S.D. Admin. R. 44:06:03:04

Current through Register Vol. 51, page 56, November 4, 2024

Section 44:06:03:04 - Provider reimbursement

The CSHS program shall pay providers for authorized services rendered according to the following:

(1) If CSHS is the primary payer for physician, laboratory, radiology, and pharmacy services, the reimbursement shall be at the Medicaid (Title XIX) reimbursement rates in Appendix A, B, C, or D to chapters 67:16:02 and 67:16:14;

(2) If CSHS is the primary payer for inpatient or outpatient hospitalizations, the reimbursement shall be at sixty-eight percent of allowable billed charges; or

(3) If CSHS is the secondary payer the reimbursement shall be the family copay amount; or the balance after any insurance or health plan payment is first deducted from the provider's bill.

S.D. Admin. R. 44:06:03:04

6 SDR 93, effective 7/1/1980; 14 SDR 182, effective 7/11/1988; 20 SDR 91, effective 12/19/1993; 23 SDR 91, effective 12/9/1996; 30 SDR 198, effective 6/23/2004; 33 SDR 106, effective 12/26/2006; 34 SDR 322, effective 6/30/2008.

General Authority: SDCL 34-1-21.

Law Implemented: SDCL 34-1-21.