<html> <head> <title>Rule 67:16:39:08 Primary care provider to provide service or refer recipient for service.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:39:08"> <META NAME="Description" Content="Administrative Rules 67:16:39:08 Primary care provider to provide service or refer recipient for service."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink=purple> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:39:08.&nbsp;&nbsp;Primary care provider to provide service or refer recipient for service.</b> Medically necessary covered services provided under the primary care </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>provider</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> program must be provided by the recipient's </span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'>primary care provider</span><span style='font-size: 12.0pt;font-family:"Times New Roman",serif'> or by another enrolled medical assistance provider to whom the </span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>primary care provider</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> referred the recipient.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Medical services provided by someone other than the recipient's </span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>primary care provider</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> or services provided without referral and authorization by the </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>primary care provider</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> are noncovered services and may be cause for denial by the department.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 20 SDR 135, effective February 22, 1994; 30 SDR 115, effective February 4, 2004; 46 SDR 50, effective October 10, 2019.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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></span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)(4)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-Reference:</b> Recipient responsible for payment of noncovered services, &#167;&nbsp;67:16:39:04.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html>