1. (a) Non-emergency medical transportation shall be covered for the purpose of allowing a recipient to access medicaid covered medical, dental, or behavioral health services from a medicaid enrolled provider pursuant to 42 CFR 441.62(a) and 42 CFR 440.170.
2. (b) The covered service shall be the least costly available to meet the recipient’s needs.
3. (c) The costs of tolls and parking fees shall be covered with evidence of a receipt submitted with the travel log.
4. (d) Only the actual number of miles traveled to and from the medicaid address and medicaid covered services shall be reimbursable and as described in He-W 574.08(a).
5. (e) Non-emergency medical transportation shall be to the nearest appropriate medicaid enrolled provider of the covered medical, dental, or behavioral health service, as determined by the department.
6. (f) Transportation shall be provided via the least costly route, as described in He-W 574.10(c).
7. (g) Wait times shall be covered for round trips only and for up to a maximum of 2 hours, rounded to the nearest half hour.
8. (h) Transportation via ambulance shall be covered as non-emergency medical transportation when medically necessary and pursuant to the requirements in He-W 572.06.

9. (i) Non-emergency medical transportation shall be covered, pursuant to He-W 546.05(d):

   1. (1) For EPSDT-eligible children;
   2. (2) For any person who needs to accompany an eligible child to the child’s medical, dental, or behavioral health service; and
   3. (3) If a child is receiving residential or facility-based care, for a parent, family member, or caregiver if their presence is necessary to actively participate in the treatment or intervention for the direct benefit of the child, without the child present.

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 (formerly He-W 574.04), eff 10-1-25, EXPIRES: 10-1-35