Apply for this type of Operating Authority Certificate if you are a motor carrier that will exclusively provide non-emergency medical transportation and
provide such transportation only, (1.) through the Department of Medical Assistance Services; (2.) through a broker operating under a contract with the
Department of Medical Assistance Services; or (3.) as a Medicaid Managed Care Organization or through a contractor of a Medicaid Managed Care
Organization contracted with the Department of Medical Assistance Services.
The following requirements MUST be met:
♦ If your application is approved, you will be required to have
proof of insurance filed with DMV by your insurance company.
Required minimum amounts are as follows:
♦ You must:
● provide non-emergency medical transportation only.
● submit a surety bond and Power of Attorney (from your surety
company) OR irrevocable letter of credit in the amount of
$25,000. The bond or LOC must be kept in effect for 3 years
from the issue date of the operating authority certificate.
NOTE: Refer to form OA435 - Passenger Carrier and
Passenger Broker Bond or form OA447 - For Hire
Operating Authority Certificate or License, Irrevocable
Letter of Credit located under "Forms and Publications" on
Minimum Bodily Injury and
Property Damage Amount
$350,000 1 to 6
$1,500,000 7 to 15
$5,000,000 16 or more
Complete all fields in this section as described below:
BUSINESS NAME - enter the legal name used to register your business.
FEDERAL TAX IDENTIFICATION NUMBER - Internal Revenue Service
assigned number that identifies your business entity.
TRADE NAME OR DOING BUSINESS AS - enter the name by which
people know your business. Only complete this field if this name is
different than your "Business Name".
BUSINESS STREET ADDRESS - enter the street number and name of
your business' physical location. This location must be where the routine
day to day operations of the business are conducted, owned or leased by
the applicant, satisfy all applicable local zoning regulations, houses all
records, and be equipped with a working telephone listed in the business
CITY - enter the city name of your business' physical location.
STATE - enter the state name of your business' physical location.
ZIP CODE - enter the postal zip code for your business' physical location.
BUSINESS MAILING ADDRESS - enter the mailing address (street
number and name OR P.O. Box) for your business. Only required if
different than business' physical location.
CITY - enter the city of the mailing address for your business.
STATE - enter the state of the mailing address for your business.
SECTION 1 -- BUSINESS INFORMATION
ZIP CODE - enter the postal zip code of the mailing address for your
COUNTY NAME - if your business is located in Virginia, enter the county
name for the business' physical location (if applicable).
BUSINESS TELEPHONE NUMBER - the number at which your business
can be reached during business hours, this number must be listed or
advertised in the name of the business.
BUSINESS FAX NUMBER - FAX transmissions sent to the physical
location of your business will use this number.
PRIMARY CONTACT PERSON NAME - enter the name of the person
who will serve as the primary DMV contact for any questions regarding
your application or business.
PRIMARY CONTACT TELEPHONE - enter the best number to reach the
primary contact person listed for your business.
PRIMARY CONTACT FAX NUMBER - enter the best number to send
FAX transmissions to the business' primary contact person.
PRIMARY CONTACT PERSON TITLE - enter the official business title of
the business' primary contact person.
PRIMARY CONTACT EMAIL ADDRESS - enter the email address for the
business' primary contact person.
SECTION 2 -- BUSINESS ENTITY INFORMATION
BUSINESS ENTITY TYPE - check to indicate if your business is structured
as a corporation or other entity type.
LIST BUSINESS OFFICIALS - enter requested information for all required
business officials as determined by your entity type.
NON-EMERGENCY MEDICAL TRANSPORTATION CARRIERS
OPERATING AUTHORITY CERTIFICATE APPLICATION
FOR NON-EMERGENCY MEDICAL TRANSPORTATION CARRIERS
Purpose: Use this form to apply for authority to exclusively provide non-emergency medical transportation only, (1.) through the Department of Medical
Assistance Services; (2.) through a broker operating under a contract with the Department of Medical Assistance Services; or (3.) as a Medicaid
Managed Care Organization or through a contractor of a Medicaid Managed Care Organization contracted with the Department of Medical
Assistance Services. For information on how to obtain For-Hire Intrastate Operating Authority for other types of for-hire services visit
Instructions: To ensure accurate and timely processing of your application, read and follow all steps outlined in the Operating Authority Certificate Application
for Non-Emergency Medical Transportation Instructions (OA 151-I).
NOTE: The application process for operating authority involves multiple steps, including the submission of various pieces of information, and requires
the applicant's continuing involvement and cooperation with DMV staff. It is critical that all required information is current and that it is submitted
timely. If after 90 days you have failed to respond to a request for information, DMV may cancel your application. If your application has been
canceled and you later decide to reapply for operating authority, you will need to begin the process as a new applicant.
Please be aware of the following prohibition: If you have been or are found guilty of performing, offering, advertising, providing, procuring,
or arranging by contract, agreement, or arrangement to transport passengers for compensation without the required license, permit, or
certificate through either a conviction resulting from a Virginia Uniform Summons or a civil penalty appropriately assessed by DMV, you will be
denied the license, permit, or certificate requested for a period of 12 months beginning from the date of the conviction or assessment of the civil