<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.sd40818e1-7a01-4515-8be1-61f9db2562ffP0 { 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.sd40818e1-7a01-4515-8be1-61f9db2562ffC0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sd40818e1-7a01-4515-8be1-61f9db2562ff000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000003 { 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="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:06:04"><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000000">67:16:06:04</span></a><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000001">.  Covered services -- Limits -- Rate of payment.</span><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0"> Covered dental services include those procedures and limitations </span><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">listed</span><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0"> on the department's fee schedule website.</span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ff000002"> </span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">    The rate of payment is limited to the lesser of the provider's usual and customary fee or the fee </span><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">listed</span><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0"> on the department's fee schedule website.</span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ff000002"> </span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">    The rate of payment </span><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">is</span><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0"> subject to review and amendment by the department under § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:28"><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000003">67:16:01:28</span></a><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">.</span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ff000002"> </span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">    The covered items and services provided </span><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">in</span><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0"> this chapter for children under the age of 21 are not subject to the established limits.</span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ff000002"> </span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">    Coverage for nonemergency adult dental services is limited to $</span><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">2</span><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">,000 per fiscal year.</span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ff000002"> </span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">    </span><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000001">Source:</span><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0"> SL 1975, ch 16, § 1; 1 SDR 66, effective April 6, 1975; 4 SDR 10, effective August 28, 1977; 4 SDR 35, effective December 22, 1977; 4 SDR 88, effective June 26, 1978; 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 11 SDR 26, effective August 21, 1984; 12 SDR 70, effective October 31, 1985; 15 SDR 167, effective May 11, 1989; 16 SDR 234, effective July 1, 1990; 18 SDR 198, effective June 3, 1992; 23 SDR 197, effective May 26, 1997; 35 SDR 88, effective October 23, 2008; 38 SDR 224, effective July 1, 2012; 42 SDR 51, effective October 13, 2015</span><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">; 49 SDR 21, effective September 12, 2022</span><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">.</span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">    </span><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000001">General Authority:</span><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000003">28-6-1</span></a><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">.</span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">    </span><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000001">Law Implemented:</span><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000003">28-6-1</span></a><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">(1)(2)</span><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">, </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000003">28-6-1</span></a><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">.1.</span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ff000002"> </span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">    </span><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000001">Cross-References:</span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000001">    </span><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">Eligibility requirements, § </span><a href="https://sdlegislature.gov/Rules?Rule=67:46:01:02"><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000003">67:46:01:02</span></a><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">.</span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">    Qualified Medicare Beneficiaries (QMB), ch </span><a href="https://sdlegislature.gov/Rules?Rule=67:46:11"><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000003">67:46:11</span></a><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">.</span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">    Fee Schedule Website Definition, </span><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">§</span><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0"> </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:01"><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0-000003">67:16:01:01</span></a><span class="sd40818e1-7a01-4515-8be1-61f9db2562ffC0">(18).</span></p><p dir="ltr" class="sd40818e1-7a01-4515-8be1-61f9db2562ffP0"><span xml:space="preserve" class="sd40818e1-7a01-4515-8be1-61f9db2562ff000002"> </span></p></div></body></html>