<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.s6ffaec41-1980-4720-a22c-6a8e88f7bdc9P0 { 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.s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s6ffaec41-1980-4720-a22c-6a8e88f7bdc9000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0-000003 { 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="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9P0"><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:35:03"><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0-000000">67:16:35:03</span></a><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0-000001">.  Claims limited to items and services covered under article.</span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0"> A provider may submit claims </span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">only </span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">for those supplies and services </span><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">that</span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0"> the provider knows, or should have known, are covered under this article. A provider</span><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">,</span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0"> other than a school district</span><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">,</span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0"> may not submit claims for services to children under </span><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">the age of 21,</span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0"> </span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">if </span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">the provider knows or should have known </span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">that the services </span><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">are listed in the child's individual education plan.</span></p><p dir="ltr" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9P0"><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9000002"> </span></p><p dir="ltr" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9P0"><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">    The submission of a claim containing miscoding that may result in inflated reimbursement or in reimbursement for noncovered services under this article is considered abuse of the program and possible fraud and may be cause for terminating the provider agreement.</span></p><p dir="ltr" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9P0"><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9000002"> </span></p><p dir="ltr" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9P0"><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">    </span><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0-000001">Source:</span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0"> 15 SDR 2, effective July 17, 1988, transferred from § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:07.02"><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0-000003">67:16:01:07.02</span></a><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">, 17 SDR 4, effective July 16, 1990; 17 SDR 184, effective June 6, 1991; 19 SDR 26, effective August 23, 1992; 19 SDR 165, effective May 3, 1993</span><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">; 49 SDR 21, effective September 12, 2022</span><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">.</span></p><p dir="ltr" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9P0"><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">    </span><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0-000001">General Authority:</span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0-000003">28-6-1</span></a><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">.</span></p><p dir="ltr" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9P0"><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">    </span><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0-000001">Law Implemented:</span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0-000003">28-6-1</span></a><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">(4)(6)</span><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">.</span></p><p dir="ltr" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9P0"><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9000002"> </span></p><p dir="ltr" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9P0"><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">    </span><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0-000001">Cross-Reference:</span><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0"> School districts, ch </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:37"><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0-000003">67:16:37</span></a><span class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9C0">.</span></p><p dir="ltr" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9P0"><span xml:space="preserve" class="s6ffaec41-1980-4720-a22c-6a8e88f7bdc9000002"> </span></p></div></body></html>