67:16:11:11Utilization review.

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

Utilization review for EPSDT services may be conducted on three levels: (1) Computerized claims processing; (2) Postpayment review; and (3) Peer review.

Source: SL 1975, ch 16, § 1; 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 15 SDR 167, effective May 11, 1989; 17 SDR 37, effective September 11, 1990.

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 2008-10 ↗
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

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