S.D. Admin. R. 67:16:49:05

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

Section 67:16:49:05 - Rate of payment

The rate of payment for travel covered under § 67:16:49:03 is available on the departments fee schedule website and limited to the following:

(1) Mileage outside the recipient's city of residence, which is limited to the actual miles between the two cities and does not include miles driven within the city. Only one mileage allowance is payable for each trip regardless of the number of recipients being transported. Mileage is a reimbursable service only if a trip is completed;

(2) Meals for the recipient. If an escort or volunteer driver is needed to transport the recipient, meals for the escort or volunteer driver are reimbursable. The department shall determine whether a meal is reimbursable based on the time of the scheduled appointment and the distance needed to be traveled;

(3) Lodging for the recipient. If a recipient is transporting himself or herself, the lodging reimbursement is limited to one payment per day. If an escort or volunteer driver is transporting his or her spouse or child who is a recipient, the lodging reimbursement is limited to one payment per day for the recipient and an additional payment is not allowed for the escort or volunteer driver. If the escort or volunteer driver is transporting someone other than his or her spouse or child, the escort or volunteer driver is allowed an additional payment per day for lodging expenses.

(4) The rate of payment for travel services provided by a commercial carrier is limited to the actual cost of the fare.

If the mode of travel chosen by the recipient is more expensive or if the provider is more distant than is medically necessary, the department shall pay the least costly method of travel suitable and available for travel to the closest facility or medical provider available and capable of providing the necessary service.

If the department determines that an individual is retroactively eligible for medical assistance, payment for those documented expenses incurred during the retroactive benefit period is subject to the limits in effect on the date of the service.

The department shall reimburse the charitable organization the amount advanced, not to exceed the limits established for each of the applicable covered services. If the recipient, escort, or volunteer driver incurs travel expenses that exceed the amount advanced by the charitable organization, reimbursement for the additional expenses is limited to the maximum amount of reimbursement established less the amount advanced by the charitable organization.

S.D. Admin. R. 67:16:49:05

44 SDR 94, effective 12/4/2017

General Authority: SDCL 28-6-1.

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