<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.s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0 { margin-top: 0; margin-bottom: 0; margin-left: 0; margin-right: 0; text-indent: 0.00in; text-align: justify; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; } span.s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s22f2fa85-ee56-49e4-a00f-b8315a0810bd000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000003 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:04:51"><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000000">67:16:04:51</span></a><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000001">.  Ceilings.</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> Ceilings are established using allowable costs as follows:</span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bd000002"> </span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">    (1)  </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">To determine the case mix adjusted direct care costs of a facility, the department shall use two ceiling calculations</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">. The first ceiling is </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred and fifteen</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. The department </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">shall</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> recognize </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent of the facility's allowable costs up to the </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred and fifteen</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent ceiling. The second ceiling </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">is one hundred and twenty-five</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. Payment for the case mix adjusted direct care costs </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">that</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> exceed the </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred and fifteen</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent ceiling and are up to the </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred and twenty-five</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent ceiling is calculated according to § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:04:54.01"><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000003">67:16:04:54.01</span></a><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">;</span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bd000002"> </span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">    (2)  </span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">To determine the nondirect care costs of health and subsistence, plant, plant operations, and other operating costs of a facility, the department shall use two ceiling calculations. </span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">The first ceiling is </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred and five</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. The department </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">shall</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> recognize </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent of the facility s allowable costs up to the </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred and five</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent ceiling. The second ceiling </span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">is established </span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">at </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred and ten</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. Payment for these nondirect care costs </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">that</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> exceed the </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred and five</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent ceiling and are up to the </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred and ten</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent ceiling is calculated according to § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:04:54.02"><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000003">67:16:04:54.02</span></a><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">;</span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bd000002"> </span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">    (3)  </span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">To determine the nondirect care costs of administration of a facility, the department shall use two ceiling calculations. </span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">The first ceiling is </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred and five</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent of the median cost of all freestanding nonchain organization affiliated nursing facilities. The department </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">shall</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> recognize </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent of the facility's allowable costs up to the </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred and five</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent ceiling. The second ceiling </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">is one hundred and ten</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent of the median cost of all freestanding nonchain organization affiliated nursing facilities. Payment for the nondirect care costs of administration </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">that</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> exceed the </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred and five</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent ceiling and are up to the </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">one hundred and ten</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> percent ceiling is calculated according to § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:04:54.03"><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000003">67:16:04:54.03</span></a><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">; and</span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bd000002"> </span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">    (4)  </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">Beginning July 1, 2023</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">, capital costs are </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">limited to a ceiling of twenty dollars and ninety-five cents</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> per resident day.</span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bd000002"> </span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">    </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000001">Source:</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> 21 SDR 8, effective July 25, 1994; 23 SDR 42, effective September 30, 1996; 24 SDR 185, effective July 6, 1998; 26 SDR 5, effective July 1, 1999; 26 SDR 21, effective August 24, 1999; 29 SDR 177, effective July 1, 2003; 29 SDR 177, adopted July 1, 2003, effective July 1, 2004; 35 SDR 312, effective July 6, 2009</span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">; 50 SDR 11, effective August 7, 2023</span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">.</span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">    </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000001">General Authority:</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000003">28-6-1</span></a><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">.</span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">    </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000001">Law Implemented:</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000003">28-6-1</span></a><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">.</span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bd000002"> </span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">    </span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000001">Cross-References</span><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000001">:</span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0"> </span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bd000002"> </span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">    </span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">Method of establishing per diem rates, § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:04:54"><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000003">67:16:04:54</span></a><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">.</span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bd000002"> </span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">    </span><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">State fiscal year, SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=4-10-10"><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0-000003">4-10-10</span></a><span class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdC0">.</span></p><p dir="ltr" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bdP0"><span xml:space="preserve" class="s22f2fa85-ee56-49e4-a00f-b8315a0810bd000002"> </span></p></div></body></html>