<html> <head> <title>Rule 67:16:40:06 Hospital to supply medical documentation to support admission.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:40:06"> <META NAME="Description" Content="Administrative Rules 67:16:40:06 Hospital to supply medical documentation to support admission."> <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>67:16:40:06.&nbsp;&nbsp;Hospital to supply documentation to support admission.</b> Before the care manager authorizes care under this chapter, the hospital must provide the care manager with medical documentation which substantiates that the admission is medically necessary and that the applicable requirements of §&nbsp;67:16:40:07, 67:16:40:08, 67:16:40:09, or 67:16:40:09.01 were met.</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; If the care manager is not able to determine whether the admission, continued stay, or discharge is justified, the care manager shall request a care management consultant to review the documentation and make the determination.</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; A care management consultant must review the documentation if the care manager determines that the admission is not justified, a continued stay is not warranted, or a patient should be discharged. The final decision as to the admission, continued stay, or discharge rests with the care management consultant. The care manager shall notify the hospital representative and the attending physician of the final determination within one working day after the final determination is made. The care manager may notify the hospital representative orally but must follow the oral notice with a written notice.</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> 21 SDR 123, effective January 19, 1995; 31 SDR 39, effective September 29, 2004.</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> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-Reference:</b> Covered services must be medically necessary, §&nbsp;67:16:01:06.02.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html>