<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.sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41P0 { 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.sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0-000003 { 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="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41P0"><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:03:06.15"><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0-000000">67:16:03:06.15</span></a><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0-000001">.  Rate of payment -- Medicare crossover claims for certain inpatient hospital services.</span><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0"> If the department receives a </span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">m</span><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">edicare crossover claim for an inpatient hospital stay and the hospital is subject to the </span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">diagnosis-related group (</span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">DRG</span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">)</span><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0"> rate of payment, the department </span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">must</span><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0"> calculate the DRG payment for the claim based on the date of service. If the amount paid by </span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">m</span><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">edicare is greater than the calculated DRG amount, the department considers the claim to be paid in full and no additional payment </span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">is to</span><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0"> be made by the department. If the amount paid by </span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">m</span><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">edicare is less than the calculated DRG amount, the department </span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">must</span><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0"> reimburse the difference between the two payment amounts up to the </span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">m</span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">edicare inpatient deductible.</span></p><p dir="ltr" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41P0"><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41000002"> </span></p><p dir="ltr" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41P0"><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">    </span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0-000001">Source:</span><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0"> 28 SDR 3, effective August 1, 2001</span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">; 52 SDR 126, effective July 1, 2026</span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">.</span></p><p dir="ltr" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41P0"><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">    </span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0-000001">General Authority:</span><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0-000003">28-6-1</span></a><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">.</span></p><p dir="ltr" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41P0"><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">    </span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0-000001">Law Implemented:</span><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0-000003">28-6-1</span></a><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">.</span></p><p dir="ltr" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41P0"><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41000002"> </span></p><p dir="ltr" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41P0"><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">    </span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0-000001">Cross-Reference:</span></p><p dir="ltr" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41P0"><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">    </span><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">Basis of reimbursement -- Inpatient services -- </span><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">In-state hospitals</span><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">, § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:03:06"><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0-000003">67:16:03:06</span></a><span class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41C0">.</span></p><p dir="ltr" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41P0"><span xml:space="preserve" class="sc1a6cfd4-4bd6-4568-932a-cdebaf1bde41000002"> </span></p></div></body></html>