NEMT Rider Satisfaction Survey: A Free Rider and Facility Feedback Form

Brokers and health plans already grade your service. They count late pickups, complaints, and failed inspections, and some ask riders directly. CMS says in its Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) that the state, the broker, and the transportation company should all watch rider complaints about courteous drivers, clean vehicles, and timely rides. A short survey of your own riders and the clinics they visit shows you the same picture first, while there is still time to fix it.

How to use this template

1. Decide who you may ask. Private pay riders and facility staff are your own contacts. For broker riders, get the broker’s written approval first. The rules are under “Who you may survey” below.
2. Fill in the blanks before you print. Write your company name and phone number on Part 1, and the broker’s complaint number for each program you serve. A rider who is unhappy should always see how to complain to the ride program, not only to you.
3. Survey the same way every month. Pick one method, such as a card handed out at drop-off during the first full week of each month, so one month’s numbers compare with the next.
4. Make it easy to answer. Offer a return envelope, large print, and the questions read aloud by office staff for riders who ask. Mercy Care in Arizona requires that its transportation services consider each member’s and family’s language and cultural preferences, so print the survey in the languages your riders speak.
5. Keep it anonymous unless the rider wants a call. The name and phone lines in Part 1 are optional. Only ask for them so you can call the rider back.
6. Read every survey the day it comes back. Any No answer or complaint in the comments goes on Part 4 and into your complaint log, then to the broker under its rules.
7. Count the month in Part 3. Divide the Yes answers by the surveys answered for each question. Compare the result with your broker’s standards in the table further down.
8. Share the results with drivers and dispatch. Mercy Care requires its transportation providers to share quality results with all levels of staff and use them to improve service. Praise drivers by name when riders do, and retrain when the same problem repeats.

The template

Part 1: Rider survey

Field	Write the entry here
Company name and phone
Date of your ride
Pickup time, if you remember
Type of ride (sedan, wheelchair van, stretcher van)

Question	Yes	Mostly	No
1. Were you picked up on time?
2. Did you get to your appointment on time?
3. Was your wait for the ride home reasonable?
4. Was the driver polite and respectful?
5. Did the driver give you the help you needed getting in and out?
6. Did you feel safe during the ride?
7. Was the vehicle clean?
8. Was the vehicle a comfortable temperature?
9. When you called us, did someone answer and help you? (Leave blank if you did not call.)
10. Would you ride with us again?

Field	Write the entry here
Overall, how was your ride? (1 poor to 5 excellent)
What should we do better?
Would you like a call back? Your name and phone (optional)
To make a complaint to your ride program, call

Part 2: Facility survey

For staff at dialysis centers, clinics, hospitals, and nursing homes whose patients ride with you. Ask about the service in general, and leave patient names off the form.

Field	Write the entry here
Facility name
Your name and role
Date
About how many of your patients ride with us each week

Question	Yes	Mostly	No
1. Your patients arrive in time for their appointment or chair time.
2. We pick your patients up within a reasonable wait after treatment.
3. Our dispatch lets you know when a driver is running late.
4. Our drivers are courteous to your staff and patients.
5. Our drivers bring patients to the right place, including hand to hand when required.
6. We handle wheelchairs, stretchers, and walkers safely.
7. It is easy to book, change, or cancel a ride with us.

Field	Write the entry here
Overall rating (1 poor to 5 excellent)
What should we do better?
Best person and phone for a follow-up call

Part 3: Monthly tally

Question	Surveys answered	Yes	Mostly	No	Share yes (Yes divided by answered)
Picked up on time
Arrived on time
Reasonable wait for the ride home
Polite driver
Right help in and out
Felt safe
Clean vehicle
Comfortable temperature
Phone answered
Would ride again
Facility overall rating of 4 or 5

Part 4: Follow-up on negative answers

Survey no.	Date received	What the rider or facility said	Complaint log no.	Broker told (date, name)	Fix made	Person told of the fix (date)

Who you may survey

Broker riders need the broker’s written approval. MART’s provider standards in Massachusetts (Attachment G, revised July 1, 2025) bar contact with a rider or caregiver for anything other than trip information. Surveys and complaint investigations need prior written approval from MART, and from the facility when there is one. MTM Health’s Rhode Island handbook (last updated July 1, 2026) bars drivers from contacting members for any purpose other than completing the trip. MTM’s standard provider agreement, in the January 1, 2023 version Pennsylvania posts, requires member information to be used only as needed to perform the agreement.

HIPAA points the same way. It lists quality assessment and improvement as a health care operation (45 CFR 164.501), but if you work under a broker’s business associate agreement, you may use rider information only as that agreement allows (45 CFR 164.502(a)(3)). Ask the broker in writing, and ask whether it will share its own survey results for your trips instead. For the rest of HIPAA, see HIPAA for NEMT.

Private pay riders and facilities are yours to ask. Survey facility staff about the service, not about named patients. Their answers also help when you pitch or renew a facility contract.

Keep thank-you gifts small. Federal law penalizes gifts that are likely to sway a Medicaid or Medicare rider toward a provider. HHS OIG’s policy statement (December 7, 2016) allows items worth no more than $15 each and $75 a year per rider, and never cash or cash equivalents. OIG counts a general purpose debit card as a cash equivalent, but not a gift card that works only at certain stores or for one purpose, such as gas. Broker rules can be stricter: MTM Health’s Rhode Island handbook bars drivers from giving members food or drinks. See anti-kickback rules for NEMT before you offer anything.

What brokers and health plans measure

Survey questions work best when they match the scorecard. These programs publish what they measure, as of September 2026:

Program	What it measures	Standard
Mercy Care, an Arizona Medicaid health plan (provider manual, July 2026)	Transportation providers collect and analyze member satisfaction and report results to Mercy Care	At least 85 percent member satisfaction; fewer than 3.5 complaints per 1,000 trips a month; average drop-off under 60 minutes before the appointment; average wait under 60 minutes after it
MTM Health in Virginia (handbook, May 2026)	A field monitor reviews each metric with the provider	On-time over 95 percent; substantiated complaints under 0.1 percent of completed trips; a quarterly on-time incentive at 95 percent or higher
Texas Medicaid health plans (UMCM 16.4, effective August 1, 2021)	The state’s external quality review organization surveys members every year	A corrective action plan within 30 days when satisfaction falls under 95 percent in a service area
Georgia brokers (DCH manual, July 1, 2026)	An independent agent runs a customer satisfaction survey every year	Results and method due to DCH by July 31 after each state fiscal year
Kentucky regional brokers (HB 2, Acts 2026, chapter 179, law since April 14, 2026)	The law requires a 2 percent capitation withhold that brokers earn back through performance measures	Measures must include rider satisfaction, delayed trips, completed trips, and time to schedule
CareOregon (manual, February 2024)	Brokerages audit a sample of every provider’s trips	Audits review pickup and drop-off times, level of transport, claims, and member satisfaction
MART in Massachusetts (July 1, 2025)	Providers verify the trips they bill	Verification can include random surveys of destination facilities and of riders, including rider surveys on pickup and drop-off times and quality of service

Texas also has each provider-owned vehicle display a “How is my driving?” sticker with a phone number for the public. Virginia requires the complaint procedure to be posted inside every vehicle, with a written copy for riders who ask. A survey card adds a third channel you control. For how brokers score providers, see NEMT broker scorecards.

Federal rules reach health plans too. Starting with the first contract rating period that begins on or after July 9, 2027, states must use the results of an annual enrollee experience survey when they monitor their Medicaid health plans (42 CFR 438.66, as amended May 10, 2024). It does not apply to NEMT PAHPs, the NEMT-only prepaid plans some states use as brokers (42 CFR 438.9), but it does cover health plans that include rides among their benefits.

When a survey answer is a complaint

A No on your survey is often a complaint under your broker’s rules. Federal managed care rules define a grievance as dissatisfaction with anything other than a benefit decision, including rudeness and the quality of service, whether or not the person asks for a fix (42 CFR 438.400). CareOregon’s manual is broader still and treats any expression of dissatisfaction as a grievance. When a rider is unhappy, its providers must:

1. Tell the rider of the right to file a grievance or complaint.
2. Explain how to file it.
3. Report the dissatisfaction to the brokerage.

Georgia’s NEMT manual (July 1, 2026) counts dissatisfaction with a vehicle’s appearance, cleanliness, or function, and with drivers, as complaints. It also requires any vehicle with two or more rider complaints about cleanliness, heating, air conditioning, or other problems within five days to be inspected, with the fix documented in the vehicle’s record. Texas goes further: a vehicle with two substantiated complaints about cleanliness, temperature, or other problems within 10 days comes off demand response rides until the health plan documents the fix (UMCM 16.4). MTM Health in Virginia assesses 2 infraction points for a complaint about a vehicle safety problem, such as a torn seat belt or broken air conditioning or heat.

Never let a survey stand in for the rider’s right to complain. MTM Health’s Rhode Island handbook bars drivers from discouraging complaints, including by refusing to give contact information, and CareOregon bars retaliation against anyone who complains. The complaint line on Part 1 keeps that door open. For deadlines and proof, see broker rider complaints and member grievance.

What the numbers usually show

Published NEMT surveys give you a benchmark:

Survey	Who answered	Results
CareOregon’s 2024 evaluation of NEMT for Health Share of Oregon members	14 percent of members in 2024, up from 6 percent in 2021	74 percent mostly or very satisfied; 96 percent felt safe with their driver; 86 percent said the pickup window got them to appointments on time
rabbittransit in Pennsylvania, 2025 shared ride survey (in the state’s June 25, 2026 broker study)	381 riders, chosen at random	92 percent satisfied; drivers rated 95 percent for being safe, skilled, and friendly; 26 percent unhappy with phone answer times and return-trip waits
Freedom Transit in Washington County, Pennsylvania, 2025 (same study)	About 300 of more than 2,700 recent riders	96 percent satisfied; the top request, from 30 percent, was shorter return-trip waits
Modivcare in Philadelphia, 2023 to 2025 (same study)	Broker performance reports	About 82 percent satisfaction and about 1.9 complaints per 1,000 trips

The same complaint shows up twice: the wait for the ride home. That is why question 3 is on the form. If it scores low, look at how dispatch handles will-call trips, and see how to improve on-time performance. For how drivers and dispatchers handle riders day to day, see NEMT customer service.