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/67:16:03

67:16:03Hospital Services

Chapter · Administrative Rules of South Dakota · View on sdlegislature.gov ↗

Rulemaking activity

Article 67:15 (LIEAP), Article 67:16 (MS - Transportation) Article 67:18 (Child Support Enforcement), Article 67:42 (Family Foster Homes), Article 67:46 (Economic Assistance)Effective

Sections (41)

67:16:03:01Definitions.
67:16:03:01.01Benefit period not to exceed 30 inpatient
67:16:03:01.02Requirements for an outlier.
67:16:03:01.03Determination
67:16:03:02Inpatient hospital
67:16:03:02.01Inpatient hospital
67:16:03:03Outpatient hospital
67:16:03:04Inpatient hospital services not covered.
67:16:03:05Outpatient hospital services not covered.
67:16:03:06Basis of reimbursement -- Inpatient services -- In-state hospitals.
67:16:03:06.01Basis of reimbursement -- Outpatient services.
67:16:03:06.02Certain in-state hospitals and hospital units exempt from diagnosis-related group basis of reimbursement.
67:16:03:06.03Basis of reimbursement -- Inpatient services -- In-state critical access hospitals.
67:16:03:06.04Basis of reimbursement -- Inpatient services -- Out-of-state hospitals.
67:16:03:06.05Basis of reimbursement -- Organ transplant
67:16:03:06.06Reimbursement for in-state DRG-exempt hospitals and units.
67:16:03:06.07Reimbursement of
67:16:03:06.08Payment for above-average, access-critical and above-average, at-risk hospitals.
67:16:03:06.09Disproportionate share
67:16:03:06.10Classification of hospitals providing certain outpatient surgical procedures.
67:16:03:06.11Basis of reimbursement -- Outpatient surgical procedures covered under subdivision 67:16:03:03(10).
67:16:03:06.12Services included in reimbursement rate for outpatient surgical procedures covered under chapter 67:16:28.
67:16:03:06.13Items and services not included in reimbursement rate for outpatient surgical services covered under chapter 67:16:28 and paid under the provisions of chapter 67:16:03.
67:16:03:06.14Payment groups for outpatient hospital surgical procedures covered under chapter 67:16:28.
67:16:03:06.15Rate of payment -- Medicare crossover claims for certain inpatient hospital services.
67:16:03:06.16Rate of reimbursement if individual subject to care management remains in psychiatric unit beyond established discharge date.
67:16:03:06.17Basis of reimbursement – Inpatient services – Claims containing revenue code 275 or 278.
67:16:03:06.18Basis of reimbursement -- Outpatient prospective payment system.
67:16:03:07Payment of hospital
67:16:03:07.01Maximum rate of payment -- Transfers between DRG-reimbursed hospital unit and DRG-exempt intensive care nursery unit in same hospital.
67:16:03:07.02Maximum rate of payment -- Patient transfer not
67:16:03:08Notification of hospital services.
67:16:03:09Verification of eligibility.
67:16:03:10Utilization review.
67:16:03:11Inpatient psychiatric hospital services.
67:16:03:12Transferred to § 67:16:03:06.
67:16:03:13Cost
67:16:03:14Claim requirements.
67:16:03:14.01Billing requirements.
67:16:03:14.02Claim requirements for individuals subject to managed care who remain in psychiatric unit beyond established discharge date.
67:16:03:15Application of other chapters.