67:16:03:06.18Basis of reimbursement -- Outpatient prospective payment system.

Section · 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

Medicare prospective payment system hospitals and out-of-state hospitals must be paid using the department's outpatient prospective payment system (OPPS). Under the OPPS, services are reimbursed using ambulatory payment classifications. The conversion factor, weights, and fee schedule rates for services not assigned an ambulatory payment classification are published on the department's fee schedule website. Outpatient prospective payments may not include any item or service for which payment may be made under other provisions of this article, unless the item or service is specifically included on the department's fee schedule website.

Source: 43 SDR 80, effective December 5, 2016; 52 SDR 126, effective July 1, 2026.

General Authority

SDCL 28-6-1 ↗
Amended by HB1239 (2020) — require the costs of nursing homes to be rebased every five years for purposes o
Amended by HB1229 (2019) — require optional services through Medicaid to be authorized through special appr
Amended by SB30 (2019) — remove certain unnecessary federal references and dates from certain provisions

Law Implemented

SDCL 28-6-1 ↗
Amended by HB1239 (2020) — require the costs of nursing homes to be rebased every five years for purposes o
Amended by HB1229 (2019) — require optional services through Medicaid to be authorized through special appr
Amended by SB30 (2019) — remove certain unnecessary federal references and dates from certain provisions
SDCL 28-6-1.1 ↗
Amended by HB1239 (2020) — require the costs of nursing homes to be rebased every five years for purposes o

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