1. (a) All recipients shall be ensured assistance to locate transportation or be reimbursed for miles traveled to access medicaid covered medical, dental, and behavioral health services as required by 42 CFR 441.62(a), 42 CFR 431.53, and 42 CFR 440.170.

2. (b) All recipients, including all home and community-based waiver service recipients and recipients residing in nursing facilities, shall be eligible to receive non-emergency medical transportation services by wheelchair van, when:

   1. (1) The recipient is confined to a wheelchair for mobility, which means:

      1. a. At the time of service, the recipient is unable to ambulate without the use of a wheelchair; and
      2. b. The recipient is unable to be transported in a private vehicle without special equipment or modifications to the vehicle; and
   2. (2) The use of a wheelchair van is required as certified on a completed “Mobility Determination for Non-Emergency Medical Transportation Universal Form for All Medicaid Plans” (September 2025), completed by a health care professional and submitted to the broker prior to the wheelchair van ride.

Source. (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; ss by #10810, eff 4-9-15; ss by #14393, eff 10-1-25, EXPIRES: 10-1-35