Section He-W 574.07 - Payment for Services(a) Except as provided by (c) below, claims for general medical transportation delivered via private transportation shall be reimbursed at the lesser amount of: (1) Actual number of miles billed multiplied by rate per mile; or(2) The maximum allowable mileage for the trip, multiplied by the rate per mile.(b) All reimbursements shall be made by one of the following methods: (1) By direct deposit to a checking account;(2) By direct deposit to a money bank card; or(c) Public transportation claims shall be reimbursed in the following manner: (1) To either the recipient or to the transportation provider; and(2) At the usual and customary charge made to the general public if receipts are attached to the Form 13A.(d) Reimbursement for tolls and parking fees shall paid if the total cost is $3.00 or more per trip and receipts are submitted with the completed Form 13A.(e) Reimbursement for volunteer drivers when a trip includes multiple passengers shall be as follows: (1) For multiple trips in one day this shall be limited to the submission of one claim per trip regardless of the number of passengers;(2) For the total miles from the volunteer driver's point of origin to the farthest distanced medical provider and return to the volunteer driver's point of origin; and(3) For total miles in the claim submission described in (2) above shall be paid at the actual mileage traveled or the maximum mileage allowance per trip, in accordance with He-W 574.10(c) , whichever is less.(f) Reimbursement shall not be made: (1) For trips provided prior to the enrollment date of the provider;(2) For claims submitted 90 days or more from the date of the trip;(3) If the medicaid enrolled provider's signature as described in He-W 574.06(b) is missing on the Form 13A;(4) If the signature of the driver or the recipient, or both, as described in He-W 574.06(b) , is missing on the Form 13A;(5) For general medical transportation provided prior to the enrollment date of the volunteer, recipient, or transit company driver; or(6) For waiting time, which is defined as the total time for which the driver must be in attendance for a recipient while the recipient is receiving a medicaid covered medical or dental service.(g) If a recipient is dual enrolled, transportation of members of his or her assistance group shall require submission of a claim for the costs of transportation as a recipient driver only.(h) Any claims submitted by a recipient driver which are submitted for payment as a volunteer driver shall be denied unless: (1) The recipient driver is also enrolled as a volunteer driver; and(2) The recipient driver is providing general medical transportation for a medicaid recipient who was unable to provide transportation him/herself.N.H. Admin. Code § He-W 574.07
(See Revision Note at chapter heading He-W 500); ss by #6163, eff 1-4-96, EXPIRED: 1-4-04
New. #8732, eff 9-30-06
Amended byVolume XXXV Number 18, Filed May 7, 2015 , Proposed by #10810, Effective 4/9/2015, Expires4/9/2025.