S.D. Admin. R. 67:16:01:06.01
Covered services are those medically necessary health care services or items that are within the service limits and meet the prior authorization requirements specified in this article or article 67:54. The department will pay for a medically necessary covered service furnished to a recipient or to a person who is found to be eligible on the date of service.
Prior authorization is based on a review of required documentation to determine if the conditions for Medicaid payment have been met. The review is not considered a medical consultation.
S.D. Admin. R. 67:16:01:06.01
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
Case management -- Primary care provider, ch 67:16:39; Covered services must be medically necessary, § 67:16:01:06.02.