67:16:41:15Utilization review.
Section · Administrative Rules of South Dakota · View on sdlegislature.gov ↗
Utilization review may be conducted on the following levels: (1) Computerized claim processing; (2) Postpayment review; and (3) Peer review. A peer review entity appointed by the department shall review claims to determine and ensure the appropriate quality, quantity, and medical necessity of mental health services provided.
Source: 22 SDR 6, effective July 26, 1995.
General Authority
- SDCL 28-6-1 ↗Amended by HB1239 (2020) — require the costs of nursing homes to be rebased every five years for purposes oAmended by HB1229 (2019) — require optional services through Medicaid to be authorized through special apprAmended 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 oAmended by HB1229 (2019) — require optional services through Medicaid to be authorized through special apprAmended by SB30 (2019) — remove certain unnecessary federal references and dates from certain provisions