TL;DR
- Service level describes how much help the driver gives the rider at each end of the trip.
- NEMTAC approved a written standard in October 2024 that defines six levels, from curb to curb through transfer services.
- States use their own names for the same thing. Minnesota calls them modes. Louisiana calls door through door an elevated level of care.
- The service level can decide who is legally allowed to take the trip. Louisiana bars transportation network companies from trips that need door to door or hand to hand assistance.
- Getting the service level wrong at booking means either sending a driver who cannot complete the trip, or providing assistance you were never paid for.
Most of what happens on an NEMT trip request is straightforward. Name, pickup address, destination, appointment time, insurance.
The service level is different. It records how much help the rider needs getting to and from the vehicle, and it is often entered as whatever the software defaults to rather than asked about. That one field affects which driver can take the trip, how long the driver will be on scene, and what the provider gets paid.
What the Levels Actually Mean
Until recently the industry had no shared written definition. NEMTAC’s board approved a levels of service standard in October 2024, which defines six levels and states that the definitions are meant to apply across providers, brokers, payors, and regulators so the language stays consistent.
| Level | What the driver does |
|---|---|
| Curb to curb | Meets the rider at the curb, no assistance needed |
| Curb to curb with assistance | Helps the rider in and out, stores and retrieves mobility aids |
| Door to door | Assists to and from the outermost door at both ends |
| Door through door | Assists from inside the pickup location and inside the drop-off location |
| Hand to hand | Hands the rider off to an appropriate caregiver at both ends |
| Transfer services | Transfers the rider to or from a stationary location, stretcher, or mobility device |
Source: NEMTAC Levels of Service Standard, BSR/NEMTAC 1001-202X.
The standard also sets out what a provider has to show for each level. For curb to curb, the evidence is that the rider can enter and exit the vehicle without the driver leaving their seat. For every level above that, the provider has to maintain drivers who are educated and credentialed in the specific type of assistance involved.
Those requirements cost money. A driver who walks a rider from inside the house to the vehicle spends longer at the pickup than one who waits at the curb, and that driver needs training the provider has to pay for and document.
States Define These Levels Differently
An operator working across more than one state will find the same terms used differently. Minnesota groups them into modes. Mode 3 is unassisted transport, which the state describes as curb to curb. Mode 4 is assisted transport, covering both door to door and door through door. The level of service assessment for Mode 4 is completed by a state contracted medical reviewer rather than by the provider or the rider.
A rider who needs the same help in both states can therefore be classified under a different name, authorized by a different process, and paid at a different rate depending on which state the trip happens in.
Who Is Allowed to Take the Trip
Service level also decides which companies can legally accept the work.
Louisiana law prohibits transportation network companies from providing NEMT to enrollees who require hand to hand or door to door assistance, to riders who need personal mobility assistance from the driver, and to minors travelling alone. The same law requires that a company’s scheduling software be able to send drivers special transport instructions, including the hand to hand or door to door level of service.
For a traditional NEMT provider, that is worth understanding in both directions. Higher assistance levels are trips a rideshare company cannot take in that state. They are also trips that carry training and insurance requirements before you can accept them.
Is the right level getting captured on every trip?
Pac Biz places trained NEMT phone agents who know what to ask at booking, so trips arrive at dispatch with the assistance needs already recorded.
Where It Goes Wrong at Booking
Most service level problems start on the phone, and they usually fall into one of three situations.
The level was never asked about. A trip comes in as curb to curb because that is the default in the software, and nobody confirmed it. The driver arrives to find a rider who cannot get out of the house without help.
The level was recorded but not passed along. The agent captured it correctly, and the driver was dispatched without seeing it. Louisiana’s rule about scheduling software being able to send special transport instructions exists because this happens.
The level changed and nobody updated the file. A standing order set up eighteen months ago still says curb to curb, though the rider’s condition has changed since then. Standing orders are the most common place for this, because nothing about the trip prompts a review.
Each of these ends the same way. Either the driver cannot complete the trip, or the driver provides more assistance than the trip was authorized and paid for.
What to Check on Your Own Accounts
Four things worth confirming, per contract:
- The exact terms your broker or health plan uses, and which NEMTAC level each one matches
- Who determines the level, since some states assign that to a medical reviewer rather than the provider
- Whether your dispatch system shows the level to the driver, and where it appears on their screen
- How often standing orders are reviewed for changes in rider need
Most operators have no set schedule for that last one. Reviewing standing orders once a year finds the riders whose needs changed after the trip was first set up.
The Short Version
Service level takes a few seconds to record and determines four things: how long the driver spends at each end of the trip, what training that driver must have, whether your company is allowed to accept the work in that state, and what you are paid for it.
Start by writing down which terms each of your payers uses and what each one requires. It is an afternoon of work, and it gives whoever answers your phone something definite to ask about.