1. (a) The rate paid shall be that established by the commissioner in accordance with RSA 161:4, VI(a).

2. (b) The maximum allowed traveled round trip mileage to medicaid enrolled providers by drivers shall not exceed the following limits:

   1. (1) 90 miles to a hospital;
   2. (2) 50 miles to a physician or behavioral health provider;
   3. (3) 300 miles to a dentist;
   4. (4) 90 miles to a physical, speech, or occupational therapist;
   5. (5) 90 miles to a dialysis provider;
   6. (6) 400 miles to a specialty provider; and
   7. (7) 30 miles to a pharmacy.
3. (c) Determination of the least costly route shall be by the use of a web-based mapping tool containing a mileage calculator, which has the functionality to allow the input of addresses and the calculation of distance between them and to identify toll roads.

4. (d) Payments for wheelchair van services shall consist of the following components:

   1. (1) A base rate, which shall:

      1. a. Be paid once only for a single one-way trip or each way of a round trip; and
      2. b. Be paid twice for 2 one-way trips for the same recipient on the same day;

   2. (2) A mileage rate, which shall:

      1. a. Be based on the most direct route to and from a destination, and not necessarily the route used;

      2. b. Be paid for loaded miles only, which shall:

         1. 1. Be the distance traveled while transporting recipients from a pick-up point to a drop-off point; and
         2. 2. Not include mileage incurred on the way to pick up a recipient or after dropping off a recipient;
      3. c. Include all miles traveled; and
      4. d. Be paid only once per trip regardless of the number of recipients transported; and
   3. (3) A payment for the wait time described in He-W 574.05(f).

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