South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:03 - Hospital services
- Section 67:16:03:01 - Definitions
- Section 67:16:03:01.01 - Benefit period not to exceed 30 inpatient hospital days - Determination of number of days. Repealed
- Section 67:16:03:01.02 - Requirements for an outlier. Repealed
- Section 67:16:03:01.03 - Determination of emergency hospital care
- Section 67:16:03:02 - Inpatient hospital services covered
- Section 67:16:03:02.01 - Inpatient hospital services requiring prior authorization
- Section 67:16:03:03 - Outpatient hospital services covered
- Section 67:16:03:04 - Inpatient hospital services not covered
- Section 67:16:03:05 - Outpatient hospital services not covered. Repealed
- Section 67:16:03:06 - Basis of reimbursement - Inpatient services - Hospitals with more than 30 Medicaid discharges
- Section 67:16:03:06.01 - Basis of reimbursement - Outpatient services other than outpatient laboratory and outpatient surgical procedures
- Section 67:16:03:06.02 - Certain in-state hospitals, hospital units, and procedures exempt from DRG basis of reimbursement
- Section 67:16:03:06.03 - Basis of reimbursement - Inpatient services - Hospitals with less than 30 Medicaid discharges
- Section 67:16:03:06.04 - Basis of reimbursement - Inpatient services - Out-of-state hospitals
- Section 67:16:03:06.05 - Basis of reimbursement - Organ transplant procedures. Repealed
- Section 67:16:03:06.06 - Reimbursement for in-state DRG-exempt hospitals and units
- Section 67:16:03:06.07 - Reimbursement of outpatient laboratory services
- Section 67:16:03:06.08 - Payment for above-average, access-critical and above-average, at-risk hospitals
- Section 67:16:03:06.09 - Disproportionate share hospitals
- Section 67:16:03:06.10 - Classification of hospitals providing certain outpatient surgical procedures
- Section 67:16:03:06.11 - Basis of reimbursement - Outpatient surgical procedures covered under subdivision 67:16:03:03 (10)
- Section 67:16:03:06.12 - Services included in reimbursement rate for outpatient surgical procedures covered under chapter 67:16:28
- Section 67:16:03:06.13 - Items and services not included in reimbursement rate for outpatient surgical services covered under chapter 67:16:28 and paid under the provisions of chapter 67:16:03
- Section 67:16:03:06.14 - Payment groups for outpatient hospital surgical procedures covered under chapter 67:16:28
- Section 67:16:03:06.15 - Rate of payment - Medicare crossover claims for certain inpatient hospital services
- Section 67:16:03:06.16 - Rate of reimbursement if individual subject to care management remains in psychiatric unit beyond established discharge date
- Section 67:16:03:06.17 - Basis of reimbursement - Inpatient services - Claims containing revenue code 275 or 278
- Section 67:16:03:06.18 - Basis of Reimbursement-OPPS
- Section 67:16:03:07 - Payment of hospital services
- Section 67:16:03:07.01 - Maximum rate of payment - Transfers between DRG-reimbursed hospital unit and DRG-exempt intensive care nursery unit in same hospital
- Section 67:16:03:07.02 - Maximum rate of payment - Patient transfer not medically necessary
- Section 67:16:03:08 - Notification of hospital services. Repealed
- Section 67:16:03:09 - Verification of eligibility. Repealed
- Section 67:16:03:10 - Utilization review
- Section 67:16:03:11 - Inpatient psychiatric hospital services
- Section 67:16:03:12 - Transferred
- Section 67:16:03:13
- Section 67:16:03:14 - Claim requirements
- Section 67:16:03:14.01 - Billing requirements
- Section 67:16:03:14.02 - Claim requirements for individuals subject to managed care who remain in psychiatric unit beyond established discharge date
- Section 67:16:03:15 - Application of other chapters
- Appendix A - List of Diagnosis-Related Groups (DRGs), repealed, 30 SDR 26, effective September 3, 2003
- Appendix B - List of Outpatient Laboratory Services, repealed, 30 SDR 26, effective September 3, 2003
- Appendix C
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