South Dakota Administrative Rules
Title 22 - Counties
Article 22:02 - Catastrophic county poor relief
Chapter 22:02:02 - Reimbursements
Section 22:02:02:05 - Application for reimbursement - Evidence of payment

(1) A copy of the provider's invoice showing dates of service;

(2) Evidence, such as a copy of the approved county voucher, that payment was made by the county, including the amount paid;

(3) If the request for reimbursement is for a hospital claim incurred after June 30, 1997, documentation which establishes both the individual's and the county's share of the hospital bill;

(4) If county payment to a hospital was based on the Medicaid rate, a copy of the documentation from Medicaid which calculates the Department of Social Services payment rate; and

(5) A voucher signed by the county board of commissioners chair or vice-chair.

If the claim being submitted is the first reimbursement request covering a particular individual, the county must also submit evidence which shows that the county has met its $20,000 share of the expenses for that individual for the 12-month period in which the services were rendered.

If the claim is for an organ transplant, the county must submit evidence of compliance with SDCL 28-13A-13.