DHS 107.23(3)(a)5.a.a. If a recipient is pronounced dead by a legally authorized person after an ambulance is requested but before the ambulance arrives at the pick-up site, emergency service only to the point of pick-up is covered. DHS 107.23(3)(a)5.b.b. If ambulance service is provided to a recipient who is pronounced dead enroute to a hospital or dead on arrival at the hospital by a legally authorized person, the entire ambulance service is covered. DHS 107.23(3)(a)6.6. Ambulance reimbursement shall include payment for additional services provided by an ambulance provider such as for drugs used in transit or for starting intravenous solutions, EKG monitoring for infection control, charges for reusable devices and equipment, charges for sterilization of a vehicle including after carrying a recipient with a contagious disease, and additional charges for services provided at night or on weekends, or on holidays. Separate payments for these charges shall not be made. DHS 107.23(3)(a)7.7. Non-emergency transfers by ambulance that are for the convenience of the recipient or the recipient’s family are reimbursed only when the attending physician documents that the participation of the family in the recipient’s care is medically necessary and the recipient would suffer hardship if the transfer were not made by ambulance. DHS 107.23(3)(b)1.1. Transportation by SMV shall be covered only if the purpose of the trip is to receive an MA-covered service. Documentation of the name and address of the service provider shall be kept by the SMV provider. Any order received by the transportation provider by telephone shall be repeated in the form of written documentation within 10 working days of the telephone order or prior to the submission of the claim, whichever comes first. DHS 107.23(3)(b)2.2. Charges for waiting time are covered charges. Waiting time is allowable only when a to-and-return trip is being billed. Waiting time may only be charged for one recipient when the transportation provider or driver waits for more than one recipient at one location in close proximity to where the MA-covered services are provided and no other trips are made by the vehicle or driver while the service is provided to the recipient. In this subdivision, “waiting time” means time when the transportation provider is waiting for the recipient to receive MA covered services and return to the vehicle. DHS 107.23(3)(b)3.3. Services of a second SMV transportation attendant are covered only if the recipient’s condition requires the physical presence of another person for purposes of restraint or lifting. The transportation provider shall obtain a statement of the appropriateness of the second attendant from the physician, physician assistant, nurse midwife or nurse practitioner attesting to the need for the service and shall retain that statement. DHS 107.23(3)(b)5.5. A trip to a sheltered workshop or other nonmedical facility is covered only when the recipient is receiving an MA-covered service there on the dates of transportation and the medical services are of the level, intensity or extent consistent with the medical need defined in the recipient’s plan of care. DHS 107.23(3)(b)6.6. Trips to school for MA-covered services shall be covered only if the recipient is receiving services on the day of the trip under the Individuals with Disabilities Education Act, 20 USC 33, and the MA-covered services are identified in the recipient’s individual education plan and are delivered at the school. DHS 107.23(3)(b)7.7. Unloaded mileage as defined in sub. (1) (c) 5. is not reimbursed if there is any other passenger in the vehicle whether or not that passenger is an MA recipient. DHS 107.23(3)(b)8.8. When 2 or more recipients are being carried at the same time, the department may adjust the rates. DHS 107.23(3)(b)9.9. Additional charges for services at night or on weekends or holidays are not covered charges. DHS 107.23(3)(b)10.10. A recipient confined to a cot or stretcher may only be transported in an SMV if the vehicle is equipped with restraints which secure the cot or stretcher to the side and the floor of the vehicle. The recipient shall be medically stable and no monitoring or administration of non-emergency medical services or procedures may be done by SMV personnel. DHS 107.23(3)(c)1.1. Non-emergency transportation of a recipient by common carrier is subject to approval by the county or tribal agency or its designee before departure. The reimbursement shall be no more than an amount set by the department and shall be less per mile than the rates paid by the department for SMV purposes. Reimbursement for urgent transportation is subject to retroactive approval by the county or tribal agency or its designee. DHS 107.23(3)(c)2.2. The county or tribal agency or its designee shall reimburse the recipient or the vendor for transportation service only if the service is not provided directly by the county or tribal agency or its designee. DHS 107.23(3)(c)3.3. Transportation provided by a county or tribal agency or its designee shall involve the least costly means of transportation which the recipient is capable of using and which is reasonably available at the time the service is required. Reimbursement to the recipient shall be limited to mileage to the nearest MA provider who can provide the service if the recipient has reasonable access to health care of adequate quality from that provider. Reimbursement shall be made in the most cost-effective manner possible and only after sources for free transportation such as family and friends have been exhausted. DHS 107.23(3)(c)4.4. The county or tribal agency or its designee may require documentation by the service provider that an MA-covered service was received at the specific location. DHS 107.23(3)(c)5.5. No provider may be reimbursed more for transportation provided for an MA recipient than the provider’s usual and customary charge. In this subdivision, “usual and customary charge” means the amount the provider charges or advertises as a charge for transportation except to county or tribal agencies or non-profit agencies. DHS 107.23(4)(4) Non-covered services. The following transportation services and charges related to transportation services are non-covered services: DHS 107.23(4)(a)(a) Emergency transportation of a recipient who is pronounced dead by a legally authorized person before the ambulance is called; DHS 107.23(4)(d)(d) Charges for excess mileage resulting from the use of indirect routes to and from destinations;