1. (a) Except as provided by (d) below, claims for family and friends non-emergency medical transportation delivered via private transportation shall be reimbursed at the lesser amount of:

   1. (1) Actual number of miles billed multiplied by rate per mile; or
   2. (2) The maximum allowable mileage for the trip, multiplied by the rate per mile.
2. (b) Public transportation shall be coordinated by the broker and the broker shall be responsible for reimbursement.
3. (c) Reimbursement for tolls and parking fees shall be paid if receipts are submitted with the family and friends reimbursement claim.

4. (d) Reimbursement for family and friends drivers when a trip includes multiple passengers shall be as follows:

   1. (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. (2) For the total miles from the medicaid address of the first recipient to the final destination and return to the original pickup address; and
   3. (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(b), whichever is less.

5. (e) Reimbursement shall not be made:

   1. (1) For trips provided prior to the date the provider was enrolled with the broker, unless prior authorized by the broker;
   2. (2) For claims submitted 90 days or more from the date of the trip;
   3. (3) If the medicaid enrolled provider’s signature is missing on the “Request for Reimbursement of Medical Transportation by Private Car” (September 2025); or
   4. (4) If the signature of the driver or the recipient, or both, is missing on the “Request for Reimbursement of Medical Transportation by Private Car” (September 2025).
6. (f) Reimbursement shall be made to the recipient who then shall be responsible for paying the family and friends driver.

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 574.07), eff 10-1-25, EXPIRES: 10-1-35