CHAPTER 67:16:12
FAMILY PLANNING SERVICES
Section
67:16:12:01 Definitions.
67:16:12:02 Scope of services.
67:16:12:02.01 Services not covered.
67:16:12:03 Rate of payment.
67:16:12:04 Utilization review.
67:16:12:05 Billing requirements.
67:16:12:06 Claim requirements.
67:16:12:07 Application of other chapters.
67:16:12:01. Definitions. Terms used in this chapter mean:
(1) "Family planning services," medically approved services and supplies which are available for individuals of childbearing age for the purpose of providing freedom of choice to determine, in advance, the number and spacing of children.
Source: SL 1975, ch 16, § 1; 1 SDR 30, effective October 13, 1974; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 16 SDR 227, effective June 25, 1990.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
67:16:12:02. Scope of services. The department may provide the following family planning services to eligible individuals:
(1) Diagnosis;
(2) Treatment;
(3) Drugs, supplies, devices, and procedures, except agents to promote fertility; and
(4) Related counseling under the supervision of a physician or other licensed practitioner.
Source: SL 1975, ch 16, § 1; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 17 SDR 200, effective July 1, 1991; 44 SDR 94, effective December 4, 2017.
General Authority: SDCL 28-6-1(1)(2).
Law Implemented: SDCL 28-6-1(1)(2).
67:16:12:02.01. Services not covered. The following services are not covered:
(1) Agents to promote fertility;
(2) Procedures to reverse a previous sterilization;
(3) Removal of implanted contraceptive capsules if done to reverse the intent of the original implant; and
(4) Artificial insemination.
Source: 19 SDR 26, effective August 23, 1992.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
67:16:12:03. Rate of payment. The department shall make
payments according to the applicable provisions of chapters 67:16:01, 67:16:02,
67:16:03, 67:16:05, 67:16:13, 67:16:14, 67:16:28, and 67:16:44 for services
provided under this chapter.
Source:
SL 1975, ch 16, § 1; 1 SDR 30, effective October 13, 1974; 7 SDR 66, 7 SDR
89, effective July 1, 1981; 16 SDR 227, effective June 25, 1990; 34 SDR 68,
effective September 12, 2007.
General
Authority: SDCL 28-6-1.
Law
Implemented: SDCL 28-6-1.
67:16:12:04. Utilization review. The department may conduct utilization reviews for family planning services on the following levels:
(1) Computerized claims processing;
(2) Postpayment review; and
(3) Peer reviews.
Source: SL 1975, ch 16, § 1; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 16 SDR 227, effective June 25, 1990.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
67:16:12:05. Billing requirements. A claim submitted
under this chapter must be submitted at the provider's usual and customary
charge and in accordance with the applicable provisions of chapters 67:16:01,
67:16:02, 67:16:03, 67:16:05, 67:16:13, 67:16:14, 67:16:28, and 67:16:44.
Source:
16 SDR 227, effective June 25, 1990; 34 SDR 68, effective September 12, 2007.
General
Authority: SDCL 28-6-1.
Law
Implemented: SDCL 28-6-1.
67:16:12:06. Claim requirements. A claim for services
covered under § 67:16:12:02 must be submitted according to the following:
(1) If the claim relates to
a physician's service, follow the claim requirements of chapter 67:16:02;
(2) If the claim relates to
hospital services, follow the claim requirements of chapter 67:16:03;
(3) If the claim relates to
home health services, follow the claim requirements of chapter 67:16:05;
(4) If the claim relates to
clinic services, follow the claim requirements of chapter 67:16:13;
(5) If the claim relates to
prescription drugs, follow the claim requirements of chapter 67:16:14;
(6) If the claim relates to
ambulatory surgical center services, follow the claim requirements of chapter
67:16:28; and
(7) If the claim relates to
federally qualified health centers and rural health clinic services, follow the
claim requirements of chapter 67:16:44.
Source:
17 SDR 4, effective July 16, 1990; 34 SDR 68, effective September 12, 2007.
General
Authority: SDCL 28-6-1.
Law
Implemented: SDCL 28-6-1.
67:16:12:07. Application of other chapters. In addition
to the rules contained in this chapter, providers and recipients must meet the
requirements of chapters 67:16:01, 67:16:26, 67:16:33, 67:16:34, 67:16:35, and
67:16:39.
Source:
17 SDR 184, effective June 6, 1991; 34 SDR 68, effective September 12, 2007.
General
Authority: SDCL 28-6-1.
Law
Implemented: SDCL 28-6-1.
