NEMT Drug and Alcohol Policy Template: DOT and Non-DOT Versions

Federal Medicaid law requires states to make sure every NEMT provider they pay, other than a public transit authority, has a process to address any violation of a state drug law. CMS explains the rule, section 1902(a)(87) of the Social Security Act, in its Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023). Brokers go further and ask for a written testing policy. This template holds two versions: a DOT version for drivers covered by federal transportation testing rules, and a non-DOT version built from broker and state rules for everyone else.

Which version you need

Your drivers	Rules that apply	Use
Drive a vehicle that needs a CDL: designed for 16 or more people including the driver, or rated at 26,001 pounds or more	FMCSA testing rules (49 CFR part 382) and DOT test procedures (49 CFR part 40)	DOT version, FMCSA rules
Drive, dispatch, or maintain vehicles under contract for a transit agency funded under 49 U.S.C. 5307, 5309, or 5311	FTA testing rules (49 CFR part 655) and part 40	DOT version, FTA rules
Drive sedans, minivans, or wheelchair vans that need no CDL, for brokers, health plans, facilities, or private pay riders	Your broker contracts, your state Medicaid rules, and state employment law	Non-DOT version
Some of each	Both sets of rules	Both versions, with separate random pools and separate forms

The FMCSA testing rule reaches companies that carry sick and injured people. The exception for that work in 49 CFR 390.3T(f) does not apply to part 382 (49 CFR 382.103). Under FTA rules, covered work includes operating a revenue service vehicle, controlling dispatch, and maintaining vehicles, with a narrow exception for maintenance that some rural and small-area agencies contract out (49 CFR 655.4). See do NEMT drivers need a CDL and NEMT driver drug testing for the full test.

Keep the two programs apart. A DOT test must be completely separate from a non-DOT test, and you may never use the federal custody and control form for a non-DOT test, even with the DOT wording crossed out. You also may not give a DOT test to someone DOT rules do not cover (49 CFR 40.13).

How to use this template

1. Pick your version. Check DOT, non-DOT, or both in Part 1. Use the DOT column in Part 4, and the FMCSA or FTA column in Part 5, only for people those rules cover.
2. Name the people and places. You need one person who answers driver questions, a designated employer representative who receives results and takes drivers off duty, a collection site, a lab, and a medical review officer. DOT programs also need a list of substance abuse professionals. An owner who is the company’s only CDL driver must still test from a random pool of two or more drivers, such as a consortium’s pool, and must name a consortium or third-party administrator to make the owner’s Clearinghouse reports (49 CFR 382.103 and 382.705).
3. Copy each broker’s rule into Part 4. Write the tests, the panel, the random rate, and where results go, from each broker agreement and handbook you hold. The table in “What brokers and states require” shows common ones.
4. Check your state’s law. Some states limit when you may test, what you may test for, and what you may do after a positive result. Read “State laws that limit testing” before you sign the policy.
5. Train supervisors. Anyone who decides on a reasonable suspicion test needs training first. DOT rules set at least 60 minutes on alcohol and 60 minutes on drugs (49 CFR 382.603 and 655.14).
6. Hand it out and get signatures. Give every covered driver a copy before testing starts, and give a copy to each driver you hire or move into a covered job. Each driver signs Part 15, and you keep the signed receipt (49 CFR 382.601). Minnesota also requires a posted notice that the policy exists and where to read it.
7. Send a copy to each broker that asks. MTM Health’s standard agreement requires a copy on request. CareOregon’s manual says you must send documentation of your policy to the brokerage when asked, and drivers may have to sign an attestation.
8. Review it every year and whenever a rule, a broker contract, or your fleet changes. File each driver’s paperwork in the driver file.

The template

Part 1: Policy details

Field	Entry
Company name
Effective date
Last reviewed
Version (DOT, non-DOT, or both)
DOT rules that apply (FMCSA, FTA, or none)
Person who answers questions about this policy, name and phone
Designated employer representative, name and phone
Backup representative, name and phone
Collection site, address and hours
After-hours collection site or mobile collector, phone
Laboratory
Medical review officer, name and phone
Consortium or third-party administrator, if any
Substance abuse professionals (DOT), names and phones
Employee assistance program or help line
Brokers, health plans, and facilities whose rules this policy follows

Part 2: Who this policy covers

Role	DOT rule that applies (FMCSA, FTA, or none)	Company rules apply (yes or no)
Drivers of vehicles that need a CDL
Drivers of sedans, minivans, and wheelchair vans
Attendants and escorts
Dispatchers
Mechanics and vehicle cleaners
Owners and managers who drive
Job applicants for any role above

Covered time starts when a person begins work or must be ready to work. It includes waiting for dispatch, inspecting the vehicle, driving, helping riders in and out, securing wheelchairs, and staying with a broken-down vehicle. It ends when the person is relieved of all duty.

Part 3: What is not allowed

1. Using alcohol while on duty, or in the 4 hours before duty.
2. Reporting for duty or staying on duty with an alcohol concentration of 0.04 or more. Under the DOT version, a result of 0.02 to 0.039 also means no covered work: for at least 24 hours under FMCSA rules, and for at least 8 hours or until a retest reads under 0.02 under FTA rules. Company limit for the non-DOT version: ______.
3. Using alcohol for 8 hours after an accident that requires a test, or until the test is done, whichever comes first.
4. Using, having, or selling illegal drugs while on duty, in a company vehicle, or on company property.
5. Working while impaired by any drug, including cannabis and any prescription or over-the-counter medicine.
6. Carrying alcohol, drugs, or unauthorized controlled substances in a vehicle.
7. Refusing a test, or tampering with, diluting, or substituting a specimen.

Part 4: When we test

Test	DOT version (federal rule)	Non-DOT version (write our rule and each broker’s)
Pre-hire	Drug test with a verified negative result before any covered work. An alcohol test is optional. If used, every new hire gets one, after a conditional job offer.
Random	Unannounced, spread through the year, each covered driver with an equal chance each time. Minimums for 2026: 50 percent of drivers for drugs and 10 percent for alcohol. The driver goes to the site at once when told.
Post-accident	See Part 5
Reasonable suspicion	Ordered by a trained supervisor from specific, current observations of appearance, behavior, speech, or body odor. Written record signed within 24 hours or before results come back, whichever is first.
Return to duty	After any violation, only after a substance abuse professional’s evaluation and a negative test. Collected under direct observation.
Follow-up	At least 6 unannounced tests in the first 12 months back, and up to 5 years, as the substance abuse professional sets. Collected under direct observation.
Yearly	Not required by DOT rules
Other (list)

Part 5: After an accident

What happened	FMCSA (CDL drivers)	FTA (transit contract work)	Our non-DOT rule
Someone died	Test the driver for alcohol and drugs	Test the driver and anyone whose work could have contributed
Someone was hurt and treated away from the scene	Test if the driver gets a moving violation citation for the accident within 8 hours (alcohol test) or 32 hours (drug test)	Test unless the driver’s performance can be completely ruled out, with the reason written down
A vehicle was towed away with disabling damage	Same as an injury	Same as an injury
Alcohol test deadline	Within 2 hours, or write down why. Stop trying at 8 hours and write down why.	Same as FMCSA
Drug test deadline	Within 32 hours	Within 32 hours

Driver steps after any accident:

1. Get help for anyone hurt and call 911. Medical care always comes first.
2. Call dispatch and the designated employer representative before leaving the scene, unless you leave to get help or emergency care.
3. Stay reachable. A driver who cannot be found for a required test may be treated as refusing it.
4. Drink no alcohol for 8 hours, or until tested.
5. Go to the collection site when told. Never drive yourself there after a serious accident. The company arranges the ride.

Accident record	Entry
Date, time, and place
Driver and vehicle
Injuries, treated away from the scene (yes or no)
Vehicle towed (yes or no)
Citation issued, and time
Test decision and reason, made by
Alcohol test time and result
Drug test collection time
Reason a test was late or not done
Broker told (who, when)

Part 6: Reasonable suspicion record (one per event)

Field	Entry
Date and time of the observation
Driver or employee name
Observed by (trained supervisor)
Appearance (eyes, balance, clothing)
Behavior (actions, reactions, driving)
Speech
Body odor, such as alcohol or cannabis
Tests ordered (alcohol, drugs, or both)
Removed from duty at (time)
Taken to the site by (never the employee driving)
Supervisor signature and date signed

Part 7: How we test

1. DOT tests use the federal custody and control form, an HHS-certified lab, and review by a medical review officer before we see a positive result.
2. Non-DOT tests use a separate collection and separate forms. The panel covers at least marijuana, cocaine, amphetamines, opioids, and PCP, or the broader panel a broker requires: ______.
3. Alcohol tests are done by a trained technician with a breath or saliva screening device. Any result of 0.02 or more is confirmed with a breath test.
4. We act on a drug test only after a confirmation test and review by the medical review officer. The employee may explain a positive result to the medical review officer.
5. Results go only to the designated employer representative, and to a broker or state when a contract or rule requires it: ______.
6. The company pays for every test it orders.

Part 8: What counts as a refusal

1. Not going to the site within the time the company sets after being told to, except for a pre-hire test.
2. Leaving the site before the test is done.
3. Not giving a specimen, or not giving enough without a medical reason.
4. Not allowing an observed or monitored collection when one is required.
5. Not cooperating: refusing to empty pockets, wash hands, or follow the collector’s instructions.
6. Having a device that could interfere with the collection.
7. A specimen the medical review officer reports as adulterated or substituted, or admitting to tampering.
8. After an accident, leaving without telling the company where you are, or not staying reachable.

A refusal has the same result as a positive test.

Part 9: After a positive result, a refusal, or a violation

1. The employee stops all covered work at once.
2. DOT version. The employee gets a list of substance abuse professionals. Covered work resumes only after the evaluation, any education or treatment, and a negative return-to-duty test. Follow-up tests come after that. For CDL drivers, we report what the Clearinghouse rules require, such as refusals and alcohol results of 0.04 or more, by the close of the third business day.
3. Non-DOT version. The employee does no broker, plan, or facility trips while any contract bars it: ______. Other duties or discipline follow state law and this policy: ______.
4. Brokers are told when a contract requires it: ______.
5. An employee with an alcohol result from 0.02 to 0.039 follows Part 3.

Part 10: Prescription and over-the-counter medicine

1. Tell your supervisor before duty about any medicine that could affect your driving, and do not drive until cleared.
2. You may drive on prescribed medicine only when your medical provider confirms in writing that it will not affect safe driving.
3. Keep medicine in its original container. Never take medicine prescribed to someone else.
4. The company keeps medical notes confidential and separate from your general personnel file.

Part 11: Reporting drug and alcohol offenses

1. Tell the company of any arrest, charge, or conviction for a drug offense or for driving under the influence, within ______ of it happening and before your next shift.
2. The company reviews it the same day and may remove you from driving while it is pending.
3. The company tells each broker as its contract requires: ______.
4. The company writes down each report and the action taken.

Part 12: Records and privacy

1. Test records stay in a locked file or secure system with controlled access, apart from the general personnel file.
2. Results are released only to people this policy names or with the employee’s written consent, unless law requires otherwise.
3. Records are kept for the periods in the table at the end of this page, or longer if a contract requires.

Part 13: Help for employees

1. Alcohol and drug misuse harms health, work, and family life. Warning signs include missed shifts, mood swings, unsafe driving, and the smell of alcohol.
2. If you think you or a coworker has a problem, talk to ______ or call the help line in Part 1.
3. SAMHSA’s National Helpline is free and confidential, day and night, at 1-800-662-4357.
4. What happens when an employee asks for help before any test or violation (write our rule): ______.

Part 14: Training record

Name	Role	Training	Minutes	Date	Trainer

Part 15: Employee acknowledgment

I received a copy of this policy, had the chance to ask questions, and agree to follow it.

Name	Role	Date received	Signature

What the DOT version must include

The FMCSA rule lists 12 topics your written materials must cover (49 CFR 382.601, as of September 2026). They include the person who answers questions, which drivers are covered, the covered part of the day, prohibited conduct, when tests happen, how tests are done, what counts as a refusal, and the consequences of a violation and of a 0.02 to 0.039 result. They also include information on the effects of alcohol and drugs and ways to get help, and the list of results reported to the Clearinghouse. Any company rule that goes beyond part 382 must be clearly labeled as your own. Each driver signs a certificate of receipt.

The FTA rule requires a policy statement adopted by your governing board, with 10 items (49 CFR 655.15). Covered employees get at least 60 minutes of training on the effects and signs of drug use, and you display and hand out information and a help line number, if one is available (49 CFR 655.14). You must tell employees before each test that it is required by part 655 (49 CFR 655.17).

Three more duties apply to FMCSA drivers:

• Clearinghouse queries. Run a full query, with the driver’s consent, before the first covered work, and a query on every covered driver at least once a year. A limited query can meet the yearly rule. Keep each query record for 3 years (49 CFR 382.701).
• Clearinghouse reports. Report alcohol results of 0.04 or more, refusals, negative return-to-duty results, completed follow-up testing, and alcohol or drug use you have actual knowledge of, each by the close of the third business day. The medical review officer reports verified positive drug results (49 CFR 382.705).
• Previous employer checks. With written consent, get the testing history from DOT-regulated employers of the last 2 years, within 30 days of the first covered work. FMCSA employers use the Clearinghouse for this, and still ask employers regulated by other DOT agencies directly (49 CFR 40.25).

Random rates: FMCSA’s minimums for 2026 are 50 percent for drugs and 10 percent for alcohol. They change only when FMCSA announces a new rate in the Federal Register, and the last drug rate change, from 25 to 50 percent, took effect in 2020 (49 CFR 382.305). FTA set the same rates for 2026 in its notice of January 15, 2026.

What brokers and states require

Program	What it requires	Date of the rule
MTM Health, standard agreement	A written substance free workplace policy with pre-employment, post-accident, reasonable suspicion, and random tests at current FTA rates. A copy goes to MTM on request. A refusal counts as a positive result, and a driver who tests positive may not transport members. No positive test and no treatment for addiction in the past 5 years. Suspected impairment means removal and a test at your expense.	Version dated January 1, 2023, as Pennsylvania posts it
MTM Health, Rhode Island	A verifiable five-panel program with pre-employment, post-accident, and random tests covering more than 25 percent of drivers each year	Handbook updated July 1, 2026
Louisiana Medicaid	A five-panel screen every year and on reasonable suspicion, with results sent straight to the broker. A failed screen needs a substance abuse professional’s clearance, then three follow-up screens over 6 months. The crash report due within 72 hours includes a drug screen done within 12 hours.	Sections 10.3 and 10.4, issued July 14, 2025
CareOregon	A drug-free workplace with an anti-drug policy and awareness program. Suspected drivers are tested at the provider’s expense, and a refusal or positive result disqualifies the driver.	Manual version 1.3, February 2024
Texas Medicaid health plans	A drug and alcohol testing program that follows 49 CFR parts 40 and 655, run by the plan or its transportation subcontractor	Uniform Managed Care Manual 16.4, version 2.0.1, August 1, 2021
Georgia Medicaid	Remove a driver at once when you suspect driving under the influence. No driver with a drunk or drugged driving conviction in the 5 years before hire.	Part II NEMT manual, version dated July 1, 2026
Verida	Current drug screens for all owners and drivers, as a contracting document	Provider credentialing page, as of September 2026
Modivcare	A passed drug screening test for each driver	Provider requirements page, as of September 2026

Georgia and New York also bar drivers from using alcohol, narcotics, illegal drugs, or drugs that impair them while on duty, and from abusing alcohol or drugs at any time (New York manual effective August 25, 2023). The Texas rule names the DOT procedures, yet part 40 bars DOT tests on people DOT rules do not cover. Ask the plan in writing how it wants the program set up. For how each broker credentials drivers, see NEMT driver requirements and NEMT policies and procedures.

State laws that limit testing

For DOT-covered drivers, the federal rules override a state law that makes following them impossible or stands in their way (49 CFR 382.109 and 655.6). For everyone else, state employment law shapes the non-DOT version. Three examples, as of September 2026:

• California. Employers may not penalize a person for off-duty cannabis use away from work, or for a test that finds nonpsychoactive cannabis metabolites. Pre-hire tests that do not screen for those metabolites are allowed, and employers may not ask applicants about past cannabis use. Laws that require testing are not affected (Government Code 12954, operative January 1, 2024).
• New York. Employers may not test for cannabis unless federal or state law requires it or Labor Law 201-d allows it, and a cannabis test alone cannot prove impairment. Action for impairment must rest on specific, articulable symptoms (Department of Labor guidance P420, October 2021).
• Minnesota. Testing must follow a written policy with six required topics, and random tests are limited to safety-sensitive jobs, where impairment would threaten anyone’s health or safety. You may not discipline anyone over an unconfirmed screen. While the confirmation is pending, you may suspend the person or move them to another job at the same pay if you believe it is needed for safety, and a person suspended without pay gets back pay if the result is negative. You may not fire an employee for a first confirmed positive without first offering counseling or treatment, at the employee’s cost or through a benefit plan (Minnesota Statutes 181.950 to 181.953).

Once you have 15 or more employees, federal disability law applies and adds two points. A test for illegal drugs is not a medical exam under that law (42 U.S.C. 12114), but the EEOC treats an alcohol test as one, so an applicant’s alcohol test waits for a conditional job offer. Past addiction is protected when the person no longer uses illegal drugs, so get advice before you apply a broker rule about past treatment.

How long to keep testing records

Record	How long	Rule
Positive drug results, alcohol results of 0.02 or more (FMCSA), refusals, substance abuse professional referrals	5 years	49 CFR 382.401; FTA, 655.71
Collection process records, including random selection and suspicion and accident decisions	2 years	49 CFR 382.401; FTA, 655.71
Negative and canceled drug results, alcohol results under 0.02	1 year	49 CFR 382.401; FTA, 655.71
Supervisor and driver training records (FMCSA)	While the person does the work, plus 2 years	49 CFR 382.401
Previous employer testing history	3 years from the first covered work	49 CFR 40.25
Clearinghouse queries and responses	3 years	49 CFR 382.701
All records of your operations under the agreement	10 years	MTM Health standard agreement

What may change in 2027

• Fentanyl. DOT proposed adding fentanyl and norfentanyl to its drug panel on September 2, 2025. As of September 2026 it was still a proposal. If it becomes final, update Part 7 and ask your lab when its panel changes.
• Saliva tests. DOT has allowed oral fluid tests since 2023, but no lab was certified for them on HHS’s list of September 1, 2026. A DOT rule effective June 10, 2026 requires a directly observed urine collection wherever part 40 calls for an oral fluid test that cannot yet be done.
• Random rates. FMCSA and FTA announce rate changes in the Federal Register, and a new rate applies from January 1 of the next year. Check the 2027 rates before January 1, 2027, and update Part 4.

For what to do after a crash, pair this policy with the incident report form. For the rest of your written rules, see NEMT policies and procedures.