S.D. Admin. R. 67:16:29:04.02

Current through Register Vol. 51, page 67, December 16, 2024

Section 67:16:29:04.02 - Provider to maintain records

The provider prescribing medical equipment must document the medical necessity in the recipient's clinical record. Unless otherwise specified in the department's coverage criteria, documentation of medical necessity must be updated annually or when the physician or other licensed practitioner's estimated quantity, frequency, or duration has changed prior to the annual renewal. Failure to properly document medical necessity is cause for nonpayment.

The clinical record must contain:

(1) Recipient name and Medicaid ID number;

(2) Diagnosis, including an explanation of the particular condition resulting from the diagnosis which relates to the equipment request;

(3) Prognosis;

(4) Length of time the item is expected to be required;

(5) Justification of medical necessity;

(6) Equipment prescribed;

(7) Prescribing provider's National Provider Identification (NPI) number, signature, and date signed;

(8) Description of equipment; and

(9) Explanation of equipment functions.

S.D. Admin. R. 67:16:29:04.02

18 SDR 210, effective 6/23/1992; 41 SDR 93, effective 12/3/2014; 44 SDR 94, effective 12/4/2017; 47 SDR 038, effective 10/6/2020; 50 SDR 063, effective 11/27/2023

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1(1)(2)(4).