22:02:02:05.  Application for reimbursement -- Evidence of payment. A county requesting reimbursement from the CCPR fund must submit an application for reimbursement to the association on a form available from the association.

          In addition to the application, a county must provide the following information to the association:

          (1)  A copy of the provider's invoice showing dates of service;

          (2)  Evidence, such as a copy of the approved county voucher, that payment was made by the county, including the amount paid;

          (3)  If the request for reimbursement is for a hospital claim incurred after June 30, 1997, documentation which establishes both the individual's and the county's share of the hospital bill;

          (4)  If county payment to a hospital was based on the Medicaid rate, a copy of the documentation from Medicaid which calculates the Department of Social Services payment rate; and

          (5)  A voucher signed by the county board of commissioners chair or vice-chair.

          If the claim being submitted is the first reimbursement request covering a particular individual, the county must also submit evidence which shows that the county has met its $20,000 share of the expenses for that individual for the 12-month period in which the services were rendered.

          If the claim is for an organ transplant, the county must submit evidence of compliance with SDCL 28-13A-13.

          Source: 11 SDR 144, effective May 2, 1985, amended effective July 1, 1985; 13 SDR 134, effective March 30, 1987; 19 SDR 76, effective November 23, 1992; 25 SDR 69, effective November 12, 1998; transferred from § 67:19:02:05, 36 SDR 27, effective August 26, 2009.

          General Authority: SDCL 28-13A-4.

          Law Implemented: SDCL 28-13A-4, 28-13A-6.