NEMT Facility Service Contract Template | Medical Transportation Agreement | Nursing Home, Hospital & Rehab Transport Contract | PDF & Word

Professionalize your healthcare transportation partnerships and clearly document service expectations with this comprehensive NEMT Facility Transportation Service Contract Template.

Designed specifically for Non-Emergency Medical Transportation (NEMT) providers entering service arrangements with nursing homes, rehabilitation centers, hospitals, long-term care facilities, therapy centers, and other healthcare organizations, this customizable agreement provides a structured framework for establishing transportation services between an NEMT Provider and a healthcare Facility.

From transportation services and facility billing to scheduling, health and safety requirements, cleaning fees, confidentiality, termination, and indemnification, this template helps both parties put important business expectations in writing.

WHAT’S INCLUDED

This NEMT Facility Transportation Service Contract includes:

• NEMT Provider Information
• Healthcare Facility Information
• Scope of Transportation Services
• Ambulatory Transportation
• Wheelchair Transportation
• Stretcher Transportation
• Medical Appointment Transportation
• Therapy Appointment Transportation
• Hospital Discharge Transportation
• Service Fees & Rate Sheet Terms
• Weekly / Biweekly / Monthly Billing Options
• Invoice Payment Deadline
• Late Payment Terms
• Approved Payment Methods
• Invoice Dispute Procedures
• Scheduling & Dispatch Requirements
• Last-Minute Transportation Requests
• Health & Safety Requirements
• Driver Certification Requirements
• Background Check Requirements
• Vehicle Inspection Requirements
• Sanitation Requirements
• Cleaning Fee Policy
• Vehicle Damage Responsibility
• Contract Term & Renewal
• Termination Procedures
• Confidentiality & Privacy Provisions
• Indemnification
• Governing Law
• Provider & Facility Signatures

SCOPE OF NEMT SERVICES

Clearly establish the transportation services your company will provide to the healthcare facility.

The agreement covers transportation for facility patients or residents traveling to:

✓ Medical Appointments
✓ Therapy Sessions
✓ Hospital Discharges
✓ Other Approved Destinations

Transportation options specifically include:

• Ambulatory Transportation
• Wheelchair Transportation
• Stretcher Transportation

SERVICE FEES & BILLING

Establish clear financial expectations before transportation services begin.

The agreement provides for compensation according to an agreed-upon Rate Sheet attached as Exhibit A and allows invoices to be submitted:

• Weekly
• Biweekly
• Monthly

Customize:

✓ Invoice Frequency
✓ Payment Due Date
✓ Late Payment Percentage
✓ Facility Rate Sheet

PAYMENT METHODS & INVOICE DISPUTES

Create a structured payment process for facility transportation accounts.

The agreement allows payment by:

✓ Check
✓ ACH Transfer
✓ Other Approved Payment Method

If the facility disputes an invoice, the contract requires the dispute to be submitted in writing within five business days of receipt, while undisputed amounts remain due on time.

SCHEDULING & DISPATCH

Establish a professional process for requesting transportation.

The facility agrees to provide accurate and timely ride requests through:

• Phone
• Portal
• Email

The provider agrees to make reasonable efforts to fulfill scheduled transportation requests, while emergency or last-minute trips may be accommodated depending on available capacity.

HEALTH & SAFETY REQUIREMENTS

Document important operational expectations for your NEMT business.

The agreement states that the provider will maintain compliance with applicable health and safety regulations involving:

✓ Vehicle Sanitation
✓ Driver Certifications
✓ Driver Background Checks
✓ Vehicle Inspections

CLEANING & VEHICLE DAMAGE FEES

Protect your transportation vehicles from unexpected cleaning and damage expenses.

The agreement provides a customizable cleaning fee when a patient causes:

• Bodily Fluid Spills
• Other Unsanitary Vehicle Conditions

It also addresses responsibility for patient-caused vehicle damage when the loss is not covered by insurance.

CONTRACT TERM & AUTOMATIC RENEWAL

Establish how long the facility relationship will remain in effect.

The template provides for an initial one-year contract term with automatic renewal unless either party provides 30 days' written notice of termination.

It also allows immediate termination in the event of a material breach.

CONFIDENTIALITY & PATIENT INFORMATION

Address the handling of confidential patient information within the transportation relationship.

The agreement requires both parties to maintain the confidentiality of patient information and states that the parties will comply with HIPAA and other privacy laws.

Organizations should determine whether their particular relationship also requires a separate Business Associate Agreement or other privacy documentation.

INDEMNIFICATION

The agreement includes a mutual indemnification provision.

Each party agrees to indemnify, defend, and hold the other harmless against claims or liabilities resulting from that party's own negligence or misconduct.

Because indemnification provisions can have significant legal and insurance consequences, this section should be reviewed for your particular business relationship and jurisdiction.

GOVERNING LAW

Customize the contract with the state whose laws will govern and interpret the agreement.

SIGNATURES

Complete the agreement with dedicated signature sections for:

• NEMT Provider Representative
• Provider Representative Name & Title
• Healthcare Facility Representative
• Facility Representative Name & Title
• Signature Dates

PERFECT FOR

• NEMT Providers
• Medical Transportation Companies
• Wheelchair Transportation Companies
• Ambulatory Transportation Providers
• Stretcher Transportation Providers
• Nursing Home Transportation Providers
• Rehabilitation Center Transportation
• Long-Term Care Transportation
• Hospital Transportation Contractors
• Healthcare Facility Administrators
• Assisted Living Transportation Providers
• Therapy Center Transportation Providers
• NEMT Business Owners
• Transportation Contract Managers
• Healthcare Transportation Partnerships

USE THIS TEMPLATE FOR

• NEMT Facility Contracts
• Nursing Home Transportation Agreements
• Rehabilitation Center Transportation Contracts
• Hospital Transportation Agreements
• Long-Term Care Facility Contracts
• Medical Appointment Transportation
• Therapy Transportation
• Hospital Discharge Transportation
• Wheelchair Transportation Agreements
• Ambulatory Transportation Agreements
• Stretcher Transportation Agreements
• Facility Billing Arrangements
• Recurring Medical Transportation Services
• Healthcare Transportation Partnerships
• NEMT Client Onboarding

EASY TO CUSTOMIZE

Personalize the agreement with your:

• NEMT Company Name
• Provider Address
• Healthcare Facility Name
• Facility Address
• Transportation Services
• Rate Sheet
• Billing Frequency
• Payment Deadline
• Late Payment Fee
• Cleaning Fee
• Scheduling Procedures
• Governing State
• Provider Representative Information
• Facility Representative Information

WHY USE AN NEMT FACILITY SERVICE CONTRACT?

A written facility transportation agreement can help establish a consistent business relationship between an NEMT provider and the healthcare organizations it serves.

It provides one organized document for establishing transportation services, pricing, billing, scheduling procedures, operational responsibilities, cleaning fees, privacy expectations, contract duration, and termination procedures.

For NEMT companies pursuing recurring facility accounts, a professional service contract can also help present a more organized process when approaching nursing homes, rehabilitation facilities, hospitals, and other healthcare organizations.

DIGITAL DOWNLOAD

THIS IS A DIGITAL PRODUCT. NO PHYSICAL ITEM WILL BE SHIPPED.

Your purchase includes a customizable 2-page NEMT Facility Transportation Service Contract in PDF and Word formats.

Simply download the files, customize the agreement with your NEMT company's information, facility information, rates, billing terms, and service procedures, and have both parties carefully review the completed agreement before signing.

IMPORTANT — PLEASE READ BEFORE PURCHASING

This template is provided for general informational, administrative, and document-preparation purposes only. It does not constitute legal, HIPAA, healthcare, transportation, insurance, regulatory, tax, or compliance advice.

Use of this template does not guarantee compliance with federal, state, local, Medicaid, Medicare, NEMT, transportation, healthcare, privacy, licensing, credentialing, or insurance requirements.

The template states that the provider will comply with applicable health and safety requirements, including sanitation, driver certifications, background checks, and vehicle inspections. Actual requirements can vary based on the provider's location, vehicle type, payer contracts, transportation services, and facility relationship.

The confidentiality provision references HIPAA. Whether HIPAA applies to a particular NEMT provider or arrangement—and whether a separate Business Associate Agreement is required—depends on the specific relationship and handling of protected health information.

The contract also includes provisions involving cleaning and damage fees, automatic renewal, termination, and mutual indemnification that should be reviewed and customized for the specific business arrangement.

NEMT providers and healthcare facilities should consider having a qualified attorney, insurance professional, and appropriate compliance professional review the completed agreement before implementation.

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