South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:03 - Hospital services
Section 67:16:03:06.18 - Basis of Reimbursement-OPPS

Medicare prospective payment system hospitals will be paid using the Departments OPPS. Under OPPS, services are reimbursed using ambulatory payment classifications. The Department will establish a conversion factor and discount factor specific to each hospital. The hospital specific conversion factor and discount factors are published on the Departments fee schedule.

Outpatient prospective payments do not include items and services for which payment may be made under other provisions of this article, such as physician services, certified registered nurse anesthetist services, prosthetic devices, ambulance services, orthotic devices and durable medical equipment for use in the patient's home, unless they are specifically included in the exception code list on the Departments fee schedule website.

General Authority: SDCL 28-6-1(2), 28-6-1.1.

Law Implemented: SDCL 28-6-1(2), 28-6-1.1.