<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.sc032f98f-b158-40d2-855d-d23def3777f6P0 { 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.sc032f98f-b158-40d2-855d-d23def3777f6C0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc032f98f-b158-40d2-855d-d23def3777f6C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc032f98f-b158-40d2-855d-d23def3777f6C0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc032f98f-b158-40d2-855d-d23def3777f6000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc032f98f-b158-40d2-855d-d23def3777f6C0-000003 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc032f98f-b158-40d2-855d-d23def3777f6000004 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc032f98f-b158-40d2-855d-d23def3777f6C2 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; text-decoration: underline; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:03:01"><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0-000000">67:16:03:01</span></a><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0-000001">.  Definitions.</span><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0"> Terms used in this chapter mean:</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6000002"> </span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">    (1)  "Cost outlier," a hospital claim </span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">that the department determines has an estimated cost greater than the diagnosis-related group base payment plus the fixed loss threshold published on the department's fee schedule website</span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">;</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6000002"> </span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">    (</span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">2</span><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">)  "Diagnosis-related group," a classification assigned to an inpatient hospital service claim </span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">using the All Patient Refined Diagnosis Related Groups classification methodology</span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">;</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6000002"> </span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">    (</span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">3</span><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">)  "Emergency hospital care," the </span><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">hospital </span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">care necessary to prevent the death or serious impairment of the health of the recipient after the sudden onset of a medical condition that is manifested by symptoms of sufficient severity to be life-threatening or require immediate medical intervention;</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6000002"> </span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">    (</span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">4</span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">)  "Hospital services," items and services provided on the hospital's premises to a patient by a hospital under the direction of a physician or a dentist;</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6000002"> </span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">    (</span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">5</span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">)  "Inpatient," a patient who has been admitted to a hospital on the recommendation of a physician or a dentist;</span><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0"> and</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6000002"> </span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">    (</span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">6</span><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">)  "Outpatient," a patient who receives professional services at a hospital, but is not provided with room, board, and services on a </span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">twenty-four</span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">-hour basis.</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6000002"> </span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">    </span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0-000001">Source:</span><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0"> SL 1975, ch 16, § 1; 1 SDR 30, effective October 13, 1974; 4 SDR 35, effective December 22, 1977; 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 12 SDR 6, effective July 28, 1985; 15 SDR 2, effective July 17, 1988; 17 SDR 180, effective May 27, 1991; 17 SDR 200, effective July 1, 1991; 19 SDR 128, effective March 10, 1993; 20 SDR 135, effective February 22, 1994; 20 SDR 144, effective March 10, 1994; 21 SDR 172, effective April 3, 1995; 22 SDR 143, May 9, 1996; 23 SDR 192, effective May 22, 1997; 24 SDR 144, effective April 30, 1998; 25 SDR 116, effective March 24, 1999; 26 SDR 157, effective June 7, 2000; 28 SDR 1, effective July 18, 2001; 28 SDR 115, effective February 27, 2002; 30 SDR 26, effective September 3, 2003; 31 SDR 107, effective February 1, 2005; 34 SDR 68, effective September 12, 2007; 37 SDR 53, effective September 23, 2010; 42 SDR 51, effective October 13, 2015</span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">; 52 SDR 126, effective July 1, 2026</span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">.</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">    </span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0-000001">General Authority:</span><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0-000003">28-6-1</span></a><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">.</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">    </span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0-000001">Law Implemented:</span><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0-000003">28-6-1</span></a><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">, </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1.1"><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0-000003">28-6-1.1</span></a><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">.</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6000002"> </span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0-000001">    </span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0-000001">Cross-Reference:</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0-000001">    </span><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">Definitions, "Website" (Fee Schedule Website), subdivision </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:01"><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0-000003">67:16:01:01</span></a><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">(18).</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6000004"> </span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">    </span><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0-000001">Collateral Reference:</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">    </span><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6C0">Solventum"! All Patient Refined Diagnosis Related Groups (APR DRGs) Classification System, </span><a href="https://www.solventum.com/en-us/home/health-information-technology/solutions/apr-drg/"><span class="sc032f98f-b158-40d2-855d-d23def3777f6C2">https://www.solventum.com/en-us/home/health-information-technology/solutions/apr-drg/</span></a><span class="sc032f98f-b158-40d2-855d-d23def3777f6C0">.</span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6000002"> </span></p><p dir="ltr" class="sc032f98f-b158-40d2-855d-d23def3777f6P0"><span xml:space="preserve" class="sc032f98f-b158-40d2-855d-d23def3777f6000002"> </span></p></div></body></html>