Statutes, codes, and regulations
South Dakota Administrative Rules
Title 67 - Department of Social ServicesArticle 67:16 - Covered medical services
Chapter 67:16:03 - Hospital services
Section 67:16:03:06.04 - Basis of reimbursement - Inpatient services - Out-of-state hospitals

S.D. Admin. R. 67:16:03:06.04

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Current through Register Vol. 51, page 57, November 12, 2024
Section 67:16:03:06.04 - Basis of reimbursement - Inpatient services - Out-of-state hospitals

The department shall reimburse out-of-state inpatient hospital services by making a prospective payment equal to the payment allowed by the Medicaid program in the state in which the hospital is located. If the Medicaid program in the hospital's home state refuses to price a claim, the payment allowed is a percentage of the provider's usual and customary charge as appropriated by the Legislature.

S.D. Admin. R. 67:16:03:06.04

15 SDR 2, effective 7/17/1988; 16 SDR 235, effective 7/5/1990; 17 SDR 200, effective 7/1/1991; 30 SDR 26, effective 9/3/2003; 31 SDR 107, effective 2/1/2005; 36 SDR 215, effective 7/1/2010; 36 SDR 215 adopted June 11, 2010, effective 7/1/2011; 37 SDR 236, effective 6/28/2011; 38 SDR 224, effective 7/1/2012; 40 SDR 15, effective 7/31/2013.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

South Dakota Medicaid State Plan, Attachment 4.19-A, page 1. Copies may be obtained from the Department of Social Services, Division of Medical Services, 700 Governors Drive, Pierre, South Dakota 57501.