|---|
| MTM Health standard agreement (January 1, 2023 version Pennsylvania posts) | If a trip cannot run because of unsafe driving conditions, notify the member and MTM of the cancellation immediately (section 2.EE). Report significant delays right away and make other plans if the appointment can still be kept (2.DD). |
| MTM Health, Virginia (handbook, May 2026) | Contact affected members or facilities with a new arrival time and notify MTM of every delay. Turn back trips you cannot run no less than 24 hours before pickup. Safety must never be traded for schedule. |
| MAS, New York (manual, October 1, 2023) | Notify MAS as soon as you know weather, an accident, or anything else stops you from making or finishing a trip |
| CareOregon, Oregon (February 2024) | Keep running trips when possible, keep a backup plan for pickups running very late, and tell the brokerage right away about any reduced capacity so trips can be reassigned. Give members an arrival estimate, or tell them the trip cannot be done. |
| TennCare health plans (contract Amendment 25, July 1, 2026) | Adverse weather procedures for members who need critical care, including renal dialysis and chemotherapy, in extreme heat, extreme cold, flooding, tornado warnings, and heavy snowfall. Backup plans when a vehicle is more than 20 minutes late. |
| Louisiana Medicaid (chapter 10, issued July 14, 2025) | When you cannot perform a trip, notify the broker immediately so it can find another provider |

The TennCare rules bind the health plans, which can pass them on to you through your provider agreement. If your broker has no written weather rule, use the strictest one in the table. Your policy belongs inside your [NEMT policies and procedures](https://nemtguide.com/guides/nemt-policies-and-procedures/) manual, and the [NEMT emergency plan template](https://nemtguide.com/templates/nemt-emergency-plan/) has fill-in pages for weather levels, backup vans, and contacts.

## Who makes the go or no-go call, and when

Name one person who decides, plus a backup. In a small company that is usually the owner or the lead dispatcher. Two people making separate calls is how a driver ends up on an icy road while the office has already canceled.

Set the times too: a first check the evening before, while you can still turn trips back in time, and a final call at a set hour before the first pickup. Write both times into the policy.

### Weather levels tied to alerts

Base your levels on the alert names your local National Weather Service office issues, not on inches of snow. Each office uses local criteria, so the snowfall that triggers a winter storm warning in the Northern Plains is much higher than in the Southeast. As of September 2026, the weather service uses these alerts and this advice:

| Your level | Alerts where you drive | What the weather service tells people | What you do |
|---|---|---|---|
| 1. Normal | None | | Run every trip |
| 2. Watch | A winter storm, extreme cold, extreme heat, or flood watch, or any advisory | Watches mean be prepared. A winter weather advisory means use caution when driving. | Run every trip with extra time. Fuel every van, charge every phone, and call riders with early pickups. |
| 3. Warning | A winter storm, ice storm, extreme cold, extreme heat, or flood warning | Winter storm warning: delay travel until conditions improve. Ice storm warning: travel is strongly discouraged. | Life-sustaining trips first. Other trips only on roads you judge safe. Tell the broker about every trip you cannot cover. |
| 4. Stop | A blizzard warning, a tornado warning, a flash flood warning, or closed roads | Blizzard warning: do not travel. Flash flood warning: flooding is imminent or happening, so move to high ground. | No trips until the decision maker restarts service. Tell the broker and each rider. |

Heat counts as weather. An extreme heat warning means extremely dangerous heat, and a heat advisory already means dangerous heat. The weather service names older adults, especially those with health conditions, on certain medicines, or with limited mobility, and people with chronic medical conditions as particularly vulnerable, and that describes many of your riders.

### Check the roads, not only the forecast

A forecast tells you what may happen. Road reports tell you what is happening. The Federal Highway Administration describes 511 as a three-digit number, available nationwide, for current travel conditions, and each state decides how to run its service. Have the decision maker check your state's 511 service at each call time, and ask drivers already out to call in what they see.

### Let drivers stop

Put a driver veto in writing: any driver who judges a road unsafe may stop, park somewhere safe, and call dispatch, with no penalty. MTM Health's Virginia handbook (May 2026) says safety must never be compromised to meet scheduling requirements. A driver who pushes through to protect your on-time score is the bigger risk to your contract.

## Which riders go first

When you cannot run every trip, run the ones where a missed ride harms the rider most. CareOregon requires rides to continue, as far as possible, for members who need critical medical care, which it defines as life-sustaining care, including renal dialysis and chemotherapy. Its brokerages set severity levels and trip categories, with life-sustaining trips as a minimum category, and announce the current level on their phone systems and to providers as an event starts and changes.

A simple order to start from:

| Priority | Trips | In a warning |
|---|---|---|
| First | Dialysis, chemotherapy, and anything else the broker marks life-sustaining | Run them whenever a safe route exists, with your most experienced drivers |
| Second | Hospital discharges and urgent same-day trips the broker sends | Run them if you can, or tell the broker at once so it can place them |
| Third | Routine visits, therapy, and day programs | Ask the broker to reschedule or reassign them early |

If your broker publishes its own categories, use its names in your policy so everyone speaks the same language.

### Dialysis riders

Dialysis centers must plan for storms too, and their plans help yours. Under federal rules, each center's emergency procedures must cover arrangements with other dialysis facilities or providers to take its patients if it has to limit or stop operations, and it must give patients an alternate emergency phone number for when the center cannot take calls ([42 CFR 494.62](https://www.ecfr.gov/current/title-42/section-494.62)). Before each season:

1. **Ask each center** you serve for its storm plan, its alternate phone number, and the backup center it would send patients to.
2. **Ask whether it moves chair times** before a forecast storm, and how it will tell you.
3. **List every dialysis rider** with their center, days, chair time, and a caregiver's phone number, and keep the list with dispatch.
4. **Keep the Kidney Community Emergency Response hotline,** 1-866-901-3773, on that list. CDC lists it for dialysis patients who need immediate help in an emergency (page dated May 15, 2024).

Get the broker's approval before you drive a rider to a different center or on a different day. New York's transportation manual (effective August 25, 2023) says any change to trip details, such as the location or day, must be approved before the trip or it may not be paid. For the weekly routine behind these rides, see [dialysis transportation](https://nemtguide.com/guides/dialysis-transportation/).

### Riders on oxygen or other equipment

Long delays and power outages are dangerous for riders who depend on equipment. Georgia's NEMT manual (July 1, 2026) makes members responsible for supplying and running their own oxygen, because NEMT vehicles and drivers are not equipped to do it. Remind these riders to travel with full, charged portable equipment when a storm is forecast, and plan the shortest route. See transporting riders with oxygen.

## How to tell the broker

Tell the broker the moment you know a trip will not run. Early notice lets it place the trip with someone else. Late notice leaves a rider waiting and lands on your record.

- **MAS, New York.** Its manual (October 1, 2023) says trip refusals within 48 hours of pickup are ten times more likely to draw a complaint.
- **MTM Health, Virginia.** Turn back trips no less than 24 hours before pickup. The handbook (May 2026) sets a standard of fewer than 0.5 percent of trips turned back, and fewer than 0.25 percent of trips a provider fails or refuses to complete.
- **CareOregon.** A pattern of reassigning many trips at the last minute is an unacceptable reason for reassignment and can lead to a corrective action plan. Adverse weather or a disaster is on its list of acceptable reasons.

When a storm is forecast, go through the next day's schedule the evening before. Turn back what you cannot cover then, starting with trips far from base or on roads that ice first. Keep the trips you can run safely, because a provider that turns back everything is no help to riders or the broker.

Use the broker's channel, whether that is its portal, dispatch line, or email, and keep a record: the time, the trip numbers, the person you spoke to, and the reason. If a trip was already underway, tell broker dispatch by phone at once. The [NEMT dispatch](https://nemtguide.com/guides/nemt-dispatch/) guide covers how to run turnbacks and reassignments during the day.

## How to tell riders and facilities

Brokers expect you to reach riders directly. CareOregon requires providers and drivers to tell members about weather delays in advance where possible, with an arrival estimate or word that the trip cannot be done. MTM Health's Virginia handbook requires you to contact affected members or facilities with the new arrival time. Louisiana's brokers must tell riders about trip changes by phone, email, or text, based on how each rider prefers to be reached (chapter 10, issued July 14, 2025).

Call in this order:

1. **Riders on life-sustaining trips,** to confirm the pickup and set a new time if needed
2. **Riders whose trips you turned back,** so no one waits outside for a van that is not coming. Tell them the broker has the trip and may send another provider.
3. **Facilities expecting riders,** such as dialysis centers and adult day programs
4. **Riders with return trips,** to agree on a pickup before conditions get worse

Keep the message short and plain:

- "This is [company] about your ride to [place] on [day]. Because of the ice, we will pick you up at [new time], about [number] minutes late. Please wait inside until the driver calls."
- "This is [company]. Because of the storm warning, we cannot drive your trip to [place] on [day]. We have told [broker], who may send another company. You can call them at [number]."

Leave only what a voicemail needs, with no health details. For riders with a will-call return, set a firm pickup time before the storm peaks so no one is stuck at a clinic after dark. See [managing will-call trips](https://nemtguide.com/guides/managing-will-call-trips/).

## Keeping drivers and riders safe on the road

Give every driver a short card with the weather service's own rules, and train on it before the season.

**Snow and ice.** Slow down, because roads that look wet can still be slick, and clear all snow and ice from the van before starting. If visibility drops, pull off the road and stop until it improves. If a van gets stuck, stay in it: run the engine about 10 minutes each hour for heat, open a window a little, keep the exhaust pipe clear of snow, and turn on the dome light at night so rescuers can see it.

**Flood water.** Never drive into it and never go around barriers. The weather service says 6 inches of fast-moving water can knock over an adult, 12 inches of rushing water can carry away most cars, and 2 feet can carry away SUVs and trucks. The road under the water may have collapsed.

**Tornadoes.** A vehicle is not a safe place. Drive to the closest shelter. If you cannot reach one, get down in the van and cover your head, or leave it for a low spot such as a ditch.

**Heat.** Even on mild days in the 70s, a parked vehicle can heat up to a level that is dangerous for adults. Never leave a rider in a parked van, even for a minute, and run the air before loading.

**Pickups and drop-offs.** The walk between the door and the van needs as much care as the drive.

- Ask riders to wait indoors until the driver calls.
- Clear or salt the path to the van, and deploy the ramp or lift where the ground is flattest and driest. Minnesota requires slip-proof ramp surfaces (Minnesota Rules 8840.5925).
- Walk door-to-door riders all the way inside, and wait until they are in.
- Keep wheelchairs, blankets, and bags dry, because a wet rider on a cold ride home is a health risk.

## Getting vans ready before the season

A van with weak heat or bald tires turns a normal storm into a missed dialysis run. Several programs set rules you can check against:

| Rule | What it requires |
|---|---|
| Virginia Medicaid (requirements updated May 26, 2026) | Working heat and air conditioning that reach 68 degrees cooling and 74 degrees heating, measured at the rear of the van |
| MTM Health, Virginia (handbook, May 2026) | The same cabin temperatures. A complaint about heat or air conditioning that does not work costs 2 points, and 3 points in a year suspend your access to its trip marketplace. |
| New York (manual, August 25, 2023) | A working air conditioner, heater, and defrosters in every vehicle, and two-way radio or cell phone contact |
| Minnesota (Rules 8840.5925) | An ice scraper in every vehicle from October 1 to April 30, and a blanket at all times |

For the rest of the kit, CDC's winter car kit list includes a charged phone and portable charger, blankets and warm clothes, a scraper and shovel, a flashlight and radio with spare batteries, water and snacks, a first aid kit, jumper cables, sand or cat litter for traction, and reflectors or a bright flag. The weather service says to keep at least half a tank of gas when extreme cold is forecast. The winter vehicle checklist turns this into a sign-off for each van.

## What you can bill when weather stops a trip

Medicaid pays for rides that happen. Louisiana's manual (chapter 10, issued July 14, 2025) says scheduled trips in which no transportation occurs are not billable. CMS says federal matching funds are not available when a provider fails to show up, because no service was given (SMD 23-006, September 28, 2023).

That leaves three questions for each storm:

- **Does the miss count against you?** CareOregon does not count unusual weather that affects all traffic and keeps you from a pickup as noncompliance, but you must still report the trip to dispatch right away. MTM's agreement has a force majeure clause: neither side breaches it when a failure results from floods, acts of God, or other circumstances beyond its control (section 26). A trip you simply skip without notice is a [missed trip](https://nemtguide.com/glossary/missed-trip/), weather or not.
- **What about a late arrival?** Under MTM's agreement, if your late pickup means the member cannot be seen, you may be assessed a provider no-show penalty or not paid for the trip (section 2.CC). Leave early, or tell MTM in time to reschedule.
- **What about the rider?** Never charge a rider for a canceled trip. CMS bars charging Medicaid members for no-shows. Record a trip canceled for weather as a weather cancellation, not as a rider no-show.

Ask the broker in writing to code weather cancellations as excused, and keep your notice records for each trip. If the broker still assesses a penalty, the [NEMT broker penalties](https://nemtguide.com/guides/nemt-broker-penalties/) guide explains how to contest one.

## After the storm

1. **Restart on the decision maker's call,** once roads are passable, starting with the riders who missed dialysis or chemotherapy.
2. **Call every dialysis center you serve.** Ask whether it is adding treatment times for patients who missed treatment. Those trips need broker approval.
3. **Check each van** for damage, fluids, tires, and lift function before it carries a rider.
4. **Check your records.** New York requires providers whose paper or electronic records are damaged by fire, flood, or other disaster to notify the Office of the Medicaid Inspector General, with the dates of service affected and proof of the loss (manual, August 25, 2023).
5. **Review what happened** with your drivers and dispatcher within a week, and update the policy while it is fresh.

## A sample bad weather policy you can adapt

Copy this into your manual, fill in the brackets, and have every driver and dispatcher sign that they read it.

1. **Decision maker.** [Name] decides whether trips run in bad weather. If [Name] cannot be reached, [Backup] decides.
2. **Call times.** The decision maker checks alerts and road reports at [time] the evening before and at [time] each morning, and tells drivers by [method].
3. **Levels.** We use four levels tied to National Weather Service alerts in our service area: Normal, Watch, Warning, and Stop, as set out in our emergency plan.
4. **Priority.** In a Warning, life-sustaining trips, such as dialysis and chemotherapy, run first. Other trips run only on routes we judge safe.
5. **Broker notice.** We tell each broker about any trip we cannot run as soon as we know, through [channel], and record the time, trip numbers, and the person we spoke to.
6. **Rider notice.** We call every affected rider and facility with a new time or a cancellation, starting with life-sustaining trips.
7. **Driver veto.** Any driver may stop and park safely if a road is unsafe, and must call dispatch at once. No driver is disciplined for a safety stop.
8. **Riders in the van.** No rider is left in a parked van or waiting outside in extreme heat or cold.
9. **Vehicles.** Every van passes the winter or summer checklist before the season, and carries the kit on the list.
10. **Review.** We review this policy after every major storm and once a year before [month].

Tell each broker you work with that the policy exists, and send a copy when asked. CareOregon requires providers to supply copies of their weather procedures on request.

## Frequently asked questions

### Can a NEMT provider cancel trips because of bad weather?

Yes, when driving is unsafe, but you must tell people right away. MTM Health's standard agreement (the January 1, 2023 version Pennsylvania posts) requires you to notify both the member and MTM immediately when inclement weather makes a scheduled trip unsafe. MAS, New York's broker, wants notice as soon as you know you cannot make or finish a trip because of weather (manual dated October 1, 2023).

### Will a broker penalize me for trips I miss in a storm?

Not always. CareOregon's manual (version 1.3, February 2024) says unusual weather affecting all traffic that keeps you from a pickup does not count as noncompliance, though you must still report it to dispatch right away. MTM's agreement has a force majeure clause covering floods and acts of God. But turnbacks still show in your numbers: MTM Health's Virginia handbook (May 2026) expects fewer than 0.5 percent.

### Can I bill Medicaid for a trip that weather canceled?

No. Medicaid pays for rides that happen. Louisiana's Medicaid manual (chapter 10, issued July 14, 2025) says scheduled trips in which no transportation occurs are not billable, and CMS says federal matching funds are not available when a provider does not show up (SMD 23-006, September 28, 2023). Never charge the rider either. CMS bars charging Medicaid members for no-shows.

### Which NEMT trips should keep running in a storm?

Life-sustaining care first. CareOregon requires rides to continue, as far as possible, for members who need critical medical care, including renal dialysis and chemotherapy, and its brokerages set trip categories that decide what gets limited as conditions worsen. TennCare's health plan contract (Amendment 25, July 1, 2026) requires adverse weather procedures for the same riders.

### How far ahead should I turn back trips I cannot run?

As early as you can. MTM Health's Virginia handbook (May 2026) expects turnbacks no less than 24 hours before pickup. MAS in New York says refusals within 48 hours of pickup are ten times more likely to draw a complaint. When a storm is forecast, turn back what you cannot cover the day before, not the morning of.

### What temperature does a NEMT van have to hold?

Check your state and broker. Virginia's Medicaid rules (updated May 26, 2026) require working heat and air conditioning that reach 68 degrees cooling and 74 degrees heating, measured at the rear of the vehicle. New York requires a working air conditioner, heater, and defrosters. MTM Health's Virginia handbook gives 2 points for a complaint about heat or air conditioning that does not work.

## Official resources

- [National Weather Service: Winter watches, warnings, and advisories explained](https://www.weather.gov/safety/winter-ww)
- [National Weather Service: Heat alerts explained](https://www.weather.gov/safety/heat-ww)
- [National Weather Service: Cold weather alerts explained](https://www.weather.gov/safety/cold-ww)
- [National Weather Service: Turn Around Don't Drown](https://www.weather.gov/safety/flood-turn-around-dont-drown)
- [CDC: Dialysis during an emergency (includes the KCER hotline)](https://www.cdc.gov/kidney-disease/caring/index.html)
- [CDC: Emergency car kit for winter storms](https://www.cdc.gov/winter-weather/safety/index.html)
- [CareOregon: Transportation Provider Manual (adverse weather section)](https://careoregon.org/docs/default-source/nemt/nemt-provider-manual.pdf)
- [FHWA: 511 travel information by phone](https://ops.fhwa.dot.gov/travelinfo/about/about511.htm)