# NEMT Passenger Abuse Prevention in 2027: Screening, Conduct Rules, Second Adults, and Reporting

Canonical URL: https://nemtguide.com/guides/prevent-rider-abuse/ · Updated 2026-10-02

NEMT passenger abuse prevention starts at hiring: check every driver against criminal records, sex offender registries, and the federal exclusion list. Then hold drivers to a signed code of conduct, send a second adult with young children and riders who cannot speak for themselves, report any suspicion at once to your broker and the state hotline, and carry the sexual abuse and molestation coverage brokers ask for.

- Federal Medicaid law only requires drivers who are not excluded and hold a valid license. The abuse-related bars come from states and brokers.
- Write the line between driver and rider down: trip-only contact, no gifts or money, physical contact only for safe help, and photo ID at every pickup.
- Arkansas requires an attendant for any minor or incapacitated adult riding without a responsible adult.
- In Texas and Florida anyone who suspects abuse of a child or vulnerable adult must report it, and brokers want to hear the same day.
- Verida and WellTrans ask for $1 million of sexual abuse and molestation coverage, and Arizona Medicaid plans may accept a $500,000 sublimit.

Many NEMT riders cannot easily protect themselves. They are older adults, people with dementia or a developmental disability, and children on their way to therapy, and they often ride alone with one driver. Brokers, states, and insurers have written rules to keep those rides safe. This guide pulls them into one plan a company with a few vans can run.

## What counts as abuse on a NEMT ride

Abuse on a ride is wider than an assault. Modivcare's 2025 annual training for transportation providers defines these kinds:

- **Physical abuse.** Non-accidental force that causes injury, pain, or impairment. On a ride that can be rough handling during a transfer or grabbing a rider.
- **Sexual abuse.** Unwanted touching, threats of a sexual nature, or sexually inappropriate remarks.
- **Psychological, verbal, and emotional abuse.** Yelling, name calling, threats, ridicule, intimidation, or shaming a rider to control them.
- **Neglect.** Failing to provide, or holding back, what a person needs to live, such as food, clothing, shelter, or medical care. On a ride that can mean leaving a rider who cannot manage alone.
- **Exploitation.** Illegal use of a rider's money or belongings.

Abuse runs in three directions. MTM Health's Virginia handbook (approved August 10, 2026) tells members never to physically or verbally abuse other members or the driver. Your plan has to protect riders from drivers, riders from other riders, and drivers from riders.

### What drivers may notice first

Drivers who pick riders up at home, sometimes several times a week, may spot abuse by someone else before anyone does. Modivcare's training lists warning signs, including:

- Injuries that do not match the explanation, or a history of similar injuries
- A rider who cowers around a certain person, or who is not given a chance to speak
- A caregiver who shows anger or indifference, or takes an unusual interest in the rider's money
- Missing belongings, weight loss with no other cause, and neglected hygiene

One sign alone does not prove abuse. It is still a reason to report what you saw.

## Screen out people with an abuse record

Federal law sets only a floor. Each state's Medicaid plan must make sure every NEMT provider and driver is not excluded from federal health programs, that each driver has a valid license, and that providers have processes to address state drug law violations and to disclose each driver's driving history ([42 U.S.C. 1396a(a)(87)](https://www.govinfo.gov/link/uscode/42/1396a?type=usc&year=mostrecent&link-type=html)). The abuse-related bars come from states and brokers:

- **MTM Health standard agreement (version January 1, 2023).** No prior conviction for a sexual crime or a crime of violence. A felony in the last 7 years only with the approval of MTM's client.
- **MTM Health, Rhode Island (updated July 1, 2026).** No felony or misdemeanor for patient, child, or elder abuse, criminal domestic violence, or sexual misconduct, and no listing on a sex offender registry in the last 10 years.
- **Texas Medicaid health plans (UMCM 16.4, version 2.0.1).** No conviction at any time for abuse, neglect, or exploitation of children, older people, or people with disabilities.
- **Arkansas broker contract (bid 710-25-049, June 5, 2025).** No sexual offense or crime of violence, and no one named as an offender in a substantiated report on the state's child or adult maltreatment registry. Staff with direct contact with children, older adults, or people with mental illness need a DHS Central Registry check first.

Two free federal searches belong in every file. The [HHS OIG exclusion list](https://nemtguide.com/glossary/oig-exclusion-list/) matters because OIG must exclude anyone convicted of patient abuse or neglect, and it tells health care employers to check the list routinely for new hires and current staff. The National Sex Offender Public Website searches the registries of all 50 states, DC, the territories, and Indian Country at once.

Screening does not end at hire. Texas health plans require providers to report a driver's new conviction, pending felony charge, or registry listing in writing within 10 business days. Minnesota requires a special transportation provider to stop using a driver immediately once the state's background study shows the driver is no longer eligible (Minn. R. 8840.5900). The checks themselves, the consent forms, and how often to repeat them are in the [NEMT driver background check guide](https://nemtguide.com/guides/nemt-driver-background-check/). The full lists of barred crimes are in [disqualifying offenses for NEMT drivers](https://nemtguide.com/guides/nemt-driver-disqualifying-offenses/).

## Conduct rules that close the door on abuse

Clear boundaries protect the rider and the driver: no personal calls, no gifts, nothing outside the trip. Broker handbooks draw those lines in plain terms. CareOregon's model manual for the brokerages that serve its Oregon plans (version 1.3, February 2024) asks providers to share conduct rules at hire and have each driver sign an acknowledgment. A code of conduct built from broker rules covers these points:

1. **Contact only for the trip.** MTM Health in Rhode Island bars drivers from contacting a member, family, attendant, or escort for any purpose beyond the assigned trip.
2. **Touch only to help.** MTM Health's Virginia handbook limits physical contact to what safe assistance or trained first aid requires.
3. **No money, gifts, food, or drinks.** Rhode Island and Virginia bar drivers from soliciting or accepting money or goods from members, and Rhode Island bars giving them food or drinks. Modivcare's gift policy bars providers from exchanging anything of value with riders.
4. **No sexual comments or conduct,** and no encouraging them. Rhode Island spells this out.
5. **No personal relationships with riders.** CareOregon treats a personal relationship with a member, and driving someone you are already in a relationship with, as conflicts of interest that must be reported.
6. **Show who you are.** Rhode Island requires a visible photo ID that names the driver and the company, shown at pickup. At door-to-door pickups, Rhode Island and Virginia require drivers to identify themselves and announce their arrival at the entrance.
7. **Never leave a rider alone in the vehicle.** MTM Health's standard agreement bars it.
8. **Never discourage a complaint.** Rhode Island bars drivers from discouraging complaints or refusing to give their contact information.

Riders need rules too. The [NEMT passenger conduct policy template](https://nemtguide.com/templates/nemt-passenger-conduct-policy/) covers behavior on board, and the [guide to difficult passengers](https://nemtguide.com/guides/difficult-nemt-passengers/) covers how drivers respond in the moment.

## When a second adult should ride along

A second adult on board protects riders who cannot speak for themselves, and it protects your driver from a false claim. Some programs require one:

- **Arkansas (bid 710-25-049).** The broker provides an attendant when a minor or an incapacitated adult rides without a responsible adult. For children 3 and younger going to an early intervention day treatment center, there must be at least one attendant for every three children. The driver may count toward that ratio but can never be the only adult on a vehicle carrying a child under 3.
- **MTM Health, Rhode Island.** Drivers may not carry children and their escorts with an unrelated adult member, and may not carry private pay passengers with Medicaid members.
- **Hamilton County, Ohio (RFP KB05-25R, December 2025).** The county may ask for an extra driver or monitor in limited cases, based on the risk to other riders or behavior problems.

Each program sets its own age for when a child needs an adult on the ride. See [NEMT child passengers](https://nemtguide.com/guides/children-in-nemt/) and [escorts and caregivers](https://nemtguide.com/guides/escorts-and-caregivers/).

Dispatch can lower the risk where no rule requires a second adult:

- **Flag riders who must not share a van** with a certain person, and check the flag every time you group trips.
- **Keep the same trusted driver** on standing orders for riders with dementia or a developmental disability.
- **Plan the order of stops** so a vulnerable rider is not left alone with the driver for a long stretch when it can be avoided.

## Cameras record what happened

Video settles claims that would otherwise come down to one word against another. Colorado now requires two-way video dash cameras that capture each pickup and drop-off for providers carrying Health First Colorado members, effective July 1, 2026, except fleets of five or fewer vehicles. Arkansas's broker contracts require an interior camera that records all passenger activity. Hamilton County, Ohio asks for a front-mounted camera with a 360-degree view of the driver, any monitor, and the riders, with a notice of the camera posted on the vehicle. CareOregon strongly recommends inward and outward facing cameras and says footage can help a brokerage decide whether a complaint is substantiated.

Save the clip the moment anyone raises a concern. Modivcare's incident form warns that losing evidence, even by accident, can bring significant court sanctions if the incident becomes a lawsuit. The [NEMT dash cameras guide](https://nemtguide.com/guides/nemt-dash-cameras/) covers equipment, audio consent, rider privacy, and how long to keep footage.

## Who must report abuse, and to whom

Reporting duties come from state law and from your contracts. A report to the broker never replaces a report the law requires.

### State law

The rules below were current as of October 2026.

| State | Who must report | Where and when |
|---|---|---|
| Texas, older adults and people with disabilities | Any person with cause to believe | Immediately to DFPS, 1-800-252-5400, or the agency that licenses the facility (48.051) |
| Texas, children | Any person with reasonable cause to believe | Immediately to law enforcement or DFPS (Family Code 261.101 and 261.103) |
| Florida, vulnerable adults | Any person who knows or suspects | Immediately to the Florida Abuse Hotline, 1-800-962-2873 (415.1034) |
| Florida, children | Any person who knows or suspects | Immediately to the Florida Abuse Hotline (39.201) |
| Virginia, older or incapacitated adults | Listed workers, including agency employees and contractors in care or support roles | Immediately to local social services or the APS hotline (63.2-1606) |

Knowingly failing to report is a Class A misdemeanor in Texas, for adults and for children (Human Resources Code 48.052 and Family Code 261.109). In Florida, knowingly and willfully failing to report abuse of a vulnerable adult is a second degree misdemeanor (415.111).

Two Texas details matter for a driver making a report. The DFPS hotline site says to call when a situation is urgent and use the website only for situations that do not need investigation right away. And since September 1, 2023, DFPS cannot accept anonymous reports of child abuse, so the reporter gives a name and phone number.

In other states, the adult protective services and child protective services agencies take the reports. The Eldercare Locator (1-800-677-1116), run by the federal Administration for Community Living, connects callers with local services for older adults. Call 911 first when anyone is in danger.

### Your contracts

- **Arkansas** requires any driver, agent, employee, or subcontractor who suspects maltreatment of a child, an adult, or a long-term care resident to report it, or have it reported, immediately.
- **Modivcare's 2025 training** says its providers are not legally mandated reporters, but requires them to report any suspected abuse, neglect, or exploitation to their Provider Relations contact immediately.
- **MTM Health in Rhode Island** treats sexual harassment or misconduct and physical assault as Tier 1 incidents: call MTM at once, send a written report within 24 hours, and send any police report within five business days.
- **CareOregon's guidelines** call for written notice to the brokerage immediately for any allegation of abuse by a driver.

### Rides for nursing home residents

If you contract with a long-term care facility that received at least $10,000 in federal funds the year before, federal law makes the facility's contractors covered individuals. Each must report any reasonable suspicion of a crime against a resident to HHS and local law enforcement within 2 hours if it caused serious bodily injury, and within 24 hours otherwise ([42 U.S.C. 1320b-25](https://www.govinfo.gov/link/uscode/42/1320b-25?type=usc&year=mostrecent&link-type=html)). A covered individual who fails to report faces a civil money penalty and possible exclusion. As of October 2026 the maximum is $288,655, or $432,981 if the failure makes the harm worse, the 2025 inflation-adjusted amounts in [45 CFR 102.3](https://www.ecfr.gov/current/title-45/section-102.3).

HIPAA does not stand in the way. It allows reports of child abuse to the agency authorized to receive them, and reports about an adult victim to protective services when a law requires the report ([45 CFR 164.512](https://www.ecfr.gov/current/title-45/section-164.512)). The [HIPAA guide for NEMT](https://nemtguide.com/guides/hipaa-for-nemt/) covers the rest of your privacy duties, and mandatory reporter explains how the duty works day to day.

## What to do the moment someone reports abuse

Act the same day, in this order:

1. **Make the rider safe.** Call 911 if anyone is in danger or hurt.
2. **Take the driver off trips** until the review ends. CareOregon's guidelines have the brokerage suspend a driver suspected of harassing a member right away, pending its investigation.
3. **Call the broker** by its deadline. For abuse and misconduct, Rhode Island, Modivcare, and CareOregon all ask for immediate notice.
4. **Make the report the law requires** to protective services or the police. Do not wait for your own review to finish.
5. **Save the evidence:** video, GPS data, dispatch notes, texts, and the trip log.
6. **Write the incident report** on the broker's form. Modivcare wants its form within 24 hours. Use the [NEMT incident report form](https://nemtguide.com/templates/nemt-incident-report-form/) for your own file.
7. **Record the complaint and the outcome.** Minnesota's special transportation rules require a record of every complaint or allegation of misconduct against a driver, with a summary of your investigation and any action taken. The [NEMT complaint log](https://nemtguide.com/templates/nemt-complaint-log/) is built for that.
8. **Never pressure the rider or family** to drop the complaint.

The [guide to broker rider complaints](https://nemtguide.com/guides/broker-rider-complaints/) covers how brokers handle the findings afterward.

## Training on abuse and reporting

Several programs write abuse and reporting into driver training:

- **Minnesota special transportation (Minn. R. 8840.5910).** Within 45 days of starting, each driver and attendant takes an abuse-prevention course of at least 4 hours covering sexual abuse or misconduct, protection of vulnerable adults, maltreatment of minors, how to respond to victims, and reporting duties. Every three years after that, they take 2 hours of abuse prevention and 2 hours on passenger assistance and abuse prevention, taught in person unless the state approves another format.
- **MTM Health, Virginia.** Mandatory reporter training on suspected abuse, neglect, or exploitation, and sexual harassment training, before a driver carries members.
- **Greater Oregon Behavioral Health (manual revised July 2025).** Mandatory reporter training every year as part of driver credentialing.
- **Modivcare, every year.** Signs of abuse, neglect, and exploitation, and how to report them.
- **CareOregon.** Written provider policies on preventing harassment, sexual harassment, and sexual assault, shared with every driver.

Train dispatchers and office staff too, because they take the calls from riders and families. See [NEMT driver training](https://nemtguide.com/guides/nemt-driver-training/) and [broker training requirements](https://nemtguide.com/guides/nemt-broker-training-requirements/).

## The insurance brokers expect: sexual abuse and molestation coverage

An abuse claim against a driver is a claim against your company. Brokers and agencies ask for abuse and molestation coverage, often written as SAM. Here is what four programs ask for.

| Who asks | Minimum SAM coverage | Where it goes |
|---|---|---|
| Verida, Georgia | $1 million, $2 million aggregate | On the general liability policy |
| WellTrans (agreement revised October 16, 2025) | $1 million per incident, without sub-limits | Occurrence-based general liability. The certificate must confirm it. |
| Hamilton County, Ohio (December 2025) | An abuse and molestation endorsement on $2 million of general liability | Or a separate SAM policy of at least $1 million per occurrence or claim |
| AHCCCS health plans (effective October 1, 2024) | May be sublimited to no less than $500,000, or $250,000 for subcontracts under $50,000 | Where the plan requires it. The certificate must say SAM is included or not excluded. |

Modivcare's provider page calls SAM critical coverage for working with vulnerable populations and suggests higher limits where needed.

Before you renew, ask your agent in writing whether your general liability and auto policies cover or exclude abuse and molestation, and whether the coverage reaches claims of negligent hiring or supervision. Then match the certificate to each broker's wording. The [NEMT insurance requirements guide](https://nemtguide.com/guides/nemt-insurance-requirements/) lists the other coverages brokers set.

## A NEMT passenger abuse prevention checklist

1. Run criminal, sex offender registry, and exclusion checks on every driver, attendant, and dispatcher before their first shift.
2. Repeat the checks on your brokers' schedule, and search the OIG exclusion list routinely.
3. Have every driver sign a code of conduct: trip-only contact, touch only to help, no gifts or money, no personal relationships, photo ID at every pickup.
4. Send a second adult with young children and riders who cannot speak for themselves, and follow each broker's escort rules.
5. Flag riders who must not share a van, and check the flag before you group trips.
6. Install cameras where your state or broker requires them, and save footage the moment a concern comes up.
7. Post your state's abuse hotline number in every van and at the dispatch desk.
8. Train every driver and dispatcher on the signs of abuse and how to report, at hire and every year.
9. Carry sexual abuse and molestation coverage at the limits your brokers require.
10. When anyone raises a concern, pull the driver from trips, call the broker, report to the state, and save the evidence the same day.

## Frequently asked questions

### Are NEMT drivers mandatory reporters?

It depends on the state. In Texas and Florida everyone who suspects abuse of a child or a vulnerable adult must report it, so drivers are covered. Virginia lists who must report, including anyone employed by or contracted with an agency who works with adults in a supportive or direct care role. Modivcare's 2025 provider training says its providers are not legally mandated reporters, but still requires them to report every suspicion immediately.

### Can a driver with a criminal record drive Medicaid riders?

Sometimes, and the rules come from your broker and state. MTM Health's standard agreement bars any conviction for a sexual crime or a crime of violence. Texas health plans bar any conviction for abuse, neglect, or exploitation of children, older people, or people with disabilities, however old it is. Arkansas bars anyone named as an offender in a substantiated report on its child or adult maltreatment registry.

### Does HIPAA stop me from reporting suspected abuse?

No. The HIPAA privacy rule allows reports of child abuse or neglect to the agency authorized to receive them (45 CFR 164.512(b)). It also allows reports about an adult victim to protective services when a law requires the report, when the adult agrees, or in the other cases 45 CFR 164.512(c) lists. Report only what the agency asks for.

### Should a second adult ride with a child?

Usually yes, and some programs require it. Arkansas requires an attendant when a minor or an incapacitated adult rides without a responsible adult, and on a vehicle carrying children under 3 to an early intervention day treatment center, the driver can never be the only adult. MTM Health in Rhode Island keeps children and their escorts off rides with unrelated adult members.

### What insurance covers an abuse claim against a driver?

Sexual abuse and molestation coverage, often called SAM. Verida's Georgia provider page asks for $1 million of it with a $2 million aggregate on your general liability policy, and WellTrans wants it without sub-limits. Ask your agent in writing whether your general liability and auto policies cover or exclude abuse claims, and match the certificate wording each broker wants.

### What should a driver do if a rider harasses them?

Stay safe first. MTM Health's Virginia handbook tells drivers to pull over in a safe place outside traffic and call dispatch when a rider's behavior interferes with safe driving. CareOregon's guidelines expect drivers to finish rides unless they have a credible fear for their safety, and let a provider ask the brokerage not to carry a verbally abusive member again. Report it like any other incident.

## Official resources

- [HHS OIG: List of Excluded Individuals and Entities](https://oig.hhs.gov/exclusions/)
- [U.S. Department of Justice: National Sex Offender Public Website (all states)](https://www.nsopw.gov/)
- [ACL: Eldercare Locator, find local adult protective services (1-800-677-1116)](https://eldercare.acl.gov/)
- [Texas DFPS: Texas Abuse Hotline (1-800-252-5400)](https://www.txabusehotline.org/Login/Default.aspx)
- [Florida DCF: Florida Abuse Hotline (1-800-962-2873)](https://www.myflfamilies.com/services/abuse/abuse-hotline)
- [Minnesota Rules 8840.5910, abuse-prevention training for drivers and attendants](https://www.revisor.mn.gov/rules/8840.5910/)