S.D. Admin. R. 67:16:03:06.06

Current through Register Vol. 51, page 57, November 12, 2024

Section 67:16:03:06.06 - Reimbursement for in-state DRG-exempt hospitals and units

Reimbursement to in-state DRG-exempt hospitals and units is based on reasonable and allowable costs following guidelines established in 42 C.F.R. §§ 413.1 to 413.157, inclusive, ( August 1, 2015), with the following exceptions:

(1) Costs associated with certified registered nurse anesthetists that relate to exempt units of hospitals are included as allowable costs;

(2) Capital and education costs incurred for inpatient services are included as allowable costs;

(3) Psychiatric unit services are paid at the usual and customary charge for the services provided, the daily rate located on the department's fee schedule website, or at the rate payable according to § 67:16:03:06.16, whichever is less. The daily rate of payment is subject to review and amendment by the department under the provisions of § 67:16:01:28;

(4) Rehabilitation hospital services are paid at the lesser of the usual and customary charge for the services provided or the daily rate located on the department's fee schedule website; and

(5) Perinatal units, rehabilitation units, and children's care hospitals are reimbursed at a daily rate established by the department according to the guidelines provided in the South Dakota Medicaid State Plan. The daily rates are located on the department's fee schedule website.

S.D. Admin. R. 67:16:03:06.06

17 SDR 180, effective 5/27/1991; 18 SDR 198, effective 6/3/1992; 19 SDR 128, effective 3/10/1993; 20 SDR 144, effective 3/10/1994; 21 SDR 172, effective 4/3/1995; 22 SDR 143, effective 5/9/1996; 23 SDR 192, effective 5/22/1997; 24 SDR 144, effective 4/30/1998; 26 SDR 157, effective 6/7/2000; 28 SDR 1, effective 7/18/2001; 28 SDR 115, effective 2/27/2002; 31 SDR 39, effective 9/29/2004; 35 SDR 49, effective 9/10/2008; 37 SDR 236, effective 6/28/2011; 37 SDR 236, adopted June 8, 2011, effective 7/1/2012; 38 SDR 224, effective 7/1/2012; 42 SDR 51, effective 10/13/2015

General Authority: SDCL 28-6-1(2).

Law Implemented: SDCL 28-6-1(2), 28-6-1.1.

South Dakota Medicaid State Plan, Attachment 4.19A, pages 4-5. Copies may be obtained from the Department of Social Services, Division of Medical Services, 700 Governors Drive, Pierre, South Dakota 57501.