How to Get PACE Transportation Contracts in 2027: Rules, Pricing, and Steps

A PACE program is one of the few health care buyers that owns the whole problem of getting a frail older adult to care. It pays for the medical visit, the day center, and the ride in between. That makes it a steady, recurring customer for a NEMT company that can meet its rules.

What PACE is and why it buys rides

PACE stands for Programs of All-Inclusive Care for the Elderly. Each program runs a PACE center, a building with a primary care clinic, therapy, dining, and social activities, and it serves the people enrolled in its service area (42 CFR 460.6). To join, a person must be 55 or older, live in the service area, need a nursing home level of care as certified by the state, and be able to live safely in the community with PACE’s help (42 CFR 460.150).

PACE must cover every Medicare and Medicaid service, plus anything else its care team decides a participant needs (42 CFR 460.92). Medicare.gov lists transportation to and from the PACE center and medical appointments among PACE services. Participants pay no deductible or copay for anything the team approves.

Three facts shape the business for you:

• PACE is the only payer for its participants. While enrolled, a participant gets Medicare and Medicaid benefits only through the PACE organization (42 CFR 460.90). The PACE program pays for the ride, not the state’s NEMT broker.
• The riders are frail. Every participant qualified for nursing home level care. Expect wheelchairs, walkers, and oxygen, and drivers trained to transfer riders safely.
• The schedule repeats. The care team decides how often each participant attends the center (42 CFR 460.98(f)). Center days become standing routes, with medical appointments added on top.

CMS’s monthly contract summary for September 2026 lists 208 PACE contracts, with 81,439 Medicare beneficiaries enrolled as of the September 1, 2026 payment. Names vary by state. In Pennsylvania, every PACE provider has “LIFE” in its name, for Living Independence for the Elderly, according to the state Department of Human Services.

How PACE programs buy transportation

A PACE program can run its own vans, hire a contractor, or do both. The federal transportation rule covers each case: the program must maintain the vehicles it owns, rents, or leases to the manufacturer’s recommendations, and when a contractor drives, the program must make sure the contractor’s vehicles are maintained the same way (42 CFR 460.76).

When the program uses an outside company for any care-related service, it must have a written contract (42 CFR 460.70). The same rule gives you two ways in:

• The contractor list. Each PACE center must keep a current list of its contractors on file and give a copy to anyone who asks (42 CFR 460.70(c)). Ask for it. It tells you whether the program already contracts for rides and with whom.
• The contractor liaison. Each program must name an official liaison to coordinate with its contractors (42 CFR 460.70(b)(3)). That person, or the PACE center manager, is who you pitch.

Transportation also has a seat on the care team. The interdisciplinary team at each center must include a driver or a driver’s representative (42 CFR 460.102(b)(11)). If your company fills that role under contract, the contract must say your representative will do the duties of the role, take part in care team meetings, answer to the PACE program, and cooperate with its competency program (42 CFR 460.70(d)(6)).

New PACE centers need contracts before they open

A new PACE program, or an existing one adding a PACE center, needs a State Readiness Review of the new center as part of its application to CMS. CMS’s application, updated in 2025, says the state must confirm that contracts with all contractors are signed by the time the center opens, and that drivers are employees or contractors by then. Any program applying to expand its service area, with or without a new center, must also attest that its transportation system has been reviewed and changed as needed for the larger area.

A new center or a bigger service area is the best time to win a transportation contract, because the program must plan its rides before it grows. Ask the PACE programs near you whether they plan either one.

What a PACE transportation contract must say

Federal rules list what goes into every PACE contract (42 CFR 460.70(d)). Read each line of a draft against this table before you sign.

The contract must include	What it means for you
Your name and the services you furnish, with a work schedule if appropriate	Spell out center routes, appointment trips, hours, days, and service levels such as wheelchair or stretcher
The payment rate and method	Every rate goes in writing: per trip, per mile, per hour, or per route
Start and end dates, and how the contract is extended, renegotiated, and ended	Know your notice period and when you can ask for a new rate
You furnish only services the care team authorizes	A ride nobody at PACE ordered is not payable
You accept PACE payment as payment in full and do not bill participants, CMS, the state, or private insurers	No copays, no balance bills, no Medicaid or broker claims for these riders
You hold CMS, the state, and participants harmless if PACE does not pay you	If the program falls behind, you chase the program, never the rider
You do not assign the contract or delegate duties without prior written approval	Overflow partners need written approval first
You submit the reports PACE requires	Trip logs, incident reports, and on-time data, as the contract lists them

The program must also contract only with a company that meets every federal and state requirement that applies to it (42 CFR 460.70(b)(1)). Hold every license, permit, and inspection your state requires of a NEMT company. See NEMT license requirements. Contractors must also follow the PACE rules on service delivery, participant rights, and quality improvement.

The facility transportation agreement template has a section on the terms PACE contracts must carry. Use it as your starting draft.

What PACE requires of your drivers and vans

PACE rules treat your drivers like the program’s own staff. Each one has direct contact with participants, so each one must meet the personnel rules before the first ride.

Requirement	Rule	What to keep on file
One year of experience with a frail or elderly population, or PACE training on it at hire	42 CFR 460.64(a)(3)	Past job records or the training certificate
Not excluded from Medicare or Medicaid, and no disqualifying convictions	42 CFR 460.68(a)	OIG and SAM search results, background check
Current licenses and certifications for the job	42 CFR 460.71(b)(3)	Driver’s license and any state permit or certificate
Medically cleared for communicable diseases, and free of active tuberculosis	42 CFR 460.64(a)(5)	Physical exam or PACE risk assessment, TB result
All immunizations up to date	42 CFR 460.64(a)(6)	Immunization record
Orientation to the PACE program and its emergency plan	42 CFR 460.71(a)(1)	Orientation sign-in sheet
Competencies shown before working independently	42 CFR 460.64(a)(4) and 460.71(a)	Skills check signed by the evaluator
Training in participants’ special needs and in emergencies	42 CFR 460.76(d)	Training log with dates and topics

The conviction rule is broad. A PACE program may not employ or contract with anyone excluded from Medicare or Medicaid, anyone convicted of a crime tied to a health care or social service program, or anyone with a court finding or nurse aide registry finding of abuse, neglect, or mistreatment. It also may not use anyone convicted of an offense that brings mandatory exclusion under section 1128(a) of the Social Security Act, or anyone whose convictions for physical, sexual, drug, or alcohol offenses it finds would put participants at risk (42 CFR 460.68(a)). Run the OIG exclusion list and SAM exclusions checks on every driver before hire.

Vehicles have three rules of their own under 42 CFR 460.76. They must be safe, accessible, and equipped for the participants. They must be maintained to the manufacturer’s recommendations. They must be able to communicate with the PACE center, and CMS’s 2025 application asks programs to attest that every vehicle has a working hands-free device for it. Keep a maintenance log for each van.

The program must also tell your drivers about relevant changes in each rider’s care plan (42 CFR 460.76(e)). The 2025 application names advance directives as one of those changes. Agree in writing on how updates reach the driver before the next ride.

What state reviewers look for

The State Readiness Review in CMS’s 2025 application lists what reviewers check in a PACE transportation program:

1. Evidence of state vehicle inspections.
2. Written agreements with any transportation contractor that meet 42 CFR 460.70.
3. Written procedures for training and monitoring drivers, covering transfers of ambulatory and non-ambulatory participants, use of the equipment that transfers and secures riders, and emergencies during transfer, transport, and arrival.
4. A way for drivers to reach the PACE center during every trip.
5. Written procedures to check each driver’s license and record of traffic violations or accidents.
6. A smoking policy for vehicles, with signs.

A contractor who already has these on paper saves the program work, and that is part of your pitch.

What CMS checks in a PACE audit

CMS audits PACE organizations, and its audit protocol (OMB 0938-1327, in the package on CMS’s PACE Audits page, last modified June 9, 2026) reaches contract drivers directly.

• Your drivers are on the list. For the audit, the program lists all its personnel, including contracted staff who transported participants. CMS then picks up to 10 personnel records to review.
• Your paperwork gets checked. Auditors ask for background checks, OIG exclusion checks done before hire, licenses, communicable disease clearance, the tuberculosis result, completed competencies, and the dates each person first had participant contact and first worked alone.
• A van gets inspected. CMS observes at least one vehicle the program uses. It asks whether riders and equipment such as wheelchairs, oxygen, and walkers are secured, whether the vehicle can reach the center, and whether drivers were trained for special needs and emergencies.

A missing TB result on one of your drivers can become a finding against the PACE program. Build each file to the driver file checklist, and give the program copies on request. Quality matters after the audit too: the program’s quality improvement program must track nonclinical areas, and transportation is one of them (42 CFR 460.134).

How to price a PACE transportation contract

Federal rules require only that the payment rate and method be written into the contract. PACE rates are negotiated, so you set your price from your own costs. Start with your cost per hour and per mile, then choose a structure.

Pricing method	How it works	Fits best when
Per one-way trip plus loaded miles	A base rate for each leg, plus a rate for each mile with the rider aboard	Scattered appointment trips
Per vehicle hour	The program pays for each hour a van and driver are assigned to it	Center routes with many stops and waits
Per route or per day	A fixed price for a set morning and afternoon center run	Stable attendance on fixed days
Mixed	A route price for center days, trip pricing for appointments	A program that uses you for both

Whatever you choose, write down the terms that decide your margin: waits past a set time, no-shows and late cancellations, escorts and attendants, stretcher and bariatric rides, after-hours and weekend trips, and trips outside the service area. Your state’s Medicaid fee schedule is a useful benchmark, but your PACE rate is whatever the contract says. See how much to charge for NEMT and the rate sheet template.

Speed is worth money to a PACE program. Once its care team approves a service, the program generally must arrange or schedule it within 7 calendar days (42 CFR 460.98(c)). A contractor who can book appointment rides inside that window helps the program meet a federal deadline.

How to win a PACE contract, step by step

1. Find the programs near you. Search the Medicare.gov PACE plan finder for your area, and check your state Medicaid agency’s PACE page.
2. Ask each center for its contractor list. The center must give you a copy (42 CFR 460.70(c)).
3. Reach the right person. Ask for the contractor liaison, the center manager, or whoever represents transportation on the care team.
4. Ask what they need. Openings to ask about: overflow when the program’s own vans are full, wheelchair or stretcher rides it cannot staff, long trips to specialists, and a new center or service area.
5. Build a PACE-ready package. Include your license and insurance certificates, vehicle list with inspection dates, driver roster with every item from the tables above, training outline, and a sample trip report. A one-page capability statement helps.
6. Offer a start the program can test. A single route or appointment overflow lets the program see your on-time record before it moves more work.
7. Price in writing. Send a rate sheet covering every trip type and the terms listed above.
8. Sign a contract that meets 42 CFR 460.70. Check each required term, and add how drivers report grievances, service requests, and incidents.
9. Complete orientation and training. The program must orient your staff and confirm their competency before they work alone (42 CFR 460.64 and 460.71).
10. Report and improve. Send the reports the contract lists, on time, and track your own on-time rate by route.

For how PACE compares with hospitals, nursing homes, and day programs as customers, see NEMT facility contracts and adult day center transportation.

Records, privacy, and reports

The PACE program keeps one medical record for each participant, and it must document services furnished by contractors and their reports (42 CFR 460.210). It must keep records for at least 10 years from the last entry, or longer if state law requires (42 CFR 460.200). Your trip logs may end up in that record, so keep them complete: pickup and drop-off times, the vehicle, the driver, and anything unusual during the ride.

Drivers hear things. A participant may complain about a late van or ask for a different day at the center. Federal rules let participants make both grievances and service requests to any contractor who transports them (42 CFR 460.120 and 460.121). The program must bring a service request to its care team within 3 calendar days and resolve a grievance within 30 calendar days. Train drivers to write down what they hear and report it to the program that day.

Participant information is private. If your contract has you create, receive, or keep participants’ health information on the PACE program’s behalf, expect a business associate agreement under the HIPAA rules (45 CFR 164.504(e)). See HIPAA for NEMT providers for the policies to have in place first.