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Administrative Rules
Rule 22:02:02:07 Reasons for claim denial.

          22:02:02:07.  Reasons for claim denial. The board shall deny a county's claim for reimbursement for any of the following reasons:

 

          (1)  The county has not paid its CCPR annual assessment;

          (2)  The county has not paid its supplemental CCPR fund assessment;

          (3)  The county has not paid the first $20,000 for the individual for the 12-month period;

          (4)  The county has not provided the evidence required under § 22:02:02:05;

          (5)  The service was provided before January 1, 1985;

          (6)  The service was provided before the date of county participation;

          (7)  The county has not been approved as a participating county;

          (8)  The request for reimbursement has been delayed and the county failed to notify the department according to § 22:02:02:03;

          (9)  The claim is for an organ transplant for which the county has failed to meet the requirements of SDCL 28-13A-13;

          (10)  The county failed to follow its guidelines when determining eligibility;

          (11)  The county failed to pursue other third-party payment sources;

          (12)  The individual was not eligible for county poor relief; or

          (13)  The claim exceeds the payment limits established in § 22:02:02:08.

 

          Source: 11 SDR 144, effective May 2, 1985, amended effective July 1, 1985; 19 SDR 76, effective November 23, 1992; 22 SDR 2, effective July 17, 1995; 25 SDR 69, effective November 12, 1998; transferred from § 67:19:02:07, 36 SDR 27, effective August 26, 2009.

          General Authority: SDCL 28-13A-4.

          Law Implemented: SDCL 28-13A-4.

 

Online Archived History: