# NEMT Subcontractor Agreement Checklist: Terms to Settle Before You Share Trips

Canonical URL: https://nemtguide.com/templates/nemt-subcontractor-agreement-checklist/ · Updated 2026-09-30

A NEMT subcontractor agreement checklist lists what two transportation companies must settle in writing before one runs the other's trips: the payer's written consent, credentialed drivers and vans, insurance, trip records and billing deadlines, pay, a HIPAA business associate agreement, audits, and how the deal ends. It is not a contract. Use it to brief the lawyer who drafts one.

- Get the payer's written consent first. MTM Health and WellTrans require it, and New York Medicaid does not allow subcontracting at all.
- Every driver and van on the prime's trips must be credentialed with the payer, or the trip may go unpaid.
- The prime stays answerable to its payer, so the payer's insurance, records, and reporting rules pass down to the subcontractor.
- Sign a HIPAA business associate agreement before any rider details change hands, and match the payer's breach reporting clock.
- Count the pay date from the day complete trip records arrive, because late records can push the prime past its filing limit.

When one NEMT company runs another's trips, the company that holds the payer contract is the prime and the one driving is the subcontractor. The paper between them has to carry every promise the prime made to its broker, health plan, or facility. This checklist lists those terms in the order a lawyer drafts them, with a blank for what the two companies agree.

## How to use this template

1. **Do Part 1 before you talk about rates.** If the payer does not allow subcontracting, stop there. [Subcontracting NEMT trips](https://nemtguide.com/guides/subcontract-nemt-trips/) explains which programs allow it and the safer routes when they do not.
2. **Fill in Parts 2 to 10 together.** Both owners sit down with the prime's payer agreement open, write the agreed answer in each blank, and initial the line.
3. **Attach the payer's own documents.** Keep the consent letter, the payer's credentialing list, its insurance page, and its performance standards with the checklist, so the subcontract can point to them.
4. **Hand the finished list to a lawyer.** This is a checklist, not a contract and not legal advice. A health care attorney turns it into the subcontract and the business associate agreement.
5. **Review it when the payer changes its terms.** MTM Health may amend its standard agreement, rates included, on written notice, and the change stands unless the provider rejects it in writing within 30 days (section 20). Every change like that has to reach the subcontract too.

## The template

### Part 1: Is subcontracting allowed?

| Check | Answer, date, or document | Initials |
|---|---|---|
| Payer that sends the trips (broker, health plan, facility, or private customer) and the date of the prime's agreement | | |
| Section of that agreement on assignment and subcontracting, read by both companies | | |
| Payer's written consent received, naming the subcontractor, service area, and levels of service | | |
| State Medicaid manual checked for a ban on provider-to-provider subcontracting | | |
| State rule on vehicle ownership checked (whose name the vans must be registered and insured in) | | |
| Payer confirms whether the subcontractor needs its own Medicaid enrollment or credentialing | | |
| For facility or private pay work: the customer's contract allows another company to do the work | | |

### Part 2: The parties and the work

| Term | Agreed term |
|---|---|
| Prime: legal name, EIN, address, NPI, and Medicaid provider number | |
| Subcontractor: legal name, EIN, address, NPI, and Medicaid provider number, if any | |
| Subcontractor's Form W-9 on file with the prime | |
| Person at each company who receives legal notices, and how (mail, courier, email) | |
| Counties or regions covered | |
| Levels of service: ambulatory, wheelchair, stretcher, or other | |
| Trip types: standing orders, will-call returns, hospital discharges, same-day trips | |
| Days and hours the subcontractor will take trips | |
| Start date, length of the term, and how it renews | |
| The two companies stay independent: each hires, pays, trains, and insures its own staff | |

### Part 3: Drivers, attendants, and vehicles

| Term | Agreed term |
|---|---|
| Every driver and attendant credentialed with the payer before the first trip | |
| A file kept for each driver and attendant, owner-drivers included, and shown to the prime on request | |
| File contents: license, background check at hire and yearly, driving record, drug and alcohol results, training certificates | |
| Training topics the payer requires, such as passenger assistance, securement, fraud, waste and abuse, and HIPAA | |
| Drug and alcohol policy and testing that match the payer's rules | |
| Owners, drivers, attendants, and office staff checked against exclusion lists every month | |
| Who may pull a driver off the prime's trips, and when | |
| Vehicle list: year, make, VIN, plate, level of service, lift or ramp | |
| Vans owned or leased by the subcontractor, and registered, insured, and maintained in its name | |
| Each van approved by the payer before use, with current inspections | |
| New or removed drivers and vans reported to the prime within ___ days, before they run a trip | |

### Part 4: Insurance

| Coverage | MTM standard agreement (January 1, 2023) | WellTrans, Indiana (October 16, 2025) | Subcontractor will carry |
|---|---|---|---|
| Auto liability | $500,000 combined single limit on every vehicle used | Greater of the local taxi ordinance or $1,500,000 per accident on sedans and vans, written as "Any Auto" or symbols 2, 8, and 9 | |
| General liability | $500,000 per occurrence and $500,000 aggregate, broad form contractual | $1,000,000 per incident, broad form, including sexual abuse and molestation with no sub-limits | |
| Workers' compensation | Statutory amounts | Indiana statutory, plus employer's liability of $100,000 each accident, $100,000 disease each employee, and $500,000 disease policy limit | |
| Professional liability | Not listed | $1,000,000 per accident for wheelchair vehicle operators | |
| Additional insureds | MTM and all affiliates | WellTrans, Professional Management Enterprises, and Indiana state and FSSA officers and staff | Prime and payer |
| Pays first | Primary and non-contributory | Primary over WellTrans's insurance for claims under the agreement | |
| Waiver of subrogation | In favor of MTM | In favor of WellTrans | |
| Cancellation notice | Specific notice of cancellation endorsement | Written notice at least 30 days before any end or change | |
| Certificates | At signing and at each renewal | Before the start date, and again on any renewal or change | |

### Part 5: Running the trips

| Term | Agreed term |
|---|---|
| How trips are offered and accepted, and the cutoff time for the next day | |
| How and by when an accepted trip can be handed back | |
| Backup plan for every accepted trip | |
| The payer's service standards the subcontractor follows (attach them): on-time windows, wait time, level of assistance | |
| No driver or attendant leaves a rider alone in the vehicle | |
| Only the prime speaks for both companies to the payer, unless the payer says otherwise | |
| Delays that will make a rider late: prime told at once, by phone | |
| Accidents and incidents: phone call within ___ hours, written report within ___ hours | |
| Complaints from riders or facilities: sent to the prime within ___ hours | |
| Criminal charges and civil claims against the subcontractor or its drivers: reported to the prime at once | |
| Neither company solicits the other's riders, facilities, or staff during the term and for ___ months after | |

### Part 6: Trip records and billing

| Term | Agreed term |
|---|---|
| What each trip record shows: trip ID, scheduled and actual pickup, departure and arrival times, rider signature, mileage, no-show proof | |
| How records are delivered: the payer's app, a trip log, or a file | |
| Records due within ___ days of each trip, well before the payer's filing limit | |
| Only the prime bills the payer. The subcontractor invoices the prime. | |
| Neither company bills a rider for a covered trip | |
| Records kept at least 10 years, or longer if the payer requires | |
| The prime, the payer, the state, CMS, and HHS OIG may audit the subcontractor's records, premises, and vehicles | |
| Copies of requested records sent within ___ days | |

### Part 7: Pay

| Term | Agreed term |
|---|---|
| Rate basis: a set price per trip, a price per mile, or a share of the payer's rate | |
| Wait time, after-hours, and no-show pay, only where the payer pays them | |
| Payment date, counted from the day complete trip records arrive | |
| Denied or recouped trips: charged to the company whose error caused the denial | |
| Payer penalties and liquidated damages: passed to the company whose service caused them | |
| Offsets against later payments allowed only with written notice | |
| How disputes are raised, and the deadline to raise one | |
| Final payment after the agreement ends, and what the prime may hold back | |
| No payment by either company for referring riders | |

### Part 8: Privacy and the business associate agreement

| Term the business associate agreement covers | Agreed term |
|---|---|
| Rider information used and shared only to run the trips, or as the law requires | |
| Safeguards for paper manifests and for phones, tablets, and email | |
| Unauthorized uses, security incidents, and breaches reported to the prime within ___ | |
| The same terms signed by anyone the subcontractor shares rider details with, including a billing or factoring company | |
| Requests to see, correct, or account for rider information answered within ___ business days | |
| Records on privacy practices open to HHS | |
| Rider information returned or destroyed when the work ends, where feasible | |
| The prime may end the agreement if the subcontractor breaks a material term of the business associate agreement | |
| Payer's written consent on file for sharing member information with the subcontractor | |

### Part 9: Compliance promises

| Promise | Agreed term |
|---|---|
| Neither company, nor any owner, driver, or staff member, is excluded from federal or state health programs | |
| Monthly exclusion screening, with notice to the prime the same day a match is found | |
| No kickbacks, gifts, or payments for referrals, to anyone | |
| Fraud, waste, and abuse training for every driver and office worker, with dates on file | |
| Cooperation with the payer's audits, spot checks, and corrective action plans | |
| Compliance with the ADA and nondiscrimination rules on every trip | |
| Immediate notice of any investigation, audit, or government inquiry | |
| Any state rule the payer adds, such as work eligibility checks | |

### Part 10: Ending the agreement

| Term | Agreed term |
|---|---|
| Notice either company gives to end it without cause: ___ days | |
| Cure period after written notice of a breach: ___ days | |
| Ends at once if the payer ends the prime's contract or withdraws consent | |
| Ends at once if insurance lapses, an owner or driver is excluded, or a rider's safety is at risk | |
| Trips already accepted are run through the notice period | |
| Standing orders handed back to the prime on a set date | |
| Rider information and trip records returned or destroyed | |
| Last invoice due date and last payment date | |
| Terms that continue after it ends: confidentiality, records, audits, and responsibility for claims | |

### Sign-off

| | Prime | Subcontractor |
|---|---|---|
| Printed name and title | | |
| Signature | | |
| Date | | |
| Attorney who reviewed the agreement, and date | | |

## Why the payer's agreement decides first

A subcontract cannot give the subcontractor more than the payer gave the prime. As of September 2026, the published agreements and manuals set these rules:

| Program | Rule on handing trips to another company |
|---|---|
| New York Medicaid (manual effective August 25, 2023) | Forbidden. Providers are personally and directly responsible for transporting enrollees. A provider short of vehicles alerts the broker, which finds another provider. |
| MTM Health standard agreement (January 1, 2023) | No subcontracting of any service without MTM's express written consent (12.A). No pay for trips by uncredentialed drivers or in uncredentialed vehicles (2.N and 6.B). |
| WellTrans, Indiana (revised October 16, 2025) | No assignment or delegation without written consent, which WellTrans may withhold at its sole discretion. An unauthorized assignment is void (II.H). |

New York adds a vehicle rule. Ambulance, ambulette, and taxi providers must own their vehicles or lease them in their own name, with each vehicle registered to, insured by, and maintained by the provider. Using a vehicle registered to or insured by someone else can lead to disenrollment.

Consent does not move the prime's duties. MTM's agreement has each provider defend MTM and its client against claims tied to its service, including claims by personnel the provider engaged (10.A), and its insurance limits do not cap that promise (10.C). MTM may also pass along any amount its client assesses because of the provider's performance (7.A). That is why Parts 4 and 7 match each cost to the company that caused it. For the wider picture of working with several payers, see [working with multiple NEMT brokers](https://nemtguide.com/guides/multiple-nemt-brokers/).

## The HIPAA terms the agreement must carry

Every manifest carries protected health information. Under HIPAA, a subcontractor is anyone a business associate hands a function to, other than its own workforce ([45 CFR 160.103](https://www.ecfr.gov/current/title-45/section-160.103)). A business associate may let a subcontractor handle that information only after getting satisfactory assurances, documented in a written agreement ([45 CFR 164.502(e)](https://www.ecfr.gov/current/title-45/section-164.502)). The contents HIPAA requires of that agreement are the first eight rows of Part 8, applied to subcontractors by [45 CFR 164.504(e)(5)](https://www.ecfr.gov/current/title-45/section-164.504).

Payers often ask for more than the federal minimum:

- **Breach clock.** HIPAA requires a business associate to report a breach without unreasonable delay and no later than 60 calendar days after discovering it ([45 CFR 164.410](https://www.ecfr.gov/current/title-45/section-164.410)). WellTrans's subcontractor business associate agreement wants unauthorized uses and security incidents reported within one business day, and a breach reported in writing no more than one business day after discovery.
- **Everyone downstream.** WellTrans requires a business associate agreement with any subcontractor or agent that gets protected health information, and names billing companies, factoring companies, and anyone else that receives trip logs, manifests, or billing documents. See [NEMT factoring](https://nemtguide.com/guides/nemt-factoring/) before you sell invoices.
- **Consent to share.** MTM requires each provider to sign its business associate agreement (2.I), and bars sharing member information with any person or business without MTM's written consent (21.B).

HHS publishes sample business associate agreement provisions (content last reviewed June 16, 2017) that a lawyer can adapt. HHS notes that they are sample language only. The [business associate agreement](https://nemtguide.com/glossary/business-associate-agreement/) entry explains when a NEMT company needs one, and the [NEMT HIPAA policy](https://nemtguide.com/templates/nemt-hipaa-policy/) covers the rules your own staff follow.

## Screening, records, and audits that pass down

**Exclusion screening.** Federal law requires each state to have a check in place, which may be a signed attestation, confirming that every NEMT provider and individual driver it pays is not excluded from any federal health care program, that each driver holds a valid license, and that each provider has a process to address state drug law violations and to disclose each driver's driving history to the state (section 1902(a)(87) of the Social Security Act, explained in CMS guidance SMD 23-006, September 28, 2023). Federal health programs pay nothing for items or services an excluded person furnishes ([42 CFR 1001.1901](https://www.ecfr.gov/current/title-42/section-1001.1901)). OIG may penalize anyone who arranges or contracts with a person they know or should know is excluded ([42 CFR 1003.200(b)(4)](https://www.ecfr.gov/current/title-42/section-1003.200)). Record each monthly check on the [exclusion screening log](https://nemtguide.com/templates/exclusion-screening-log/), and keep each driver's credentials on the [driver file checklist](https://nemtguide.com/templates/nemt-driver-file-checklist/).

**Records and audits.** When a Medicaid health plan subcontracts its work, the subcontract must let the state, CMS, the HHS Inspector General, and the Comptroller General audit the subcontractor and the subcontractor's own contractors. That right lasts 10 years from the end of the contract period or the end of an audit, whichever is later ([42 CFR 438.230(c)(3)](https://www.ecfr.gov/current/title-42/section-438.230)). Brokers carry the same weight in their provider agreements: MTM wants full records for 10 years (2.S), and WellTrans wants them for the term plus 10 years, with copies within three days.

**Trip records.** MTM's Virginia handbook (approved August 10, 2026) denies a claim unless the electronic trip log shows the trip ID, scheduled pickup, actual pickup, departure and arrival times, and the member's signature. MTM's standard agreement does not pay a claim filed more than 90 days after the date of service, unless its client sets another limit (6.A). Part 6 sets the subcontractor's due date inside whatever limit applies. The [NEMT trip log template](https://nemtguide.com/templates/nemt-trip-log-template/) has the fields most payers check.

**Incident clocks.** WellTrans wants a phone call within 3 hours of any accident or incident that injures a driver or rider, and a written report within 24 hours of any accident or incident, injury or not. Its schedule of liquidated damages charges $1,000 for each day an incident report is late. Write the payer's clocks into Part 5, with time to spare for the prime.

**Referral payments.** The federal anti-kickback statute makes it a felony to knowingly and willfully pay or receive anything of value in return for referring a person for services a federal health care program pays for, punishable by a fine of up to $100,000, up to 10 years in prison, or both ([42 U.S.C. 1320a-7b(b)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320a-7b&num=0&edition=prelim)). Pay in a subcontract should be for rides given, never for riders sent. See [anti-kickback rules for NEMT](https://nemtguide.com/guides/anti-kickback-rules-for-nemt/).

**Signing.** Federal law says a contract in interstate commerce cannot be denied legal effect only because an electronic signature or record was used to form it ([15 U.S.C. 7001](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title15-section7001&num=0&edition=prelim)). Keep the signed subcontract, the business associate agreement, and the payer's consent together, and send the prime's broker any copy it asks for.

## Frequently asked questions

### What should a NEMT subcontractor agreement include?

The payer's written consent, the parties and the work, driver and vehicle credentialing, insurance limits and additional insureds, how trips are offered and handed back, incident reporting clocks, trip records and billing deadlines, pay and denials, a HIPAA business associate agreement, exclusion screening, audit access, record keeping, and how either side ends it. The template below lists each one with a blank for the agreed term.

### Do I need the broker's permission to subcontract NEMT trips?

Usually, and sometimes it is not allowed at all. MTM Health's standard agreement (January 1, 2023 version posted by Pennsylvania) bars subcontracting any service without MTM's express written consent (section 12.A). WellTrans's Indiana agreement (revised October 16, 2025) lets WellTrans withhold consent at its sole discretion and voids an unauthorized assignment. New York's Medicaid manual (effective August 25, 2023) forbids it.

### What insurance should a NEMT subcontractor carry?

At least what the prime's payer requires, with the prime and the payer named as additional insureds. MTM's standard agreement sets $500,000 combined single limit auto, $500,000 general liability per occurrence, and statutory workers' compensation. WellTrans in Indiana requires at least $1,500,000 per accident on vans, $1,000,000 general liability, and $1,000,000 professional liability for wheelchair vehicles. Both want the provider's policy to pay first.

### Do I need a business associate agreement with my subcontractor?

Plan on one. HIPAA lets a business associate share protected health information with a subcontractor only after written assurances that meet 45 CFR 164.504(e). MTM requires each provider to sign its business associate agreement (section 2.I). WellTrans requires its providers to sign one with anyone that gets rider details, including billing and factoring companies. Sign it before the first manifest is sent.

### How long must a NEMT subcontractor keep trip records?

Put at least 10 years in the agreement, or longer if the payer asks. MTM wants full records kept for 10 years (section 2.S), and WellTrans wants them for the contract term plus 10 years, with copies within three days of a request. Federal rules for Medicaid health plan subcontracts give the state, CMS, and HHS OIG a right to audit for 10 years after the contract period ends or an audit finishes, whichever is later.

### Can a subcontractor bill the broker or the rider directly?

No. The prime is the payer's provider, so only the prime bills the payer, and the subcontractor invoices the prime. MTM's agreement also bars billing a member for any service, even when MTM or its client does not pay, except a copay MTM or its client allows (section 6.C). Write both rules into the agreement.

### What if one of the subcontractor's drivers is on the OIG exclusion list?

Pull the driver at once and tell the prime. Federal health programs pay nothing for services an excluded person furnishes (42 CFR 1001.1901), and OIG can penalize anyone who contracts with a person they knew or should have known was excluded (42 CFR 1003.200(b)(4)). MTM bars any driver or attendant on the OIG or federal excluded parties lists. Require monthly screening and same-day notice of a match.

## Official resources

- [HHS: Sample business associate agreement provisions](https://www.hhs.gov/hipaa/for-professionals/covered-entities/sample-business-associate-agreement-provisions/index.html)
- [eCFR: What a business associate contract must contain (45 CFR 164.504(e))](https://www.ecfr.gov/current/title-45/section-164.504)
- [HHS OIG: Search the exclusion list](https://oig.hhs.gov/exclusions/)
- [MTM Health standard provider agreement (Pennsylvania copy, January 1, 2023)](https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/healthchoices/documents/transportation-provider-services-agreement-01-01-2023.pdf)
- [New York Medicaid Transportation Policy Manual (subcontracting and vehicle ownership)](https://www.emedny.org/ProviderManuals/Transportation/PDFS/Transportation_Manual_Policy_Section.pdf)
- [IRS: Form W-9](https://www.irs.gov/forms-pubs/about-form-w-9)