South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:03 - Hospital services
Section 67:16:03:02 - Inpatient hospital services covered

(1) Semiprivate room accommodations and board. Private rooms are covered when justified by a statement of medical necessity from the attending physician or other licensed practitioner;

(2) Regular nursing services routinely furnished by a hospital;

(3) Supplies, such as splints and casts, and use of appliances and equipment, such as wheelchairs, crutches, and prostheses;

(4) Whole blood or packed red cells;

(5) Diagnostic services;

(6) Therapeutic services;

(7) Operating and delivery rooms;

(8) Drugs and biologicals ordinarily furnished by the hospital;

(9) Medical social services;

(10) Services of hospital residents and interns who are in approved training programs;

(11) Dialysis treatments;

(12) Services of hospital-based physicians or other licensed practitioners;

(13) Sterilizations authorized under § 67:16:02:09;

(14) Hysterectomies authorized under 42 C.F.R. §§ 441.250 to 441.259, inclusive (as amended to April 1, 2017); and

(15) Services listed on the department's prior authorization website if authorized under § 67:16:03:02.01.