<html> <head> <title>Rule 67:16:04:58 Facility's average per diem charge.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:04:58"> <META NAME="Description" Content="Administrative Rules 67:16:04:58 Facility's average per diem charge."> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Originator content="Microsoft Word 10"> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:04:58.&nbsp;&nbsp;Facility's average per diem charge.</b> A nursing facility which elects to participate in the Medicaid program must notify the department of its average per diem charge to individuals who are not presently receiving nursing facility benefits under Medicare, Medicaid, or Veterans Administration programs. Notice must be made by the first day of the third month after the department notifies the facility of the Medicaid per diem rates set by the department.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Medicaid reimbursement is limited to the lower of the facility's average private pay per diem charge, as case mix adjusted, or the facility's Medicaid per diem rates for direct and nondirect care established by the department by July 1 of each year. If the facility's case mix adjusted average private pay per diem charge is less than the facility's case mix adjusted Medicaid per diem rate, the department shall amend the facility's case mix adjusted Medicaid rate to be no greater than the facility's case mix adjusted private pay per diem charge.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 17 SDR 50, effective October 7, 1990; 18 SDR 67, effective October 13, 1991; transferred from §&nbsp;67:16:04:07.07, 21 SDR 8, effective July 25, 1994.</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A></font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A></font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html>