<html> <head> <title>Rule 67:16:44:07 Payment limitations.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:44:07"> <META NAME="Description" Content="Administrative Rules 67:16:44:07 Payment limitations."> <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:Calibri; panose-1:2 15 5 2 2 2 4 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; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; font-family:"Calibri",sans-serif; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} 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>67:16:44:07.&nbsp;&nbsp;Payment limitations.</b> Payments</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> at an all-inclusive rate</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> to a </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>federally qualified health center or rural health clinic</span><span style='font-size: 12.0pt;font-family:"Times New Roman",serif'> are subject to the following limitations:</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; (1)&nbsp;&nbsp;Encounters with more than one health professional and multiple encounters with the same health professional</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>,</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> which take place on the same day</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>,</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> constitute a single visit</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>, unless the visit meets the criteria stated in subdivision (2) of this section</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; (2)&nbsp;&nbsp;Payment is limited to two visits a day. The second visit is payable only if, after the first visit, the patient suffers illness or injury </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>t</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>h</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>at</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> requires additional diagnosis or treatment</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>, one of the visits is for behavioral health services covered under chapters 67:16:41 or 67:16:48, or one of the visits is for dental services provided under chapter 67:16:06</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>;</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> and</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; (3)&nbsp;&nbsp;Payment is limited to those covered services provided by a physician, </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>physician assistant, nurse practitioner,</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'> visiting nurse</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>, mental health provider listed in &#167;&nbsp;67:16:41:03, dentist, or an accredited substance use disorder provider</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>Source:</b> 23 SDR 109, effective January 5, 1997; 33 SDR 44, effective September 20, 2006; 37 SDR 53, effective September 23, 2010; 44 SDR 94, effective December 4, 2017; 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)</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> </div> </body> </html>