Section · Administrative Rules of South Dakota · View on sdlegislature.gov ↗
requirements. Admission to a medically complex program is a covered service if the following criteria are met: (1) Medical documentation substantiates that the service is medically necessary. Medical documentation includes a diagnosis, a complete medical history, copies of progress notes from physicians or other professionals providing care or services, laboratory tests, X rays, physician or other licensed practitioner orders and a treatment plan outlining the needed care, and any other documentation which may be necessary to determine medical necessity for the child's admission; (2) Home health care is not a viable option as determined by the department based on the child's medical needs, the availability of home health services, and cost effectiveness; (3) The facility has notified the child's school district that the child has been referred to the facility for services and may be in need of an educational program; (4) The cost of care does not exceed the cost of care in the child's home; and (5) Professional nursing services are necessary on a 24-hour basis and the child requires at least two of the following services: (a) Intravenous medications more than twice a day which must be administered by a registered nurse; (b) Drug therapy stabilization which requires skilled monitoring on a 24-hour basis; (c) Nutritional therapy during an unstable period; (d) Alternative nutritional feeding, such as nasogastric or gastrostomy feeding, during an unstable period; (e) Tracheostomy care during an unstable period; (f) Colostomy or ileostomy care during an unstable period; (g) Skilled skin care and monitoring for the treatment of a decubitus ulcer; (h) Monitoring of oxygen saturation when oxygen is being administered; (i) Skilled nursing observation and assessment following casting or surgeries; (j) Direct paraprofessional care for more than eight hours a day which is supervised by a medical professional; (k) Peritoneal dialysis during an unstable period; (l) Infectious disease care during an unstable period; (m) Use of a ventilator during an unstable period; or (n) Professional monitoring to manage end stage disease process. For purposes of this rule, an unstable period is that period of time necessary for a child to return to a medically stable state following a disease process, illness, or surgery.
Source: 23 SDR 2, effective July 15, 1996; 44 SDR 94, effective December 4, 2017.