S.D. Admin. R. 67:16:44:07

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

Section 67:16:44:07 - Payment limitations

Payments at an all-inclusive rate to a FQHC or RHC are subject to the following limitations:

(1) Encounters with more than one health professional and multiple encounters with the same health professional which take place on the same day constitute a single visit, unless the visit meets the criteria stated in subdivision (2) of this section;

(2) Payment is limited to two visits a day. The second visit is payable only if, after the first visit, the patient suffers illness or injury which requires additional diagnosis or treatment, one of the visits is for behavioral health services covered under the provisions of 67:16:41 or 67:16:48, or one of the visits is for dental services provided under the provisions of 67:16:06;

(3) Payment is limited to those covered services provided by a physician, physician assistant, nurse practitioner, visiting nurse, mental health provider listed in § 67:16:41:03, dentist, or an accredited substance use disorder provider.

S.D. Admin. R. 67:16:44:07

23 SDR 109, effective 1/5/1997; 33 SDR 44, effective 9/20/2006; 37 SDR 53, effective 9/23/2010; 44 SDR 94, effective 12/4/2017; 46 SDR 050, effective 10/10/2019

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

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