<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.sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0 { 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.sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000003 { 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="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:04:54"><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000000">67:16:04:54</span></a><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000001">.  Method of establishing per diem rates.</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0"> The department shall establish a case mix adjusted direct care per diem rate and a nondirect care per diem rate for each facility prior to July </span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">first</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0"> of each year. These rates are based on the facility's allowable costs, the facility's </span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">Patient Driven Payment Model</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0"> case mix score, inflation factors, cost ceilings, occupancy, and known future cost increases that have prior departmental approval.</span></p><p dir="ltr" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0000002"> </span></p><p dir="ltr" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">    The case mix adjusted direct care per diem rate is established on a facility-specific basis using allowable direct patient care costs and paid according to the </span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">Patient Driven Payment Model</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0"> index </span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">under the Patient Driven Payment Model classification system </span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">on a resident-specific basis. The case mix adjusted direct care per diem rate is established by calculating the average </span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">Patient Driven Payment Model</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0"> case mix score for the facility, determining the per diem case mix component cost for the facility by dividing the allowable cost by </span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">total resident days</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">, and dividing the facility's per diem case mix component cost by its </span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">Patient Driven Payment Model</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0"> average case mix score. The case mix adjusted direct care per diem cost is used to establish the case mix adjusted direct care cost ceilings established in § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:04:51"><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000003">67:16:04:51</span></a><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">, and the case mix adjusted direct care per diem rate is subject to those ceilings and the payment limits established in § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:04:54.01"><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000003">67:16:04:54.01</span></a><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">.</span></p><p dir="ltr" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0000002"> </span></p><p dir="ltr" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">    The nondirect care per diem rate is established on a facility-specific basis using all other allowable costs. The nondirect care per diem rate is based on cost components consisting of health and subsistence, general administrative, other operating, plant</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">, plant </span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">operation</span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">s</span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">, and capital. T</span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">h</span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">e nondirect care per diem rate</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0"> is established by dividing</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0"> the allowable nondirect care costs</span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">,</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0"> by the occupancy determined according to § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:04:49"><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000003">67:16:04:49</span></a><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">. The allowable nondirect care costs are used to establish the ceilings contained in § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:04:51"><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000003">67:16:04:51</span></a><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">, and the nondirect care per diem rate is subject to those ceilings and the payment limits established in § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:04:54.02"><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000003">67:16:04:54.02</span></a><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">. The nondirect care cost is not subject to case mix adjustment.</span></p><p dir="ltr" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0000002"> </span></p><p dir="ltr" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">    The per diem rate for the nondirect care costs of administration is subject to the payment limits established in § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:04:54.03"><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000003">67:16:04:54.03</span></a><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">.</span></p><p dir="ltr" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0000002"> </span></p><p dir="ltr" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">    </span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000001">Source:</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0"> 16 SDR 26, effective August 13, 1989; 17 SDR 50, effective October 7, 1990; 18 SDR 67, effective October 13, 1991; transferred from § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:04:07.05"><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000003">67:16:04:07.05</span></a><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">, 21 SDR 8, effective July 25, 1994; 23 SDR 42, effective September 30, 1996; 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</span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">; 50 SDR 11, effective August 7, 2023</span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">.</span></p><p dir="ltr" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">    </span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000001">General Authority:</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000003">28-6-1</span></a><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">.</span></p><p dir="ltr" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">    </span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000001">Law Implemented:</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000003">28-6-1</span></a><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">.</span></p><p dir="ltr" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0000002"> </span></p><p dir="ltr" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">    </span><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000001">Cross-Reference:</span><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0"> Payment adjustment due to review of resident assessment, § </span><a href="https://sdlegislature.gov/Rules?Rule=67:45:03:08"><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0-000003">67:45:03:08</span></a><span class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0C0">.</span></p><p dir="ltr" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0P0"><span xml:space="preserve" class="sc85152dd-a6a4-41d8-850e-f8b71fa9e2d0000002"> </span></p></div></body></html>