CHAPTER 46:32:01
ITEMIZED BILLING
Section
46:32:01:01 Definitions.
46:32:01:02 Financial assessment.
46:32:01:03 Patient able to pay itemized costs.
46:32:01:04 Patient unable to pay itemized costs.
46:32:01:05 Patient unable to pay per diem.
46:32:01:06 Patient unable to pay reduced per diem.
46:32:01:07 Itemized billing.
46:32:01:08 HSC medical procedure fee.
46:32:01:09 Off-site medical care cost.
46:32:01:10 Payor classifications.
46:32:01:11 Pharmaceutical and dispensing fee.
46:32:01:12 Professional fees.
46:32:01:13 Room rate determination by treatment program.
46:32:01:14 Supply cost.
46:32:01:01. Definitions. Terms used in this chapter mean:
(1) "Applied adjustments," the difference between a patient's total itemized bill and any previously agreed upon, contractual, or legislated agreement with a respective payor;
(2) "BFM," the Bureau of Finance and Management;
(3) "Contract," the payor classification in which a patient, legally responsible person, nongovernment agency, or business entity has a contractual agreement with the HSC for the provision of mental health or chemical dependency services, or both;
(4) "Dispensing fee," pharmaceutical handling fee to recover the cost of pharmacy labor;
(5) "ECT," electro convulsive therapy;
(6) "HSC," the Human Services Center in Yankton, SD;
(7) "Medical procedure," ECT, laboratory, specialty clinic, or x-ray service;
(8) "Off-site medical treatment," medical treatment at a facility other than HSC that is provided to a patient;
(9) "Per diem," daily patient cost for a course of treatment as provided in 27A-13-7;
(10) "Private pay," the payor classification in which a patient, legally responsible person, or agency does not have health insurance coverage;
(11) "Professional fee," the cost of providing the services of a medical doctor, physician-assistant, nurse practitioner, or psychologist services;
(12) "Room rate," the cost of providing room, board, and direct care by a specific hospital treatment program;
(13) "Supplies," supplies provided to a patient during a course of treatment at the HSC.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-4-2, 27A-13-3.1, 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.1, 27A-13-3.2.
46:32:01:02. Financial assessment. Any patient admitted to the HSC must complete a financial statement. The HSC shall use the financial statement to determine the patient's ability to pay. The HSC shall categorize the gross income of the patient as a percent of the current federal poverty level to determine the patient's ability to pay.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-4-2, 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.1, 27A-13-3.2.
46:32:01:03. Patient able to pay itemized costs. If the HSC determines that patient or legally responsible person has the financial resources to pay itemized costs, the HSC shall bill those costs less applied adjustments to the applicable payor. The applicable payors may be the patient, commercial insurance, Champus, Medicare, Medicaid, or the county of the patient's residence.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-4-2, 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.1, 27A-13-3.2.
46:32:01:04. Patient unable to pay itemized costs. If the HSC determines that a patient or legally responsible person does not have the financial resources to pay the itemized costs of the patient's program, but does have the ability to pay the per diem cost, the HSC shall bill the per diem cost.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-4-2, 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.1, 27A-13-3.2.
46:32:01:05. Patient unable to pay per diem. If the HSC determines that a patient or legally responsible person does not have the financial resources to pay the per diem, but does have an ability to pay a lesser amount as provided in SDCL 27A-13-9 and 27A-13-10, the HSC shall bill the patient or legally responsible person the lesser amount.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-4-2, 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.1, 27A-13-3.2.
46:32:01:06. Patient unable to pay reduced per diem. If the HSC determines that a patient or legally responsible person does not have the financial resources to pay the itemized costs, the per diem, or a lesser amount, the HSC shall assess the patient's account to the state after payments by the county of the patient's residence have been applied to the patient's account.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-4-2, 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.1, 27A-13-3.2.
46:32:01:07. Itemized billing. The HSC shall calculate and maintain a billing statement for each patient's course of treatment and provide an itemized bill for each patient.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.1, 27A-13-3.2.
46:32:01:08. HSC medical procedure fee. The HSC shall bill each patient for the patient's medical procedures. The cost of any medical procedure shall reflect the actual cost of providing the medical procedure including salaries, benefits, operating expenses, travel, contracted services, supplies and materials, grants and subsidies, and capital outlay in accordance with BFM fixed assets and depreciation policy.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.1, 27A-13-3.2.
46:32:01:09. Off-site medical care cost. If a patient is not assessed to pay a per diem and requires medical treatment outside the scope of services provided by the HSC, the patient shall be billed individually for the treatment at the HSC's cost.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.2.
46:32:01:10. Payor classifications. Upon admission to the HSC, the HSC shall classify each patient in one of the following payor classifications:
(1) Champus;
(2) Contract;
(3) County;
(4) Medicaid;
(5) Medicare;
(6) Private pay; or
(7) Other.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.1, 27A-13-3.2.
46:32:01:11. Pharmaceutical and dispensing fee. The HSC shall bill each patient for the pharmaceuticals used in the patient's course of treatment. The charge shall be the actual cost of the specific pharmaceutical and a dispensing fee. The dispensing fee is based upon the cost of filling the prescription and includes salaries, benefits, operating expenses, travel, contracted services, supplies and materials, grants and subsidies, and capital outlay in accordance with BFM fixed assets and depreciation policy.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.1, 27A-13-3.2.
46:32:01:12. Professional fees. The HSC shall bill each patient receiving professional services a professional fee. The professional fee shall reflect the actual cost of medical doctors, physician-assistants, nurse practitioners, and psychologists and includes salaries, benefits, operating expenses, travel, contracted services, supplies and materials, grants and subsidies, and capital outlay in accordance with BFM fixed assets and depreciation policy.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.1, 27A-13-3.2.
46:32:01:13. Room rate determination by treatment program. The HSC shall calculate and bill each patient for a daily room rate based upon the cost associated with the respective treatment program. The cost of a room is based on an allocation of cost by square foot of the respective program and includes salaries, benefits, operating expenses, travel, contracted services, supplies and materials, grants and subsidies, and capital outlay in accordance with BFM fixed assets and depreciation policy. The room rate shall also include the cost of meals.
The HSC shall establish room rates for the following programs:
(1) Acute adolescent psychiatric;
(2) Adolescent chemical dependency;
(3) Adolescent long-term psychiatric;
(4) Adult chemical dependency;
(5) Adult psychiatric;
(6) Geriatrics;
(7) Intensive treatment unit;
(8) Impact; and
(9) Psychiatric rehabilitation.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.1, 27A-13-3.2.
46:32:01:14. Supply cost. The HSC shall charge the actual cost of daily supplies consumed by each patient on the patient's itemized bill. The cost shall be based upon the HSC's most recent supply contract pricing.
Source: 26 SDR 64, effective November 16, 1999.
General Authority:SDCL 27A-13-3.2.
Law Implemented:SDCL 27A-13-3.1, 27A-13-3.2.
