New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 500 - MEDICAL ASSISTANCE
Part He-W 574 - GENERAL MEDICAL TRANSPORTATION
Section He-W 574.10 - Mileage Limits and Rate

Universal Citation: NH Admin Rules He-W 574.10

Current through Register No. 40, October 3, 2024

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

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

(1) 75 miles to a hospital;

(2) 45 miles to a physician or mental health provider;

(3) 300 miles to a dentist;

(4) 75 miles to a physical, speech, or occupational therapist;

(5) 90 miles to a dialysis provider;

(6) 400 miles to a referred medical provider; and

(7) 20 miles to a pharmacy.

(c) The maximum allowed billable round trip mileage for travel to medicaid enrolled providers by volunteer drivers shall not exceed the following limits:

(1) 95 miles to a hospital;

(2) 65 miles to a physician or mental health provider;

(3) 320 miles to a dentist;

(4) 95 miles to a physical, speech, or occupational therapist;

(5) 110 miles to a dialysis provider;

(6) 420 miles to a referred medical provider; and

(7) 40 miles to a pharmacy.

(d) 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.

(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

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