South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:46 - Eligibility for medical services
Chapter 67:46:09 - Disabled children
Section 67:46:09:12 - Cost not to exceed cost of medical institutional care

Current through Register Vol. 51, page 43, September 23, 2024

Based on the level of care determination, the actual itemized cost of all Medicaid covered services provided in the home may not exceed 100 percent of the Medicaid-allowable cost of care in a medical institution. Medicaid allowable cost is the amount payable when cost share, insurance, or Medicare deductible or coinsurance has been applied.

The costs of all services that would be included in a medical institution's reimbursement shall be used to determine the monthly home care cost. When determining the monthly home care cost, the cost of purchased medical equipment shall be prorated on an annual basis.

When the cost of care in the home exceeds the cost of institutional care, the department shall issue a notice of intent to discontinue or deny further service. The department may reconsider its decision to discontinue or deny further service if, within 30 days from the date of the notice, the parent provides documentation to the department that future costs will decline and be within 100 percent of the cost.

The Medicaid allowable cost of care for the various medical institutions are as follows:

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Add-on payment -- Ventilator, § 67:16:04:08.04; Documentation required for ventilator add-on payment, § 67:45:02:07.