<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.sce883bc3-f615-4987-a90a-9134dc5fd152P0 { margin-top: 0; margin-bottom: 0; margin-left: 0; margin-right: 0; text-indent: 0.00in; text-align: center; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; } span.sce883bc3-f615-4987-a90a-9134dc5fd152C0 { background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sce883bc3-f615-4987-a90a-9134dc5fd152C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sce883bc3-f615-4987-a90a-9134dc5fd152000001 { background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } 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margin-bottom: 0; margin-left: 1.30in; margin-right: 0; text-indent: -1.30in; text-align: justify; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; } p.sce883bc3-f615-4987-a90a-9134dc5fd152P0-000007 { margin-top: 0; margin-bottom: 0; margin-left: 1.25in; margin-right: 0; text-indent: -1.25in; text-align: justify; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; } </style></head><body><div><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0"><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0">CHAPTER </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:01"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000000">67:16:01</span></a></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0"><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152000001"> </span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0">GENERAL PROVISIONS</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000002"><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152000001"> </span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000002"><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152000001"> </span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000002"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">Section</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:01"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:01</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Definitions.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:02"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:02</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Transferred.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:03"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:03</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Repealed.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:04"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:04</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Choosing a provider.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:05"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:05</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Transferred.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:06"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:06</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Repealed.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:06.01"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:06.01</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">    Covered services.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:06.02"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:06.02</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">    Covered services must be medically necessary.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:06.03"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:06.03</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">    Covered services requiring prior authorization.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000006"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:07"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:07</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        State payment as payment in full -- Individual responsible for payment of noncovered services.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:07.01"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:07.01</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">    Transferred</span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:07.02"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:07.02</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">    Transferred.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:08"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:08</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Services not covered.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:08.01"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:08.01</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">    Sterilization services.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:09"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:09</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Amount of payment.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:10"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:10</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Payment of mileage to provider.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:11"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:11</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Payment made to provider.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:12"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:12</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Confidential information.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:13"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:13</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Identification card.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:14"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:14</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Transferred.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:15"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:15</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Repealed.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:16"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:16</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Uniformity of services.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:17"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:17</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Fair hearings.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:18"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:18</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Civil rights.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:19"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:19</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Utilization review.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:20"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:20</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Transferred</span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:21"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:21</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Transferred.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:22"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:22</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Cost-sharing participants</span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">, Repealed</span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:22.01"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:22.01</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">    Services exempt from cost sharing</span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">, Repealed</span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000007"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:23"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:23</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Cost sharing deducted from allowable reimbursement before payment</span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">, Repealed</span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:24"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:24</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Application of chapter.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:25"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:25</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Use of </span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">Current Procedural Terminology</span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000004"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:26"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:26</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Use of </span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">International Classification of Diseases</span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:27"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:27</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Use of H</span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">ealth Care Common Procedure Coding System</span><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000006"><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:28"><span class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000005">67:16:01:28</span></a><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152C0-000003">        Rates and procedures subject to review and amendment -- Provider may request review.</span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000002"><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152000001"> </span></p><p dir="ltr" class="sce883bc3-f615-4987-a90a-9134dc5fd152P0-000002"><span xml:space="preserve" class="sce883bc3-f615-4987-a90a-9134dc5fd152000001"> </span></p></div></body></html>