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 67:16:04:54 - Method of establishing per diem rates

The department shall establish a case mix adjusted direct care per diem rate and a nondirect care per diem rate for each facility prior to July 1 of each year. These rates are based on the facility's allowable costs, the facility's Patient Driven Payment Model case mix score, inflation factors, cost ceilings, occupancy, and known future cost increases that have prior departmental approval.

The case mix adjusted direct care per diem rate is established on a facility-specific basis using allowable direct patient care costs and paid according to the Patient Driven Payment Model index under the Patient Driven Payment Model classification system on a resident-specific basis. The case mix adjusted direct care per diem rate is established by calculating the average Patient Driven Payment Model case mix score for the facility, determining the per diem case mix component cost for the facility by dividing the allowable cost by total resident days, and dividing the facility's per diem case mix component cost by its Patient Driven Payment Model average case mix score. The case mix adjusted direct care per diem cost is used to establish the case mix adjusted direct care cost ceilings established in § 67:16:04:51, and the case mix adjusted direct care per diem rate is subject to those ceilings and the payment limits established in § 67:16:04:54.01.

The nondirect care per diem rate is established on a facility-specific basis using all other allowable costs. The nondirect care per diem rate is based on cost components consisting of health and subsistence, general administrative, other operating, plant, plant operations, and capital. The nondirect care per diem rate is established by dividing the allowable nondirect care costs by the occupancy as determined according to § 67:16:04:49. The allowable nondirect care costs are used to establish the ceilings contained in § 67:16:04:51, and the nondirect care per diem rate is subject to those ceilings and the payment limits established in § 67:16:04:54.02. The nondirect care cost is not subject to case mix adjustment.

The per diem rate for the nondirect care costs of administration is subject to the payment limits established in § 67:16:04:54.03.

General Authority: SDCL 28-6-1.

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

Payment adjustment due to review of resident assessment, § 67:45:03:08.