CHAPTER 44:06:03
PROVIDERS
Section
44:06:03:01 Standards for and approval of providers.
44:06:03:02 Out-of-state care.
44:06:03:03 Repealed.
44:06:03:04 Provider reimbursement.
44:06:03:05 Acceptance of payment.
44:06:03:01. Standards for and approval of providers. All providers of CSHS authorized services must be participating providers with CSHS. Physicians and other CSHS providers must be licensed by their respective licensing authority.
Source: 6 SDR 93, effective July 1, 1980; 8 SDR 155, effective May 27, 1982; 14 SDR 182, effective July 11, 1988; 20 SDR 91, effective December 19, 1993; 30 SDR 198, effective June 23, 2004.
General Authority:SDCL 34-1-21.
Law Implemented:SDCL 34-1-21.
44:06:03:02. Out-of-state care. Out-of-state care that meets the standards of § 44:06:03:01 may be permitted if the following conditions are met:
(1) Service of comparable quality is not available within the state; or
(2) The individual is in the middle of complex care that was initiated before the development of the in-state service or application to CSHS.
Source: 6 SDR 93, effective July 1, 1980; 20 SDR 91, effective December 19, 1993; 30 SDR 198, effective June 23, 2004.
General Authority:SDCL 34-1-21.
Law Implemented:SDCL 34-1-21.
44:06:03:03. Provider agreements.Repealed.
Source: 6 SDR 93, effective July 1, 1980; repealed, 8 SDR 155, effective May 27, 1982.
44:06:03:04. Provider reimbursement. The CSHS program
shall pay providers for authorized services rendered according to the
following:
(1) If CSHS is the primary
payer for physician, laboratory, radiology, and pharmacy services, the
reimbursement shall be at the Medicaid (Title XIX) reimbursement rates in
Appendix A, B, C, or D to chapters 67:16:02 and 67:16:14;
(2) If CSHS is the primary
payer for inpatient or outpatient hospitalizations, the reimbursement shall be
at sixty-eight percent of allowable billed charges; or
(3) If CSHS is the
secondary payer the reimbursement shall be the family copay amount; or the
balance after any insurance or health plan payment is first deducted from the
provider's bill.
Source:
6 SDR 93, effective July 1, 1980; 14 SDR 182, effective July 11, 1988; 20 SDR
91, effective December 19, 1993; 23 SDR 91, effective December 9, 1996; 30 SDR
198, effective June 23, 2004; 33 SDR 106, effective December 26, 2006; 34 SDR
322, effective June 30, 2008.
General
Authority: SDCL 34-1-21.
Law
Implemented: SDCL 34-1-21.
44:06:03:05. Acceptance of payment. By the acceptance of
a payment made by the CSHS program, a provider agrees to accept the CSHS amount
allowable as payment in full for services rendered.
Source:
14 SDR 182, effective July 11, 1988; 20 SDR 91, effective December 19, 1993; 34
SDR 322, effective June 30, 2008.
General
Authority: SDCL 34-1-21.
Law
Implemented: SDCL 34-1-21.
Code
Commission Note: Appendix A to § 44:06:03:04, published separately,
and Appendixes B, C, and D to § 44:06:03:04 were repealed by 14 SDR 182,
effective July 11, 1988.
