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.