South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:04 - Nursing facility rate setting
Section 67:16:04:51 - Ceilings

(1) Case mix adjusted direct care costs -- The department shall use two ceiling calculations to determine a facility's case mix adjusted direct care costs. The first ceiling is established at one hundred fifteen percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. The department will recognize one hundred percent of the facility's allowable costs up to the one hundred fifteen percent ceiling. The second ceiling is established at one hundred twenty-five percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. Payment for the case mix adjusted direct care costs which exceed the one hundred fifteen percent ceiling and are up to the one hundred twenty-five percent ceiling is calculated according to § 67:16:04:54.01;

(2) Nondirect care costs of health and subsistence, plant, plant operations, and other operating costs-- The department shall use two ceiling calculations when determining a facility's nondirect care costs of health and subsistence, plant, plant operations, and other operating costs. The first ceiling is established at one hundred five percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. The department will recognize one hundred percent of the facility's allowable costs up to the one hundred five percent ceiling. The second ceiling is established at one hundred ten percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. Payment for these nondirect care costs which exceed the one hundred five percent ceiling and are up to the one hundred ten percent ceiling is calculated according to § 67:16:04:54.02;

(3) Nondirect care costs of administration -- The department shall use two ceiling calculations when determining a facility's nondirect care costs of administration. The first ceiling is established at one hundred five percent of the median cost of all freestanding nonchain organization affiliated nursing facilities. The department will recognize one hundred percent of the facility's allowable costs up to the one hundred five percent ceiling. The second ceiling is established at- one hundred ten percent of the median cost of all freestanding nonchain organization affiliated nursing facilities. Payment for the nondirect care costs of administration which exceed the-- one hundred five percent ceiling and are up to the one hundred ten percent ceiling is calculated according to § 67:16:04:54.03; and

(4) Capital costs -- Beginning July 1, 2023, capital costs are limited to a ceiling of twenty dollars and ninety-five cents per resident day. The capital cost limitation will be inflated subject to adjustment as appropriated.