ARTICLE 67:45

NURSING FACILITY LEVEL OF CARE AND CLAIMS

Chapter

67:45:01            Level of care.

67:45:02            Nursing facility claims and payments limits.

67:45:03            Case mix validation process.

CHAPTER 67:45:01

LEVEL OF CARE

Section

67:45:01:01                            Definitions.

67:45:01:02                            Department to determine level of care classification.

67:45:01:03                            Nursing facility level of care classification.

67:45:01:04                            Intermediate level of care classification.

67:45:01:04.01                        Adult foster care classification, Repealed.

67:45:01:04.02 to 67:45:01:04.06    Repealed.

67:45:01:05                            Self-care level of care classification.

67:45:01:05:01                        Settings and services for level of care classifications.

67:45:01:06                            Swing-bed hospital services, Repealed.

67:45:01:07                            Repealed.

67:45:01:08                            Redetermination of level of care classification.

67:45:01:09                            Repealed.

    67:45:01:01.  Definitions. Terms used in this chapter mean:

    (1)  "Activities of daily living," tasks performed routinely by a person to maintain physical functioning and personal care;

    (2)  "Adult foster care," as defined in chapter 67:46:03;

    (3)  "Alternative services," services provided in an individual's home by family, friends, or in-home service providers that allow the individual to remain in the home;

    (4)  "Assessment," a comprehensive evaluation described in § 44:73:06:10 that includes admission, readmission, and discharge information, as applicable;

    (5)  "Assisted living center," a facility that meets the definition of an assisted living center provided in SDCL 34-12-1.1;

    (6)  "Department," the Department of Social Services;

    (7)  "Instrumental activities of daily living," tasks performed routinely by an individual utilizing physical and social environmental features to manage life situations;

    (8)  "Level of care," a classification that denotes the type of care an individual requires;

    (9)  "Non-waiver assisted living," a service provided to an individual in an assisted living center who does not meet the eligibility criteria to receive waiver services;

    (10)  "Nursing facility," a facility licensed as a nursing facility by the Department of Health as defined in SDCL 34-12-1.1;

    (11)  "Self-care level of care," the ability of an individual to live independently with or without alternative services;

    (12)  "Swing bed," a licensed hospital bed approved by the Department of Health to provide short-term nursing facility care pending the availability of a nursing facility bed; and

    (13)  "Waiver services," Title XIX Long Term Services and Support services provided under chapter 67:44:03.

    Source: 18 SDR 67, effective October 13, 1991; 23 SDR 92, effective December 10, 1996; 27 SDR 32, effective October 11, 2000; 38 SDR 123, effective January 23, 2012; 51 SDR 13, effective August 12, 2024.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    67:45:01:02.  Department to determine level of care. If an assessment of the individual indicates waiver services are applicable, the department must determine if the individual requesting long-term care assistance under article 67:46 is in need of care. The need for care is established by reviewing the individual's medical, nursing, and social needs. The department shall also consider alternative services available for the individual in the community. Based on an individual's needs, the department shall assign one of the following:

    (1)  Nursing facility level of care classification;

    (2)  Intermediate level of care classification; or

    (3)  Self-care level of care classification.

    Source: SL 1975, ch 16, § 1; 1 SDR 30, effective October 13, 1974; 2 SDR 71, effective April 29, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 10 SDR 79, effective February 1, 1984; transferred from § 67:16:04:03, 18 SDR 67, effective October 13, 1991; 27 SDR 32, effective October 11, 2000; 51 SDR 13, effective August 12, 2024.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    Cross References:

    Redetermination of level of care classification, § 67:45:01:08.

    Payment limits -- Level of care classification, § 67:45:02:02.

    67:45:01:03.  Nursing facility level of care classification. The department may assign an individual to a nursing facility level of care classification if the individual requires any of the following services:

    (1)  Continuing direct care services that have been ordered by a physician and can only be provided by or under the supervision of a licensed nurse. These services include daily management, direct observation, monitoring, or performance of complex nursing procedures. For purposes of this section, continuing direct care is repeated application of the procedures or services at least once every twenty-four hours, frequent monitoring, and documentation of the individual's condition and response to the procedures or services;

    (2)  The assistance of another person for the performance of any activity of daily living according to an assessment of the individual's needs; or

    (3)  Skilled therapeutic services:

        (a)  Physical therapy, occupational therapy, or speech-language therapy in any combination that is provided at least once a week;

        (b)  Continuing mental health services provided under chapter 67:62:12 with a documented need for waiver services to prevent nursing facility placement by a staff member who meets the requirements of subdivision 67:62:06:03(2); or

        (c)  Continuing mental health services provided under chapter 67:62:13 with a documented need for waiver services to prevent nursing facility placement by a staff member who meets the requirements of subdivision 67:62:06:03(2).

    The department must complete a classification assignment for an eligible individual before payment is made for services provided. 

    Source: 18 SDR 67, effective October 13, 1991; 27 SDR 32, effective October 11, 2000; 38 SDR 123, effective January 23, 2012; 51 SDR 13, effect August 12, 2024.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    Cross References:

    Redetermination of level of care classification, § 67:45:01:08.

    Requirements for staff providing direct services and supports to clients, § 67:62:06:03.

    67:45:01:04.  Intermediate level of care classification. The department may assign an individual to an intermediate level of care classification if the individual:

    (1)  Resides, or is anticipated to reside, in an assisted living center and requires assistance available twenty-four hours a day to enable the individual to carry out those tasks associated with the activities of daily living and or the instrumental activities of daily living; or

    (2)  Resides, or is anticipated to reside, in adult foster care and needs supervision, minimal assistance, or monitoring in:

(a)  The activities of daily living or instrumental activities of daily living;

(b)  The self-administration of medications;

(c)  The self-treatment of a physical disorder; or

(d)  Self-preservation in emergencies when capable of taking action with direction.

    The department must complete a classification assignment for an eligible individual before payment is made for services provided.

    Source: SL 1975, ch 16, § 1; 2 SDR 71, effective April 29, 1976; 4 SDR 10, effective August 28, 1977; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 15 SDR 68, effective November 7, 1988; transferred from § 67:16:04:19, 18 SDR 67, effective October 13, 1991; 23 SDR 92, effective December 10, 1996; 27 SDR 32, effective October 11, 2000; 28 SDR 96, effective December 30, 2001; 38 SDR 123, effective January 23, 2012; 51 SDR 13, effective August 12, 2024.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    Cross References:

    Resident admissions, § 44:70:04:13.

    Dietetic services, chapter 44:70:06.

    Medication control, chapter 44:70:07.

    Redetermination of level of care classification, § 67:45:01:08.

    67:45:01:04.01.  Adult foster care classification. Repealed.

    Source: 23 SDR 92, effective December 10, 1996; 27 SDR 32, effective October 11, 2000; 51 SDR 13, effective August 12, 2024.

    67:45:01:05.  Self-care level of care classification. For individuals who do not meet the criteria for a nursing facility level of care classification or an intermediate level of care classification, the department must assign a self-care level of care classification. Individuals with a self-care level of care classification are not eligible for waiver services but may be eligible for services under other programs.

    Source: 18 SDR 67, effective October 13, 1991; 38 SDR 123, effective January 23, 2012; 51 SDR 13, effective August 12, 2024.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    67:45:01:05.01.  Settings and services for level of care classifications. Individuals are eligible for certain settings and services, depending on their level of care classification:

    (1)  For a nursing facility level of care classification:

        (a)  Swing bed;

        (b)  Nursing facility; and

        (c)  Home and community-based waiver services provided in § 67:44:03:06;

    (2)  For an intermediate level of care classification:

        (a)  Adult foster care; and

        (b)  Non-waiver assisted living; or

    (3)  For a self-care level of care classification, any services not covered under chapter 67:44:03.

    Source: 51 SDR 13, effective August 12, 2024.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    67:45:01:06.  Swing-bed hospital services. Repealed.

    Source: 11 SDR 26, effective August 21, 1984; transferred from § 67:16:04:20.02, 18 SDR 67, effective October 13, 1991; 51 SDR 13, effective August 12, 2024.

          67:45:01:07.  Factors not considered when determining individual's level of care classification. Repealed.

          Source: SL 1975, ch 16, § 1; 2 SDR 71, effective April 29, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 11 SDR 26, effective August 21, 1984; transferred from § 67:16:04:20, 18 SDR 67, effective October 13, 1991; repealed, 23 SDR 192, effective May 22, 1997.

    67:45:01:08.  Redetermination of level of care classification. The department shall annually redetermine an individual's level of care classification assignment.

    A redetermination may be made at more frequent intervals if a redetermination is warranted due to a change in the individual's mental or physical condition.

    If it is determined that the individual does not need a nursing facility level of care or an intermediate level of care, the department must notify the individual and the facility, if applicable. The facility shall document this notice in the individual's record.

    Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 9 SDR 11, effective August 1, 1982; transferred from § 67:16:18:14, 18 SDR 67, effective October 13, 1991; 22 SDR 16, effective August 17, 1995; 23 SDR 92, effective December 10, 1996; 26 SDR 21, effective August 24, 1999; 38 SDR 123, effective January 23, 2012; 40 SDR 122, effective January 8, 2014; 51 SDR 13, effective August 12, 2024.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    Cross-References:

    Assistance when nursing facility unable to meet individual's need -- Individual assigned to self-care -- Payment limits, § 67:45:02:08.

    Assistance when need is intermediate care for individuals with intellectual disabilities or intermediate care for the mentally disabled -- Payment limits, § 67:45:02:09.

CHAPTER 67:45:02

NURSING HOME CLAIMS AND PAYMENT LIMITS

Section

67:45:02:01                                Reserved.

67:45:02:02                                Payment limits -- Level of care classification.

67:45:02:03                                Repealed.

67:45:02:04                                Payment for reserved bed days.

67:45:02:05 and 67:45:02:06     Repealed.

67:45:02:07                                Documentation required for ventilator add-on payment.

67:45:02:08                                Assistance when nursing facility unable to meet individual's need -- Individual assigned to self-care -- Payment limits.

67:45:02:09                                Assistance when need is intermediate care for the individuals with intellectual disabilities or intermediate care for the mentally disabled -- Payment limits.

67:45:02:10                                Payment limited to resident days.

67:45:02:11                                Utilization review.

67:45:02:12                                Claim requirements.

67:45:02:13                                Repealed.

          67:45:02:01.  Reserved.

          67:45:02:03.  Payment limits when husband and wife both require nursing facility care. Repealed.

          Source: SL 1975, ch 16, § 1; 1 SDR 30, effective October 13, 1974; 2 SDR 71, effective April 29, 1976; 4 SDR 10, effective August 28, 1977; 7 SDR 66, 7 SDR 89, effective July 1, 1981; transferred from § 67:16:04:05, 18 SDR 67, effective October 13, 1991; repealed, 23 SDR 192, effective May 22, 1997.

          67:45:02:04.  Payment for reserved bed days. The department shall pay a nursing facility to reserve a bed during an eligible individual's temporary absence from the nursing facility. Payment is limited to a  maximum of five days if the absence is due to admission to an acute care general hospital and a maximum of 15 consecutive days if the absence is for therapeutic home visits and the absence has been provided for in the individual's plan of care. After 15 days of therapeutic home visiting, the individual shall be considered a new admission on return to the facility.

          Payment is limited to 100 percent of the allowable per diem rate for the facility as established under the provisions of chapter 67:16:04.

          No payment may be made to a state-owned institution for reserving a bed during an individual's absence.

          Source: SL 1975, ch 16, § 1; 1 SDR 30, effective October 13, 1974; 2 SDR 71, effective April 29, 1976; 4 SDR 35, effective December 22, 1977; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 11 SDR 26, effective August 21, 1984; 15 SDR 68, effective November 7, 1988; 16 SDR 26, effective August 13, 1989; transferred from § 67:16:04:14, 18 SDR 67, effective October 13, 1991.

          General Authority: SDCL 28-6-1.

          Law Implemented: SDCL 28-6-1.

          67:45:02:05.  Documentation required for oxygen add-on payment. Repealed.

          Source: 15 SDR 68, effective November 7, 1988; documentation requirements transferred from § 67:16:04:08.02, 18 SDR 67, effective October 13, 1991; repealed, 22 SDR 16, effective August 17, 1995.

          67:45:02:06.  Documentation required for nutritional therapy add-on payment. Repealed.

          Source: 15 SDR 68, effective November 7, 1988; documentation requirements transferred from § 67:16:04:08.02, 18 SDR 67, effective October 13, 1991; repealed, 22 SDR 16, effective August 17, 1995.

          67:45:02:07.  Documentation required for ventilator add-on payment. When an add-on payment for a ventilator is made under the provisions of § 67:16:04:08.04, the individual's record must contain the physician's orders documenting dependency on a ventilator.

          Source: 16 SDR 26, effective August 13, 1989; documentation requirements transferred from §  67:16:04:08.04, 18 SDR 67, effective October 13, 1991.

          General Authority: SDCL 28-6-1.

          Law Implemented: SDCL 28-6-1.

          67:45:02:08.  Assistance when nursing facility unable to meet individual's need -- Individual assigned to self-care -- Payment limits. When a nursing facility is unable to meet the needs of the individual, the department may assist the facility or the individual in finding an appropriate placement. Payment to the facility will continue for a maximum of 30 days or until the date of transfer to the new facility, whichever occurs first.

          When an individual no longer needs nursing facility services and is given a self-care level of care, the burden of finding a place to live rests with the individual. The department may assist the individual if so requested. Payment to the facility will continue for a maximum of 60 days or until the date of transfer to the community, whichever occurs first.

          No payment is allowed for self-care.

          Source: 5 SDR 109, effective July 1, 1979; 7 SDR 66, 7 SDR 89, effective July 1, 1981; transferred from § 67:16:04:09.01, 18 SDR 67, effective October 13, 1991.

          General Authority: SDCL 28-6-1.

          Law Implemented: SDCL 28-6-1.

          67:45:02:10.  Payment limited to resident days. Payments to nursing facilities are made in behalf of an individual for resident days only. Resident days include the day of admission but exclude the day of discharge. For purposes of this section, a resident day is when the individual is physically present in the facility at midnight or when a bed is being reserved for the individual at midnight. It is not a resident day if the individual is discharged or dies prior to midnight.

          Source: SL 1975, ch 16, § 1; 1 SDR 30, effective October 13, 1974; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 11 SDR 26, effective August 21, 1984; 15 SDR 68, effective November 7, 1988; transferred from § 67:16:04:13, 18 SDR 67, effective October 13, 1991.

          General Authority: SDCL 28-6-1.

          Law Implemented: SDCL 28-6-1.

          67:45:02:11.  Utilization review. Claims and payments for nursing facility care, adult foster care, or assisted living are subject to review on the following levels:

          (1)  At the time of admission;

          (2)  Computerized claims review and audit; and

          (3)  Annual care classification review.

          Source: 18 SDR 67, effective October 13, 1991; 22 SDR 16, effective August 17, 1995.

          General Authority: SDCL 28-6-1.

          Law Implemented: SDCL 28-6-1.

CHAPTER 67:45:03

CASE MIX VALIDATION PROCESS

Section

67:45:03:01        Definitions.

67:45:03:02        Nursing facility to submit assessments to department.

67:45:03:03        Correction to previously submitted resident assessment.

67:45:03:04        Review to validate resident classifications.

67:45:03:05        Attempt to reconcile differences.

67:45:03:06        Conference.

67:45:03:07        Written report of review.

67:45:03:08        Payment adjustment due to review of assessment.

67:45:03:09        Nursing facility to provide resident's clinical record.

67:45:03:10        Record retention.

67:45:03:11        Cases of suspected fraud -- Investigation -- Restitution.

67:45:03:12        Fair hearing.

    67:45:03:01.  Definitions. Terms used in this chapter mean:

    (1)  "Case mix," the mixture of residents of different classifications within a nursing facility;

    (2)  "Classification," a system of mutually exclusive categories that relate a resident's needs to the resident's cost of care;

    (3)  "Nurse consultant," a registered nurse employed by the department to validate resident classifications used to establish payment levels for the facility;

    (4)  "Nursing facility," a facility licensed as a nursing facility by the Department of Health and maintained and operated for the express or implied purpose of providing care to one or more persons, whether for consideration or not, who are not acutely ill but require nursing care and related medical services of such complexity as to require professional nursing care under the direction of a physician twenty-four hours a day; and

    (5)  "Assessment," a comprehensive assessment, completed using the resident assessment instrument described in § 67:73:06:10, of the functional, medical, mental, nursing, and psychosocial needs of a resident of a nursing facility and includes admission, readmission, and discharge information as applicable.

    Source: 26 SDR 21, effective August 24, 1999; 50 SDR 11, effective August 7, 2023.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    67:45:03:02.  Nursing facility to submit assessments to department. A nursing facility participating in the Medicaid program shall submit completed assessments to the department according to § 44:73:06:10.

    The nursing facility shall ensure that the documentation maintained in the resident's file replicates exactly the assessment submitted to the department.

    Source: 26 SDR 21, effective August 24, 1999; 50 SDR 11, effective August 7, 2023.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    Cross-Reference:

    Resident assessments, § 44:73:06:10.

    67:45:03:03.  Correction to previously submitted resident assessment. If a facility finds that it submitted an inaccurate or incomplete assessment, the facility shall submit a new, corrected assessment. The new assessment must:

    (1)  Indicate it is a correction document;

    (2)  Be dated with the date the new assessment is prepared; and

    (3)  Reflect the resident's status on that date.

    Corrections are restricted to the most recently submitted assessment.

    The schedule for submitting subsequent assessments is reset according to the date the corrected document is submitted.

    Source: 26 SDR 21, effective August 24, 1999; 50 SDR 11, effective August 7, 2023.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    Cross-References:

    Resident assessments, § 44:73:06:10.

    67:45:03:04.  Review to validate resident classifications. Every fifteen months, at a minimum, a nurse consultant shall conduct a facility review to validate assessments and classifications. The nurse consultant shall notify the nursing facility of a pending review at least forty-eight hours before the review is conducted. The review may encompass any resident of the nursing facility, regardless of payment source, whose assessment was completed in the last forty-five to ninety days.

    Validation of assessments and classifications is accomplished by reviewing the resident's clinical record, interviewing staff from the nursing facility, and comparing the nurse consultant's findings with the assessment completed by the facility. If a resident to be reviewed no longer lives in the facility or is temporarily absent, the nurse consultant may review another resident of the same classification. The nurse consultant may conduct the review onsite at the facility and may observe or interview the resident.

    If the nurse consultant finds an error or inconsistency on the assessment being reviewed, the nurse consultant may review that resident's assessments completed during the prior twelve months.

    If the nurse consultant identifies errors or irregularities in any one classification, the nurse consultant may expand the review to include resident assessments completed for residents of the same classification. This expanded review may include residents who have since died or been discharged from the facility.

    Source: 26 SDR 21, effective August 24, 1999; 50 SDR 11, effective August 7, 2023.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    67:45:03:05.  Attempt to reconcile differences. In completing the review of the resident, the nurse consultant and a facility staff member shall attempt to reconcile any differences between the assessments completed by the facility and the validations completed by the nurse consultant. The nurse consultant's decision prevails if a difference cannot be resolved.

    Source: 26 SDR 21, effective August 24, 1999; 50 SDR 11, effective August 7, 2023.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    Cross-Reference:

    Fair hearing, § 67:45:03:12.

    67:45:03:06.  Conference. The nurse consultant shall conduct a conference with the administrator of the facility or the facility's director of nursing to present any finding of the review conducted pursuant to § 67:45:03:04. The conference must address the following items, as applicable:

    (1)  Areas which need improvement;

    (2)  Assessments requiring classification and payment changes;

    (3)  Error patterns; and

    (4)  Staff education and training needs.

    Before the conference is concluded, the department shall give the facility staff the opportunity to provide additional information or explanations about discrepancies in the coding or documentation of the assessment. If the facility staff cannot provide evidence that supports its coding of the assessment, the decision of the nurse consultant stands.

    Staff from the nursing facility who attend the conference must sign the conference attendance sheet as an indication that the conference was held and that they attended.

    Source: 26 SDR 21, effective August 24, 1999; 50 SDR 11, effective August 7, 2023.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    Cross-References:

    Payment adjustment due to review of resident assessment, § 67:45:03:08.

    67:45:03:07.  Written report of review. Within fifteen calendar days following the conference described in § 67:45:03:06, the nurse consultant shall send to the facility a written report detailing the results of the review. The written report is the department's final decision.

    Source: 26 SDR 21, effective August 24, 1999; 50 SDR 11, effective August 7, 2023.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    Cross-Reference:

    Payment adjustment due to review of resident assessment, § 67:45:03:08.

    Fair hearing, § 67:45:03:12.

    67:45:03:08.  Payment adjustment due to review of assessment. The department shall adjust a facility's payment if a review of a resident results in either an increase or a decrease in the payment amount the nursing facility should have received on behalf of a resident. The payment adjustment is limited to the most recent assessment submitted.

    Source: 26 SDR 21, effective August 24, 1999; 50 SDR 11, effective August 7, 2023.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    67:45:03:09.  Nursing facility to provide resident's clinical record. The nursing facility shall provide the nurse consultant with the clinical record of each resident being reviewed. The resident's clinical record must include clear, concise, descriptive, and dated documentation that accurately described the resident's condition. The facility must make a resident's clinical record available to the department in a format acceptable to the department and must provide the department with copies of needed documentation from the resident's clinical record on request.

    Source: 26 SDR 21, effective August 24, 1999; 50 SDR 11, effective August 7, 2023.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    67:45:03:10.  Record retention. The facility shall retain the documentation necessary to support each resident's assessment for a minimum of six years.

    Source: 26 SDR 21, effective August 24, 1999; 50 SDR 11, effective August 7, 2023.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    67:45:03:11.  Cases of suspected fraud -- Investigation -- Restitution. If the department receives a report that suggests fraud or abuse has occurred or is occurring in a facility, the department must immediately investigate to determine the validity of the report.

    Nothing contained in this chapter restricts the department's ability to collect payments made to a facility as a result of fraud committed by the facility.

    Source: 26 SDR 21, effective August 24, 1999; 50 SDR 11, effective August 7, 2023.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    67:45:03:12.  Fair hearing. A facility may appeal an adverse decision made under the provisions of this chapter. A request for a fair hearing must be made within ten calendar days after the nursing facility receives the written notice of the department's final decision.

    A facility shall request a fair hearing in writing. A fair hearing is conducted under the provisions of chapter 67:17:02.

    A decision affecting the nursing facility's payment level is applied retroactively to the assessment start date.

    Source: 26 SDR 21, effective August 24, 1999; 50 SDR 11, effective August 7, 2023.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    Cross-Reference:

    Hearing requests, § 67:17:02:03.