South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:03 - Hospital services
Section 67:16:03:06.04 - Basis of reimbursement - Inpatient services - Out-of-state hospitals

The department shall reimburse out-of-state inpatient hospital services by making a prospective payment equal to the payment allowed by the Medicaid program in the state in which the hospital is located. If the Medicaid program in the hospital's home state refuses to price a claim, the payment allowed is a percentage of the provider's usual and customary charge as appropriated by the Legislature.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

South Dakota Medicaid State Plan, Attachment 4.19-A, page 1. Copies may be obtained from the Department of Social Services, Division of Medical Services, 700 Governors Drive, Pierre, South Dakota 57501.