South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:03 - Hospital services
Section 67:16:03:06.06 - Reimbursement for in-state DRG-exempt hospitals and units
Current through Register Vol. 51, page 43, September 23, 2024
Reimbursement to in-state DRG-exempt hospitals and units is based on reasonable and allowable costs following guidelines established in 42 C.F.R. §§ 413.1 to 413.157, inclusive, ( August 1, 2015), with the following exceptions:
(1) Costs associated with certified registered nurse anesthetists that relate to exempt units of hospitals are included as allowable costs;
(2) Capital and education costs incurred for inpatient services are included as allowable costs;
(3) Psychiatric unit services are paid at the usual and customary charge for the services provided, the daily rate located on the department's fee schedule website, or at the rate payable according to § 67:16:03:06.16, whichever is less. The daily rate of payment is subject to review and amendment by the department under the provisions of § 67:16:01:28;
(4) Rehabilitation hospital services are paid at the lesser of the usual and customary charge for the services provided or the daily rate located on the department's fee schedule website; and
(5) Perinatal units, rehabilitation units, and children's care hospitals are reimbursed at a daily rate established by the department according to the guidelines provided in the South Dakota Medicaid State Plan. The daily rates are located on the department's fee schedule website.
General Authority: SDCL 28-6-1(2).
Law Implemented: SDCL 28-6-1(2), 28-6-1.1.
South Dakota Medicaid State Plan, Attachment 4.19A, pages 4-5. Copies may be obtained from the Department of Social Services, Division of Medical Services, 700 Governors Drive, Pierre, South Dakota 57501.
