S.D. Admin. R. 67:48:04:03

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

Section 67:48:04:03 - Limit on attorney fees

For purposes of SDCL 28-6-7.1, attorney fees payable by the department are limited to the following:

(1) If the department has agreed to the terms of a settlement which the individual's attorney has negotiated, 25 percent of the settlement that relates to the Medicaid expenditures recovered;

(2) If the amount of the award is determined through a third-party mediation, an administrative hearing, or by a circuit court, 33 1/3 percent of the award that relates to the Medicaid expenditures recovered;

(3) If the amount of the award determined under subdivision (2) is appealed to and successful in a higher court, 40 percent of the award that relates to the Medicaid expenditures recovered;

(4) If the third-party mediation, administrative hearing, or court action referred to in subdivision (2) or (3) of this section is for the purpose of either reducing the amount of the award payable to the department or increasing the attorney fees payable by the department, 25 percent of the original award that relates to the Medicaid expenditures recovered; or

(5) If the award includes a workers' compensation claim, the limits established in SDCL 62-7-36.

When the attorney acting on behalf of the individual receives the award, the attorney shall immediately deduct the applicable fee from the Medicaid expenditures recovered and send the remainder to the department. The attorney must deduct the fee in one lump sum and may not deduct amounts that represent taxes on the attorney fees.

Nothing in this section prohibits the department from negotiating with the individual's attorney for a rate lower than the fees specified in this section.

S.D. Admin. R. 67:48:04:03

26 SDR 162, effective 6/14/2000.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-7.1.