How to Start an NEMT Business in Texas

Non-emergency medical transportation (NEMT) is a growing industry in Texas and across the country.

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How to Start an NEMT Business in Texas

NEMT services help individuals with limited transportation options attend their medical appointments safely and on time.

NEMT services involve:  

  • Picking patients up at their homes or other designated locations
  • Transporting them to their destination
  • Returning them home  

While some patients require little assistance, others may have mobility limitations that require drivers to help them in and out of the vehicle. In some cases, patients may be transported on wheelchairs or stretchers. If this sounds like the company you want to start, you should know a few things. First, read the Texas Health and Human Services NEMT Services Handbook. This guide provides a wealth of information regarding how to start a NEMT business in Texas.

Once you've read this handbook and still want to open a NEMT service company, there are several additional steps you must take regarding how to start a non-emergency medical transportation business in Texas, including:

1. Setup Your Business Structure

The first step is to obtain a non-emergency medical transportation license. You'll also need to request a seller's license in Texas since you're providing a service. You must also obtain a Federal Employer Identification Number (FEIN) for tax purposes.

2. Purchase Business Insurance

You must also purchase business insurance, including general liability, workers' compensation, professional liability, and commercial auto insurance.

3. Purchase NEMT Vehicles and other supplies

The next step is to purchase or lease NEMT vehicles. Depending on the types of service you want to provide, your fleet could include passenger vans, stretcher vans, wheelchair-accessible vans, and minibuses. All vehicles must be licensed, registered, and fully insured.

4. Hire Your Team

Hiring the right team is crucial to your business's success. Be sure to fully vet each candidate and conduct background checks and drug testing. Your team may need training courses to obtain a non-emergency medical transportation certification.

5. Find Clients

Once your business is up and ready to go, you can work towards finding clients. Start by registering as a Medicaid/Medicare provider to receive reimbursement for these services. You can also work with a brokerage firm to secure more clients.

How Much Does Medicaid Pay for Non-Emergency Transportation?

Medicaid reimbursement rates for NEMT transportation services vary greatly depending on numerous factors, such as type of patient, level of transportation required, location, mileage, and time of services.

Texas NEMT Application

How to apply for provider services in Texas? Depending on the type of NEMT services provided, you may need to complete the Medical Transport Provider application. This application requires you to provide details about your company structure, ownership, and other information, such as location and vehicle capacity. You will need to provide your tax id number. So, setting up your business structure before completing the non-emergency medical transportation provider application is important.

To complete the Texas NEMT application, you must also complete the Disclosure of Ownership form and sign the Medical Transportation Provider Agreement form. Additionally, you may be required to show other documentation, such as your business license, proof of general liability and commercial auto insurance, and any criminal records of any applicable employees.

You can submit this application before or after completing the Medicare enrollment process. However, if this process is not completed, you must pay the $599 fee with this application. While you can submit this application, you will still need to complete this enrollment process to receive reimbursement for providing services as a non-emergency medical transportation Texas company.

Once approved, your NEMT company is responsible for meeting all regulations outlined in the NEMT Services Handbook. This includes maintaining vehicle maintenance forms, driver's logs, and more. You must also ensure your workers complete the required training, including passenger safety, defensive driving, and passenger assistance techniques.

Depending on your location, you may face additional Texas NEMT requirements. For example, those providing services in the Dallas area must also complete an application and register with the Dallas Public Works Transportation Regulation.

Depending on the types of vehicles in your NEMT fleet, your drivers may also need to secure a CDL license in Texas. This step requires completing both a written and behind-the-wheel examination.

NEMT Certification Texas

While there are no set NEMT certification requirements for NEMT companies or personnel, it's becoming standard practice for all drivers and assistants to have both CPR and first aid certifications. Additionally, some medical providers and brokers may require this certification before referring your services.

However, the state of Texas does have NEMT driver requirements for training. To comply with the NEMT application requirements, drivers and other eligible personnel must complete this training within the first 30 days and update their training every 1 to 3 years. These training requirements include:

  • Overview of managed care and the NEMT service benefits
  • How to handle difficult caller
  • Culture diversity training
  • Customer service training
  • Civil rights training
  • Fraud, waste, and abuse training
  • Scheduling and coordination of NEMT services
  • Passenger safety training
  • How to use assistive devices training
  • Passenger assistance techniques
  • Non-discrimination training
  • Motor vehicle qualifications and conduct
  • Defensive driving courses

Many of these training courses are offered by the state of Texas or through third-party vendors. Each NEMT service provider is responsible for ensuring its staff members stay current on any training requirements.

As the demand for NEMT services grows, more NEMT certification programs are available. For example, the Community Transportation Association of America (CTAA) offers a Keys to NEMT Success program to help NEMT providers learn how to build a successful business. CTAA also offers passenger assistance safety and sensitivity courses for drivers and provides various resources for NEMT providers and staff members.

As a NEMT independent contractor, you must also obtain a NEMT business license from the state of Texas and any licenses and permits required by the local authorities in your area. 

NEMT Vehicle Requirements  

When considering how to start a non-emergency medical transportation business in Texas, one of the first concerns is the type of vehicles you need. Since you'll likely be transporting patients with cognitive or physical disabilities, your vehicles must meet ADA requirements. The best vehicles for NEMT services include wheelchair assessable vans and stretcher vans. When searching for the right vehicles for your business, compare NEMT vehicles for sale and NEMT vehicles for lease.

Wheelchair assessable vehicles must meet all ADA standards, including:

  • Handicap Lift: Regulations state that the vehicle's handicap lift platform must be at least 30" x40".
  • Lift Door Height: The vehicle's door lift must open to at least 56".
  • Wheelchair Attachment: The vehicle must have a four-point, secure tie-down system to ensure the wheelchair stays in place during transport.
  • Gearshift Interlock: The vehicle should have a working gearshift interlock system that secures the vehicle in place while loading and unloading.

No matter what type of NEMT vehicles your fleet includes, it must meet all Texas standards for Medicaid NEMT providers' vehicles. Here's a look at some of the NEMT vehicle requirements.

  • Working seatbelts with lap and shoulder belts.
  • Working heating and air conditioning
  • Working interior lights
  • Operating odometer and speedometer
  • Two exterior rearview mirrors
  • One interior rearview mirror for monitoring patients
  • Operational fire extinguisher
  • Fully stocked first aid kit securely in place and within reach of the driver
  • Retractable step or stepstool if the vehicle is not equipped with running boards
  • Proof of commercial auto insurance
  • Updated vehicle license and registration

NEMT Brokers in Texas

The last step in becoming a non-emergency medical transportation provider in Texas is finding clients to transport. While you can invest in marketing your business through a website, social media, and other means, one of the fastest ways to secure enough business is by working with one or more NEMT brokers in Texas.

A NEMT broker is the middleman between NEMT service providers and the client. The broker is responsible for finding patients through partnerships with medical facilities and various marketing techniques. Typically, brokers also manage the call center. When a client calls the call center, the broker assigns rides based on location, availability, ride type, mobility support requirements, vehicle capacity, and other criteria.

Modivcare is one of the nation's largest NEMT brokers with offices in Texas. This company, formerly known as LogistiCare, connects with over 5,000 transportation service companies nationwide. It has a long history of helping NEMT service providers establish their client base and businesses. Different brokers manage different locations, so checking out a list of NEMT brokers operating in the specific areas you want to serve is essential.

To make this a successful partnership, it's important to maintain frequent communication with your brokers and to update them regularly regarding any changes to your services or fleet. Having a system in place is also crucial to enable the broker to view your availability. NEMT software options like MediRoutes allow seamless integration with most Texas NEMT brokers. This level of integration can make it easier for brokers to assign rides to your company.

Schedule a demo today to learn about our all-in-one software solution for your non-emergency medical transportation company.

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