NEMT Passenger Conduct Policy Template: Rider Rules, Driver Steps, and ADA Limits

Most rides go fine because riders know what to expect. A written conduct policy puts the rules in one place: what riders may bring, how they ride, and what happens when a rule is broken. It also keeps your drivers from making up rules on the spot, which is how a company ends up refusing a ride the law says it must give. Use this template to set rider rules that match your broker contracts, give drivers clear steps, and stay inside federal ADA limits.

How to use this template

1. Pull the rider rules from every contract you hold. Broker handbooks, health plan contracts, and facility agreements all set rules on escorts, children, food, and extra stops. Write each payer’s rules into Part 2.
2. Let the payer’s rule win on its trips. Your own rules cover private pay riders and anything a broker leaves out.
3. Fill in Parts 1 and 2, then check Part 3 against Part 2. Cross out any rider rule in Part 3 that a payer’s rule overrides.
4. Give riders Part 3. Hand it to private pay riders and facilities before the first ride, keep a copy in each vehicle, and post the no-smoking and personal items notices inside.
5. Train drivers on Parts 4, 5, and 6. Have each driver and dispatcher sign Part 9.
6. Keep a Part 7 record for every ride stopped, refused, or cut short because of a broken rule, and send the broker its report.
7. Review the policy each time a broker updates its handbook, and write the new date in Part 1.

For handling the behavior itself, see difficult NEMT passengers. For the full federal picture, see ADA requirements for NEMT.

The template

Part 1: Policy details

Field	Entry
Company name
Effective date
Last reviewed
Policy owner, name and phone
Dispatch number drivers call when a rule is broken
Complaint line for riders and families
Applies to	Riders, escorts, attendants, drivers, and dispatchers

Part 2: Rider rules by payer

One row for each broker, health plan, and facility you drive for, copied from its contract. The last row is your own rule for private pay riders.

Payer	Escorts allowed	Children: age rule and who brings the car seat	Food and drink	Bags and items	Extra stops	Report a broken rule to, and by when
Private pay (our rule)

Part 3: Rules for riders

Hand this part to riders, escorts, and facilities. It is written to the rider.

Before your ride

1. Tell the booking line about anything or anyone coming with you: a wheelchair, walker, or scooter, oxygen, a service animal, a car seat, or an escort.
2. Be ready at your pickup time, and wait at the main door.
3. One escort may ride with you when your ride plan allows it. Any other passenger needs approval when the ride is booked.
4. Children ride with an adult and in the right car seat or booster seat, as your program’s rules say.

In the vehicle

5. Wear your seat belt the whole ride. If you ride in a wheelchair, the driver secures it before the vehicle moves. Ask for help with a buckle or for a seat belt extender at any time.
6. Stay seated and belted until the vehicle stops.
7. Do not smoke, vape, or chew tobacco.
8. Do not bring or use alcohol or illegal drugs.
9. Do not bring a weapon of any kind, including a gun carried with a permit.
10. Do not bring fuel, fireworks, or other dangerous items. Your own medical oxygen is welcome, and the tank rides secured so it cannot roll.
11. Keep food and drinks closed. If you need to eat, drink, or take medicine for your health, you may.
12. Keep bags on your lap or beside you. The driver is not responsible for items left in the vehicle.
13. The driver goes only to the stops on your trip. To add a stop, such as a pharmacy, ask the booking line.
14. Treat the driver and other riders with respect. No threats, harassment, sexual comments or touching, or bullying.
15. Please do not offer the driver money or gifts.
16. Your service animal is welcome at no extra charge. Keep it under your control during the ride.

If there is a problem

17. If a rule is broken, the driver will stop in a safe place and call our dispatch. We report problems to the program that booked your ride.
18. We never refuse or end a ride just because a disability affects how someone looks, sounds, or acts.
19. To make a complaint, call the number in Part 1 or your program’s member line. No one will be punished for complaining.

Part 4: What drivers check before the vehicle moves

Check	Done
Every rider and escort is belted, with an extender for anyone who needs one
Every wheelchair or scooter is secured, and its rider has a lap and shoulder belt
Every child is in the right car seat or booster seat, and no child seat is in the front seat
The riders on board match the trip: the member plus the escorts the trip allows
Any oxygen tank is secured so it cannot shift or roll
A service animal is on the floor or the rider’s lap, under the rider’s control
“No smoking” and “not responsible for personal items” notices are posted inside
No rider is left alone in the vehicle at any stop

Part 5: When a rule is broken

What happens	Driver’s first step	If it keeps happening	Never
A rider will not wear a seat belt	Do not start the trip. Explain the rule and offer help or an extender.	Call dispatch before leaving. The trip may be refused.	Drive with an unbelted rider
A rider unbuckles during the ride	Ask the rider to buckle up	Pull over in a safe place, stop until the belt is on, and call dispatch	Keep driving
No car seat, or the parent will not use it	Do not load the child	Call dispatch and follow Part 2 for that payer	Hold a child on a lap
Smoking or vaping	Ask the rider to put it out	Pull over safely and call dispatch. Some brokers want a call right away.	Keep driving with smoke in the vehicle
Eating or drinking	Ask the rider to close it, unless it is for a health need	Let the rider finish if it is for health	Refuse a rider who needs to eat for a medical reason
Alcohol or drug use, or a rider who seems intoxicated at pickup	Do not load, or pull over safely	Call dispatch before going on	Argue or lecture
A weapon is shown or mentioned	Do not load or move the vehicle. Get out of reach.	Call 911, then dispatch	Try to take it
Rude words or yelling with no threat	Stay calm and finish the ride	Report it after the ride	Threaten to end the ride
Shouting, swearing, or confusion caused by a disability	Keep going and stay patient	Tell dispatch if the rider may need an attendant next time	Refuse or end the ride for it
Threats, grabbing, or sexual touching	Pull over in a safe, public place and get out of reach	Call 911 if anyone is in danger, then dispatch	Leave the rider on the roadside
A request for an extra stop	Say no politely	Dispatch can ask the broker to add a stop	Make the stop anyway
An extra passenger not on the trip	Do not load them yet	Call dispatch to check with the broker	Carry an unbooked rider

Part 6: What we never do

1. Refuse or end a ride only because a disability affects how a rider looks, sounds, or acts.
2. Require a rider with a disability to bring an attendant, unless we could lawfully refuse the ride and the attendant is the condition that lets it go ahead.
3. Charge extra for a wheelchair, a lift, a service animal, or other help a rider needs because of a disability.
4. Turn away a wheelchair because it is hard to secure, or make a rider move out of a wheelchair into a seat.
5. Turn away a rider’s oxygen, respirator, or service animal.
6. Refuse a rider because our insurance company would prefer it.
7. Bill a Medicaid rider for anything, unless the program authorizes a copay. We look only to the broker or program for payment.
8. Stop taking a Medicaid rider’s trips on our own. We report to the broker and follow its decision.

Part 7: Conduct incident record (one per stopped, refused, or shortened ride)

Field	Entry
Date and time
Trip or confirmation number
Payer
Rider (and escort) names
Where it happened
The rule broken, in the driver’s words
Exact words of any threat, in quotation marks
What the driver did, step by step, with times
Dispatcher called, and time
911 called? Time and report number
How the ride ended (completed, stopped, refused)
Broker told: how, when, reference number
Witnesses
Driver name and signature

Part 8: Rider acknowledgment (private pay riders and facilities)

Rider or facility	I received the rules in Part 3	Signature	Date

Part 9: Staff sign-off

Name	Role	Date trained	Signature

What the ADA allows, rule by rule

The Department of Transportation’s ADA rules in 49 CFR part 37 cover private companies primarily in the business of carrying people (37.5(f)), so they apply to every ride you give, whoever pays. Any rider rule you write has to fit inside them.

Your rule	Allowed?	The limit	Rule
Refuse a rider for violent, seriously disruptive, or illegal conduct, or a direct threat	Yes	Never solely because a disability causes an appearance or involuntary behavior that offends or annoys	49 CFR 37.5(h)
Wheelchairs must be secured	Yes	You may not deny the ride because the chair cannot be secured well by your system	37.165(c)(3) and (d)
Riders in wheelchairs should move to a seat	Only as a suggestion	You may recommend a transfer but not require it	37.165(e)
Riders must bring an attendant	No	Allowed only as a condition of a ride you had the right to refuse	37.5(e) and Appendix D
An extra fee for a wheelchair or a service animal	No	No special charges for services needed to accommodate a disability	37.5(d)
No animals	Pets only	Service animals must be allowed	37.167(d)
No hazardous materials	Yes	Not a respirator or portable oxygen, under the federal hazardous materials rules	37.167(h)
No eating or drinking	Yes, as a general rule	Grant a request to eat or drink to avoid health problems, and to take medicine	Appendix E
Refuse riders your insurer does not want	No	Insurance terms are never a reason to refuse	37.5(g)

A direct threat is a high bar. It means a significant risk to the health or safety of others that cannot be removed by changing a policy or practice or by providing an aid or service (49 CFR 37.3). The Department’s own example of what is not one: some people with Tourette syndrome make involuntary profane outbursts, and that is no ground to refuse the ride (Appendix D to part 37).

Drivers also help. When a rider needs it or asks, drivers assist with securement, ramps, and lifts, leaving their seat to do it (49 CFR 37.165(f)), and they give riders enough time to board and get off (37.167(i)).

Service animals

The transportation rules define a service animal as any guide dog, signal dog, or other animal individually trained to work or perform tasks for a person with a disability (49 CFR 37.3). When the animal’s job is not obvious, the Justice Department’s rule, which private transportation companies follow under 49 CFR 37.5(f), allows only two questions: is the animal required because of a disability, and what work or task has it been trained to perform. You may not ask for proof of training. You may ask that the animal be removed only if it is out of control and the handler does not take effective action, or if it is not housebroken (28 CFR 36.302(c)). Caring for the animal is the rider’s job, not the driver’s (Appendix E). The service animals in NEMT guide covers the details.

Oxygen

You may not bar a rider from traveling with a respirator or portable oxygen (49 CFR 37.167(h)). Under the federal hazardous materials rules, a passenger’s oxygen cylinder carried as a material of trade must be securely closed, secured against shifting, and protected against damage (49 CFR 171.8 and 173.6(b)(1)). The rider runs it. Georgia’s manual (July 1, 2026) makes members responsible for supplying and giving their own oxygen during the ride, because vehicles and drivers are not equipped to do it, and Virginia’s MTM Health member handbook (June 2026) says drivers do not help with oxygen, so a rider on an ambulatory or wheelchair trip must be able to manage it alone. See transporting riders with oxygen.

Escorts, children, and car seats by program

These rules differ more than any others, so check the program on each trip. The rules below are the written ones as of September 2026.

Program	Escorts	Children	Car seats
MTM Health standard agreement (January 1, 2023 version Pennsylvania posts)	The member and one escort or attendant, as requested. More need MTM’s prior approval.	Set by the program	The driver must deny the ride if the proper seat is missing or refused, and never puts a child seat in the front seat
Virginia Medicaid fee-for-service, MTM Health (member handbook updated June 23, 2026)	One additional passenger, told to MTM Health at booking	12 and under ride with an adult who is at least 18, unless it is the parent. 13 to 17 may ride alone with a Minor Consent Form.	The family supplies car and booster seats
Georgia Medicaid (manual dated July 1, 2026)	One escort at no charge for members who are under 18, live in a nursing home, are blind or deaf, or have a mental disability, or as the state decides. The escort must be of legal age.	Under 18 ride with an escort, provided by a parent, foster parent, caretaker, legal guardian, or the state’s child welfare division. The broker may let an extra child ride if a seat is free.	Children under 8 ride in a child safety seat or booster. The broker must have enough providers with seats and cannot deny a ride because the family has none.
Texas Medicaid health plans (UMCM 16.4, version 2.0.1, August 1, 2021)	An adult member needs documentation for an attendant. A parent, guardian, or legal representative of a member under 18 needs none.	14 and under ride with a parent, guardian, or an adult the parent authorizes in writing. 15 to 17 also, unless they present a parent’s signed consent before the trip or the visit is care the law lets a minor keep confidential.	Drivers may not install a seat. A missing seat, or one the parent cannot install, cancels the trip as a member no-show.
Ride programs CareOregon manages in Oregon (manual version 1.3, February 2024)	Attendants ride at no charge	12 and under must have an attendant the parent or guardian provides: a parent, grandparent, guardian, or another adult of 18 or older the parent authorizes	The family provides and installs the correct seat. Drivers may not carry a child who needs one without it, and tell the brokerage.
Florida transportation disadvantaged program (Rule 41-2.006, effective September 3, 2018)	Set in each local service plan	Set in each local service plan	Who supplies and pays for child restraints is set in the local plan

Two lines run through most of them. A child never rides without the right seat, and a child never rides alone below the program’s age line. When a trip arrives without the seat or the adult it needs, the driver does not improvise. Dispatch calls the broker. For more, see transporting children in NEMT and escorts and caregivers.

Food, smoking, weapons, and belongings: what programs write

Topic	What programs require	Source and date
Food and drink	Virginia members may not eat or drink in the vehicle. CareOregon members keep food and drinks closed, with exceptions to manage health conditions.	MTM Health Virginia member handbook, June 2026. CareOregon manual, February 2024.
Smoking and vaping	Under MTM Health’s agreement, drivers must not let members smoke, use e-cigarettes, or vape, and every vehicle posts a “NO SMOKING” sign. Georgia bans smoking for passengers and staff, and drivers contact the broker immediately if a passenger will not stop. Florida bans smoking in any vehicle in its transportation disadvantaged program.	MTM agreement 3.E, January 1, 2023. Georgia manual section 911, July 1, 2026. Florida Rule 41-2.006.
Weapons and dangerous items	MTM Health’s agreement bars drivers from allowing firearms, other weapons, unauthorized controlled substances, or highly combustible materials in the vehicle. Virginia members may not bring a weapon of any size or kind, including guns carried with a permit.	MTM agreement 3.O. MTM Health Virginia member handbook, June 2026.
Belongings	Virginia members keep everything on their lap or beside them. Under MTM Health’s agreement, drivers take no responsibility for personal items, and a notice inside says so. Florida allows the property the rider or driver can carry in one trip and stow safely, at no charge. Wheelchairs, child seats, and secured oxygen do not count toward it.	MTM Health Virginia member handbook. MTM agreement 3.P. Florida Rule 41-2.006.
Extra stops	Virginia drivers make no stops beyond the reservation, such as fast food or shopping. A pharmacy stop is booked with the ride or added through MTM Health. CareOregon members request extra stops from the brokerage in advance.	MTM Health Virginia member handbook. CareOregon manual.
Behavior	Virginia does not tolerate profane or vulgar language aimed at the driver or other riders, sexual advances or harassment, or bullying. Georgia warns that violent or disruptive behavior may bring suspension or termination from the program.	MTM Health Virginia member handbook. Georgia manual section 811.5.

Some cities write rider rules into the NEMT permit. Portland’s code bars NEMT drivers from letting a passenger drink alcohol or use another intoxicant, smoke, or vape in the vehicle. It also bars refusing to take a passenger of proper demeanor to a destination within Portland once the ride was accepted (City Code 16.40.780).

Drivers keep the same rules. MTM Health’s agreement bars drivers and attendants from eating or drinking in the vehicle or in front of members, and from leaving a member alone in the vehicle (sections 3.F and 2.JJ). Texas bars drivers from soliciting or accepting money or goods from members (UMCM 16.4, section 2550). Put the driver side in your NEMT driver handbook.

When a Medicaid rider keeps breaking the rules

Your job is the record and the report. MTM Health’s agreement requires you to report incidents during a member’s transport and to cooperate with the investigation (section 2.BB). CareOregon wants every incident on a member’s ride reported within 24 hours, and written notice right away when anyone is hurt or the driver is accused of abuse. Write what was seen and heard, not what was felt. Use the NEMT incident report form or Part 7 above.

What happens next belongs to the broker or the state. CMS lists steps a state may take when a rider’s past conduct affected a driver’s ability to drive safely (SMD 23-006, September 28, 2023):

• limiting the rider to one provider willing to handle the extra challenges,
• requiring a specialized transport suited to the rider’s behavior and needs,
• special prior authorization steps to arrange rides,
• letting the rider arrange their own ride as a reasonable accommodation, or
• consulting the rider’s doctors and behavioral health providers.

Before limiting rides in any way, CMS says the state should send the rider a letter describing the efforts made and the behavior behind the change.

States put this into practice in their own ways:

• Georgia. After a complaint about a member’s abusive behavior or misconduct, the broker sends a warning letter by certified mail. After two warnings, it sends a denial letter with review and appeal rights. Rides continue during the appeal unless the member keeps up documented unsafe or unacceptable behavior (manual Appendix L, July 1, 2026).
• Oregon. CareOregon expects drivers to finish scheduled rides, even with a verbally abusive member, unless the driver has a credible fear of not being able to carry the member safely. Drivers may not force a member out, or threaten not to finish the ride, over verbal behavior that is not threatening. You may ask the brokerage not to carry a verbally abusive member again, and it honors reasonable requests. The brokerage may change how a risky rider travels, such as a set provider or an attendant, but the change may not be a denial of service (manual version 1.3, February 2024).

Private pay riders are yours to manage. You set the rules, put them in Part 3 and Part 8, and decide what happens after a broken rule, within the ADA limits above. For complaints from any rider, see broker rider complaints.