Filed as: Medical Services
South Dakota is streamlining its hospital payment rules to align with federal standards and simplify administration. The changes update how the state reimburses both in-state and out-of-state hospitals for inpatient and outpatient services, replacing outdated formulas with standardized methodologies like diagnosis-related groups (DRGs) and the outpatient prospective payment system (OPPS), with specific rates published on the department's fee schedule website. The department is also repealing duplicative rules on coding standards (CPT, ICD, and HCPCS codes) that now appear in federal regulations, and repealing numerous outdated hospital-specific exemptions and payment provisions. Bills for hospital services must now follow the department's billing guidance website rather than hard-coded procedural requirements in the rules themselves.
AI-generated from the adopted rule text — verify against the official documents.
Updates hospital reimbursement methodologies including inpatient and outpatient hospital services for both instate and out-of-state hospitals to more closely align with industry standards, repeal rules that are duplicative of federal regulation or other rules, and to make style and form changes.
Senator Mehlhaff moved to deem the process complete, seconded by Representative Muckey; the motion passed unanimously after lengthy discussion of the new APR-DRG and percent-of-charge hospital reimbursement methodologies, including concerns raised by Representative DeGroot about reduced outpatient rates for a Brookings hospital.
No specific cites listed — see the package documents.
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