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 67:16:04:58 - Facility's average per diem charge

A nursing facility which elects to participate in the Medicaid program must notify the department of its average per diem charge to individuals who are not presently receiving nursing facility benefits under Medicare, Medicaid, or Veterans Administration programs. Notice must be made by the first day of the third month after the department notifies the facility of the Medicaid per diem rates set by the department.

Medicaid reimbursement is limited to the lower of the facility's average private pay per diem charge, as case mix adjusted, or the facility's Medicaid per diem rates for direct and nondirect care established by the department by July 1 of each year. If the facility's case mix adjusted average private pay per diem charge is less than the facility's case mix adjusted Medicaid per diem rate, the department shall amend the facility's case mix adjusted Medicaid rate to be no greater than the facility's case mix adjusted private pay per diem charge.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.