Non-Emergency Medical Transportation (NEMT): Medicaid provides transportation to appointments for covered services to members who don't have access to their own transportation.
Manual
Non-Emergency Medical Transportation (NEMT) Manual (Last updated 12/01/2023)
Contacts
All calls should be directed to Vermont Public Transportation Association (VPTA): Toll free at 1-833-387-7200. Please visit the VPTA website for more information.
DVHA NEMT Reimbursement Rates
Non-Emergency Medical Transportation Per Member Per Month Payment Methodology
Tools
Non-Emergency Medical Transportation Checklist (7/26/2021) This checklist should be utilized by providers to help with submission of the physician referral form, listed below. This checklist should not be used in lieu of the actual form.
Transportation Needs Assessment Tool (09/28/2020) This is a tool that should be utilized by providers to help determine what forms, listed below, are necessary for providing a member with transportation. This tool should not be used in lieu of the actual forms. One of the below forms should be submitted if determined necessary by this tool.
Forms
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Hardship Mileage Waiver Form (01/01/2021) Form to be handed out by sub-contractor and filled out by member if requesting hardship mileage reimbursement under the Hardship Mileage Program guidelines. Member needs to go through sub-contractor to be eligible for this program.
- NEMT Rule and Guidelines Document (11/01/2022) Form to be handed out by sub-contractor and filled out by member prior to the initial utilization of the DVHA NEMT program.
- Personal Choice Driver Waiver Form (01/01/2019) Form to be used in specific situations where an individual has been allowed to select their own driver.
- Physician Referral Form - OVER 100 miles. PRINTABLE (12/28/2021) Form to be filled out and signed by provider's office. Form is necessary for transportation requests over 100 miles from members residence to a participating provider.
- Physician Referral Form - OVER 100 miles. EDITABLE (12/28/2021) Form to be filled out and signed by provider's office. Form is necessary for transportation requests over 100 miles from members residence to a participating provider.
- Physician Referral Form - UNDER 100 miles. PRINTABLE (05/12/2022) Form to be filled out and signed by provider's office. Form is necessary for transportation requests under 100 miles from members residence to a participating provider.
- Public Transportation Medical Exemption Form PRINTABLE (12/28/2021) Form to be filled out by provider’s office if medical conditions warrant the use of any specific mode of transport, or if medical conditions limit which modes may be utilized by the transportation provider.
- Public Transportation Medical Exemption Form EDITABLE (12/28/2021) Form to be filled out by provider’s office if medical conditions warrant the use of any specific mode of transport, or if medical conditions limit which modes may be utilized by the transportation provider.
- Transportation Employment Exception Verification Form PRINTABLE (12/28/2021) Form to be filled out by the employer of the member of the household who is unable to transport the member to scheduled appointments.
- Transportation Employment Exception Verification Form EDITABLE (12/28/2021) Form to be filled out by the employer of the member of the household who is unable to transport the member to scheduled appointments.
- Vehicle Exception Form PRINTABLE (12/28/2021) Form to be filled out by member if vehicle(s) in household are not available for the transport of members to scheduled appointments.
- Vehicle Exception Form EDITABLE (12/28/2021) Form to be filled out by member if vehicle(s) in household are not available for the transport of members to scheduled appointments.
Additional Information
For further information on Medicaid billable ambulance transports (emergent and non-emergent) that are not covered under the Non-Emergency Medical Transportation program, visit the Ambulance Services webpage.