CHAPTER 67:16:04
\r\n\r\n\r\n\r\n
NURSING FACILITY\r\nRATE SETTING
\r\n\r\n\r\n\r\nSection
\r\n\r\n67:16:04:01 Transferred.
\r\n\r\n67:16:04:02 Repealed.
\r\n\r\n67:16:04:03 Transferred.
\r\n\r\n67:16:04:04 Repealed.
\r\n\r\n67:16:04:04.01 Repealed.
\r\n\r\n67:16:04:05 Transferred.
\r\n\r\n67:16:04:05.01 Transferred.
\r\n\r\n67:16:04:06 Transferred.
\r\n\r\n67:16:04:06.01 Transferred.
\r\n\r\n67:16:04:06:02 Transferred.
\r\n\r\n67:16:04:06.03 Transferred.
\r\n\r\n67:16:04:06.04 Transferred.
\r\n\r\n67:16:04:06.05 Transferred.
\r\n\r\n67:16:04:07 Transferred.
\r\n\r\n67:16:04:07.01 Transferred.
\r\n\r\n67:16:04:07.02 Transferred.
\r\n\r\n67:16:04:07.03 Transferred.
\r\n\r\n67:16:04:07.04 Transferred.
\r\n\r\n67:16:04:07.05 Transferred.
\r\n\r\n67:16:04:07.06 Transferred.
\r\n\r\n67:16:04:07.07 Transferred.
\r\n\r\n67:16:04:07.08 Repealed.
\r\n\r\n67:16:04:08 Transferred.
\r\n\r\n67:16:04:08.01 Transferred.
\r\n\r\n67:16:04:08.02 Repealed.
\r\n\r\n67:16:04:08.03 Repealed.
\r\n\r\n67:16:04:08.04 Transferred.
\r\n\r\n67:16:04:08.05 Transferred.
\r\n\r\n67:16:04:08:06 Transferred.
\r\n\r\n67:16:04:08:07 Transferred.
\r\n\r\n67:16:04:08.08 Transferred.
\r\n\r\n67:16:04:08.09 Transferred.
\r\n\r\n67:16:04:09 Repealed.
\r\n\r\n67:16:04:09.01 Transferred.
\r\n\r\n67:16:04:10 Repealed.
\r\n\r\n67:16:04:11 Repealed.
\r\n\r\n67:16:04:12 Repealed.
\r\n\r\n67:16:04:13 Transferred.
\r\n\r\n67:16:04:14 Transferred.
\r\n\r\n67:16:04:15 Repealed.
\r\n\r\n67:16:04:16 Repealed.
\r\n\r\n67:16:04:17 Repealed.
\r\n\r\n67:16:04:18 Repealed.
\r\n\r\n67:16:04:19 Transferred.
\r\n\r\n67:16:04:20 Transferred.
\r\n\r\n67:16:04:20.01 Repealed.
\r\n\r\n67:16:04:20.02 Transferred.
\r\n\r\n67:16:04:21 Repealed.
\r\n\r\n67:16:04:21.01 Repealed.
\r\n\r\n67:16:04:22 Repealed.
\r\n\r\n67:16:04:23 Repealed.
\r\n\r\n67:16:04:24 Repealed.
\r\n\r\n67:16:04:25 Repealed.
\r\n\r\n67;16:04:26 Repealed.
\r\n\r\n67:16:04:27 Repealed.
\r\n\r\n67:16:04:28 Repealed.
\r\n\r\n67:16:04:29 Repealed.
\r\n\r\n67:16:04:30 Transferred.
\r\n\r\n67:16:04:31 Transferred.
\r\n\r\n67:16:04:32 Transferred.
\r\n\r\n67:16:04:33 Definitions.
\r\n\r\n67:16:04:34 Required financial reports.
\r\n\r\n67:16:04:35 Deadline extensions.
\r\n\r\n67:16:04:36 Record retention.
\r\n\r\n67:16:04:37 Audits -- Appeal provisions.
\r\n\r\n67:16:04:38 Time limits for requesting hearing.
\r\n\r\n67:16:04:39 Notification of per diem rates.
\r\n\r\n67:16:04:40 Absence of regulations -- Allowable costs\r\nbased on CMS-15.
\r\n\r\n67:16:04:41 Routine services.
\r\n\r\n67:16:04:42 Nonroutine services.
\r\n\r\n67:16:04:43 Repealed.
\r\n\r\n67:16:04:44 Allowable costs of related-party\r\ntransactions.
\r\n\r\n67:16:04:45 Rent\r\npaid to related-party organization not allowable -- Cost of ownership used.
\r\n\r\n67:16:04:46 Depreciation.
\r\n\r\n67:16:04:47 Costs not allowed.
\r\n\r\n67:16:04:48 Repealed.
\r\n\r\n67:16:04:49 Occupancy.
\r\n\r\n67:16:04:50 Return on net equity.
\r\n\r\n67:16:04:51 Ceilings.
\r\n\r\n67:16:04:52 Maximum capital cost for leased facility.
\r\n\r\n67:16:04:53 Repealed.
\r\n\r\n67:16:04:54 Method of establishing per diem rates.
\r\n\r\n67:16:04:54.01 Method\r\nof establishing per diem rates -- Case mix adjusted direct care costs.
\r\n\r\n67:16:04:54.02 Method\r\nof establishing per diem rates -- Nondirect care costs of health and\r\nsubsistence, plant/operational, and other operating costs.
\r\n\r\n67:16:04:54.03 Method\r\nof establishing per diem rates -- Nondirect care costs of administration.
\r\n\r\n67:16:04:55 Provisional per diem rates.
\r\n\r\n67:16:04:56 Per diem rates as payment in full.
\r\n\r\n67:16:04:56.01 Per\r\ndiem rate -- Existing facility experiencing new operational ownership.
\r\n\r\n67:16:04:57 Repealed.
\r\n\r\n67:16:04:58 Facility's average per diem charge.
\r\n\r\n67:16:04:59 Repealed.
\r\n\r\n67:16:04:60 Basis of payment.
\r\n\r\n67:16:04:61 Preadmission screening.
\r\n\r\n67:16:04:62 Medicare Provider Reimbursement Manual.
\r\n\r\n67:16:04:63 Repealed.
\r\n\r\n\r\n\r\n\r\n\r\n
67:16:04:33. Definitions. Terms used in this chapter mean:
(1) \"Administration costs,\" costs defined in the statistical and cost summary report that relate to patient care and includes the administrator's and assistant administrator's salaries, administrative travel, office salaries, office supplies and expenses, central office and home office expenses, dues, fees, subscriptions, professional license fees, and legal and accounting expense;
(2) \"Capital costs,\" costs associated with building insurance, building depreciation, furniture and equipment depreciation, amortization of organization and preoperating costs, mortgage interest, rent on the facility and grounds, equipment rent, and return on net equity;
(3) \"Case mix,\" the mixture of residents of different classifications within a nursing facility;
(4) \"Case mix score,\" the average of the Patient Driven Payment Model nursing case mix group weights for residents in a facility over a particular time period;
(5) \"Chain organization,\" a group of two or more health care facilities that are owned, leased, or otherwise controlled by one organization;
(6) \"Desk audit,\" a review of the statistical and cost reports to determine omissions, erroneous calculations, reasonableness of selected cost items, and compliance with other reporting requirements before establishing a database from which per diem rates are established;
(7) \"Field audit,\" a comprehensive, on-site review of the statistical and cost reports to determine omissions, erroneous calculations, reasonableness of selected cost items, and compliance with other reporting requirements before establishing a database from which per diem rates are established;
(8) \"Hospital-affiliated nursing facility,\" a licensed nursing facility that is under common ownership with, is operated by the same administrative authority as, and shares on a daily basis common services areas with, the licensed hospital, and that is required to use the stepdown method of allocation required by Medicare if the stepdown results in part of the cost of the shared areas being allocated between the hospital and the nursing facility, and the stepdown numbers are the numbers used for Medicare reimbursement;
(9) \"Nursing facility,\" any facility that is licensed, maintained, and operated for the express or implied purpose of providing care to one or more persons, whether for consideration or not, who are not acutely ill but require nursing care and related medical services of such complexity as to require professional nursing care under the direction of a physician twenty-four hours a day;
(10) \"Over-the-counter medications,\" medications that can be purchased by the general public without a physician or other licensed practitioner's prescription;
(11) \"Patient Driven Payment Model,\" the relative ratio of resources required to care for one class of residents when compared to another class of residents as measured by the resident assessment using the nursing case mix group;
(12) \"Related-party transaction,\" a business transaction between parties having a common ownership or control interest;
(13) \"Resident assessment,\" a comprehensive assessment of a nursing facility resident completed under § 44:73:06:10;
(14) \"Routine services,\" services and items necessary for the care, treatment, and comfort of a resident;
(15) \"Salvage value,\" the estimated value of a depreciable asset at the end of its useful life. The value is estimated at the time of acquisition or construction and is deducted from the cost of the depreciable property to arrive at the basis for depreciation;
(16) \"Stepdown method of allocation,\" an accounting methodology in which costs flow from nonrevenue-producing cost centers to revenue-producing cost centers. On ledgers showing this allocation, the lists of numbers take on a visual tiering appearance from the left of the page to the right;
(17) \"Straight-line depreciation method,\" a procedure followed in depreciation computations that assigns equal segments of the cost of an item to the benefits to be yielded by the item, often over a period of time; and
(18) \"Swing-bed hospital,\" an acute care general hospital that has been approved by the Department of Health to provide short-term nursing facility services in a portion of its licensed hospital beds pending the availability of a nursing facility bed.
Source: SL 1975, ch 16, § 1; 1 SDR 30, effective October 13, 1974; 2 SDR 16, effective September 4, 1975; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 11 SDR 26, effective August 21, 1984; 15 SDR 68, effective November 7, 1988; 16 SDR 26, effective August 13, 1989; 18 SDR 67, effective October 13, 1991; transferred from § 67:16:04:01, 21 SDR 8, effective July 25, 1994; 24 SDR 185, effective July 6, 1998; 26 SDR 5, effective July 1, 1999; 26 SDR 21, effective August 24, 1999; 35 SDR 312, effective July 6, 2009; 44 SDR 94, effective December 4, 2017; 50 SDR 11, effective August 7, 2023.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1(4).
67:16:04:41. Routine\r\nservices. For purposes of cost reporting, the department considers the\r\nfollowing items and services to be routine:
\r\n\r\n\r\n\r\n
(1) Shelter;
\r\n\r\n\r\n\r\n
(2) At least three\r\nmeals a day planned from the basic four food groups in quantity and variety to provide\r\nmedically prescribed diets, including special oral, enteral, or parenteral\r\ndietary supplements used for meal or nourishment supplementation, even if\r\nwritten as a prescription item by a physician or other licensed practitioner
\r\n\r\n
(3) Expendable items\r\nused in the care and treatment of residents such as alcohol, applicators,\r\ncotton balls, band-aids, linen savers, colostomy supplies, catheters, catheter\r\nsupplies, irrigation equipment, needles, syringes, IV equipment, support hose,\r\nhydrogen peroxide, enemas, tongue depressors, facial tissue, and\r\nover-the-counter medications;
\r\n\r\n\r\n\r\n
(4) Screening tests\r\nsuch as Clinitest, Testape, and Ketostix;
\r\n\r\n\r\n\r\n
(5) Personal hygiene\r\nitems such as soap, lotion, powder, shampoo, deodorant, toothbrushes,\r\ntoothpaste, denture cups and cleaner, mouthwash, and pericare products;
\r\n\r\n\r\n\r\n
(6) Social services,\r\nactivities, and the supplies necessary for each;
\r\n\r\n\r\n\r\n
(7) Laundry services;
\r\n\r\n\r\n\r\n
(8) Therapy services\r\nif provided by a facility employee or by a consultant who is under contract\r\nwith the facility;
\r\n\r\n\r\n\r\n
(9) Transportation\r\nservices necessary to meet the medical and activity needs of the residents\r\nexclusive of ambulance services and secure medical
\r\n\r\n
(10) Items which are\r\nused by individual residents but which are reusable and expected to be\r\navailable, such as resident gowns, water pitchers, bedpans, ice bags, bed\r\nrails, canes, crutches, walkers, wheelchairs, traction equipment, alternating\r\npressure pad and pump, and other medical equipment;
\r\n\r\n\r\n\r\n
(11) General nursing\r\nservices, including restorative nursing activities, toileting programs,\r\nadministration of oxygen and medications, hand or tube feeding, care of\r\nincontinence, enemas, tray service, and personal hygiene including bathing,\r\nskin care, hair care, shaving, and oral hygiene;
\r\n\r\n\r\n\r\n
(12) Oxygen and\r\noxygen regulators, concentrators, tubing, masks, tents, and other equipment\r\nnecessary for the administration of oxygen; and
\r\n\r\n\r\n\r\n
(13) Respiratory\r\nservices and supplies.
\r\n\r\n\r\n\r\n
Source: SL 1975, ch 16,\r\n§ 1; 1 SDR 30, effective October 13, 1974; 2 SDR 88, effective July 1,\r\n1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 11 SDR 26, effective August\r\n21, 1984; 15 SDR 68, effective November 7, 1988; 17 SDR 50, effective October\r\n7, 1990; 18 SDR 67, effective October 13, 1991; transferred from\r\n§ 67:16:04:06, 21 SDR 8, effective July 25, 1994; 44 SDR 94, effective\r\nDecember 4, 2017.
\r\n\r\nGeneral Authority: SDCL 28-6-1(1)(2).
\r\n\r\nLaw Implemented: SDCL 28-6-1(1)(2).
\r\n\r\n\r\n\r\n
67:16:04:46. Depreciation. The department calculates depreciation as follows:
(1) Masonry buildings are calculated using the straight-line depreciation method not to exceed three percent of the capital cost basis of the building. The capital cost basis for depreciation of new construction, major renovations, and facilities acquired through purchase is subject to a salvage value computation of at least fifteen percent;
(2) Frame buildings are calculated using the straight-line depreciation method not to exceed four percent of the capital cost basis of the building. The capital cost basis for depreciation of new construction, major renovations, and facilities acquired through purchase is subject to a salvage value computation of at least fifteen percent;
(3) Fixed equipment is calculated based on the useful life of the item as determined according to the Estimated Useful Lives of Depreciable Hospital Assets, 2018 Edition; and
(4) Major movable equipment, furniture, automobiles, and specialized equipment is calculated using the straight-line depreciation method and the useful life of the item is determined according to the Estimated Useful Lives of Depreciable Hospital Assets, 2018 Edition.
A facility may deviate from a determination based on the Estimated Useful Lives of Depreciable Hospital Assets if the facility provides the department with documented historical proof of the asset's useful life.
Source: 16 SDR 26, effective August 13, 1989; transferred from § 67:16:04:08.07, 21 SDR 8, effective July 25, 1994; 26 SDR 5, effective July 1, 1999; 26 SDR 21, effective August 24, 1999; 29 SDR 177, effective July 1, 2003; 35 SDR 312, effective July 6, 2009; 59 SDR 11, effective August 7, 2023.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
Reference: Estimated Useful Lives of Depreciable Hospital Assets, 2018 edition, published by the American Hospital Association, 155 North Wacker Drive, Chicago, Illinois 60606, https://www.aha.org/; $88.
67:16:04:49. Occupancy. To determine the nondirect care per diem rate of a facility, the department shall use the facility's actual occupancy, or three percent less than the statewide average of all nursing facilities, whichever is greater.
The department shall waive this provision for the first twelve months of operation of a newly constructed facility that does not replace an existing facility. For the second twelve months, the occupancy factor used to establish the facility's per diem rate is three percent less than the statewide average of all nursing facilities, or the facility's actual occupancy for the last quarter of the first twelve months prorated to twelve months, whichever is greater.
Source: 15 SDR 68, effective November 7, 1988, effective July 1, 1989; 17 SDR 50, effective October 7, 1990; 18 SDR 67, effective October 13, 1991; transferred from § 67:16:04:06.04, 21 SDR 8, effective July 25, 1994; 29 SDR 177, effective July 1, 2003; 29 SDR 177, adopted July 1, 2003, effective July 1, 2004; 50 SDR 11, effective August 7, 2023.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
67:16:04:51. Ceilings. Ceilings are established using allowable costs as follows:
(1) To determine the case mix adjusted direct care costs of a facility, the department shall use two ceiling calculations. The first ceiling is one hundred and fifteen percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. The department shall recognize one hundred percent of the facility's allowable costs up to the one hundred and fifteen percent ceiling. The second ceiling is one hundred and twenty-five percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. Payment for the case mix adjusted direct care costs that exceed the one hundred and fifteen percent ceiling and are up to the one hundred and twenty-five percent ceiling is calculated according to § 67:16:04:54.01;
(2) To determine the nondirect care costs of health and subsistence, plant, plant operations, and other operating costs of a facility, the department shall use two ceiling calculations. The first ceiling is one hundred and five percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. The department shall recognize one hundred percent of the facility’s allowable costs up to the one hundred and five percent ceiling. The second ceiling is established at one hundred and ten percent of the median cost of all nursing facilities that have an average case mix score of 1.00 or more for the reporting period. Payment for these nondirect care costs that exceed the one hundred and five percent ceiling and are up to the one hundred and ten percent ceiling is calculated according to § 67:16:04:54.02;
(3) To determine the nondirect care costs of administration of a facility, the department shall use two ceiling calculations. The first ceiling is one hundred and five percent of the median cost of all freestanding nonchain organization affiliated nursing facilities. The department shall recognize one hundred percent of the facility's allowable costs up to the one hundred and five percent ceiling. The second ceiling is one hundred and ten percent of the median cost of all freestanding nonchain organization affiliated nursing facilities. Payment for the nondirect care costs of administration that exceed the one hundred and five percent ceiling and are up to the one hundred and ten percent ceiling is calculated according to § 67:16:04:54.03; and
(4) Beginning July 1, 2023, capital costs are limited to a ceiling of twenty dollars and ninety-five cents per resident day.
Source: 21 SDR 8, effective July 25, 1994; 23 SDR 42, effective September 30, 1996; 24 SDR 185, effective July 6, 1998; 26 SDR 5, effective July 1, 1999; 26 SDR 21, effective August 24, 1999; 29 SDR 177, effective July 1, 2003; 29 SDR 177, adopted July 1, 2003, effective July 1, 2004; 35 SDR 312, effective July 6, 2009; 50 SDR 11, effective August 7, 2023.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
Cross-References:
Method of establishing per diem rates, § 67:16:04:54.
State fiscal year, SDCL 4-10-10.
67:16:04:52. Maximum capital cost for leased facility. The maximum capital cost for leased facilities is limited to the lower of actual costs or the total capital costs per resident day established in § 67:16:04:51.
The capital cost items for computing the above limit consist of rent, building insurance, building depreciation, furniture and equipment depreciation, amortization of organization and preoperating costs, capital related interest, and return on net equity. The capital cost items are allowable only if incurred and paid by the lessee. Capital costs incurred by the lessor and passed on to the lessee are not allowed in any other manner than as outlined in this section. No reimbursement is allowed for additional costs related to subleases.
The maximum allowed for the rental component of the capital cost items for facilities negotiating new leases and facilities renewing, assigning, selling, transferring, or otherwise changing existing leases, is limited to the lower of actual lease costs or seventy percent of the average per diem cost of the capital cost for owner-managed facilities, excluding hospital-affiliated facilities.
Source: 16 SDR 26, effective August 13, 1989; 17 SDR 50, effective October 7, 1990; 18 SDR 67, effective October 13, 1991; transferred from § 67:16:04:08.09, 21 SDR 8, effective July 25, 1994; 26 SDR 5, effective July 1, 1999; 26 SDR 21, effective August 24, 1999; 29 SDR 177, effective July 1, 2003; 29 SDR 177, adopted July 1, 2003, effective July 1, 2004; 35 SDR 312, effective July 6, 2009; 50 SDR 11, effective August 7, 2023.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
67:16:04:54. Method of establishing per diem rates. The department shall establish a case mix adjusted direct care per diem rate and a nondirect care per diem rate for each facility prior to July first of each year. These rates are based on the facility's allowable costs, the facility's Patient Driven Payment Model case mix score, inflation factors, cost ceilings, occupancy, and known future cost increases that have prior departmental approval.
The case mix adjusted direct care per diem rate is established on a facility-specific basis using allowable direct patient care costs and paid according to the Patient Driven Payment Model index under the Patient Driven Payment Model classification system on a resident-specific basis. The case mix adjusted direct care per diem rate is established by calculating the average Patient Driven Payment Model case mix score for the facility, determining the per diem case mix component cost for the facility by dividing the allowable cost by total resident days, and dividing the facility's per diem case mix component cost by its Patient Driven Payment Model average case mix score. The case mix adjusted direct care per diem cost is used to establish the case mix adjusted direct care cost ceilings established in § 67:16:04:51, and the case mix adjusted direct care per diem rate is subject to those ceilings and the payment limits established in § 67:16:04:54.01.
The nondirect care per diem rate is established on a facility-specific basis using all other allowable costs. The nondirect care per diem rate is based on cost components consisting of health and subsistence, general administrative, other operating, plant, plant operations, and capital. The nondirect care per diem rate is established by dividing the allowable nondirect care costs, by the occupancy determined according to § 67:16:04:49. The allowable nondirect care costs are used to establish the ceilings contained in § 67:16:04:51, and the nondirect care per diem rate is subject to those ceilings and the payment limits established in § 67:16:04:54.02. The nondirect care cost is not subject to case mix adjustment.
The per diem rate for the nondirect care costs of administration is subject to the payment limits established in § 67:16:04:54.03.
Source: 16 SDR 26, effective August 13, 1989; 17 SDR 50, effective October 7, 1990; 18 SDR 67, effective October 13, 1991; transferred from § 67:16:04:07.05, 21 SDR 8, effective July 25, 1994; 23 SDR 42, effective September 30, 1996; 26 SDR 5, effective July 1, 1999; 26 SDR 21, effective August 24, 1999; 29 SDR 177, effective July 1, 2003; 29 SDR 177, adopted July 1, 2003, effective July 1, 2004; 50 SDR 11, effective August 7, 2023.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
Cross-Reference: Payment adjustment due to review of resident assessment, § 67:45:03:08.
67:16:04:59. Add-on\r\npayment -- Ventilator. Repealed.
\r\n\r\n\r\n\r\n
Source: 16 SDR 26,\r\neffective August 13, 1989; 18 SDR 67, effective October 13, 1991; transferred\r\nfrom § 67:16:04:08.04, 21 SDR 8, effective July 25, 1994; 44 SDR 94,\r\neffective December 4, 2017.
\r\n\r\n\r\n\r\n
67:16:04:60. Basis of payment. Payment to participating providers of nursing facility services is made on the following basis:
(1) Payment to an in-state facility is calculated using the per diem rates according to § 67:16:04:54, multiplying the case mix adjusted direct care per diem rate by the resident's Patient Driven Payment Model weight established by the resident assessment, and adding the nondirect care rate for each day the Medicaid resident is an inpatient resident;
(2) Payment to an out-of-state facility providing nursing facility services to residents of South Dakota is the lesser of the Medicaid rate established by the state in which the facility is located or the South Dakota statewide average Medicaid rate for all in-state facilities. Payment to an out-of-state facility for care not available at an in-state facility is the rate recognized for the facility by the Medicaid agency in the state in which the facility is located;
(3) Payment for reserved bed days is governed by the provisions of § 67:45:02:04 and is based on the resident's latest resident assessment and Patient Driven Payment Model nursing case mix group at the time of the resident's absence;
(4) A swing-bed hospital is reimbursed at a daily rate established by the department. The daily rates are located on the department's fee schedule website; and
(5) Coinsurance under the Medicare program is payable at the Medicare coinsurance rate.
Source: SL 1975, ch 16, § 1; 2 SDR 16, effective September 4, 1975; 2 SDR 88, effective July 1, 1976; 7 SDR 23, effective September 18, 1980; 7 SDR 76, effective February 11, 1981; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 11, effective August 13, 1981; 11 SDR 26, effective August 21, 1984; 15 SDR 68, effective November 7, 1988; 16 SDR 26, effective August 13, 1989; 18 SDR 67, effective October 13, 1991; transferred from § 67:16:04:08, 21 SDR 8, effective July 25, 1994; 24 SDR 185, effective July 6, 1998; 26 SDR 21, effective August 24, 1999; 38 SDR 224, effective July 1, 2012; 42 SDR 51, effective October 13, 2015; 50 SDR 11, effective August 7, 2023.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1(2).
Cross-Reference: Payment adjustment due to review of resident assessment, § 67:45:03:08.
67:16:04:61. Preadmission\r\nscreening. No payment may be made in behalf of a resident of a nursing\r\nfacility who is mentally ill or intellectually or developmentally disabled and\r\nwho was admitted to the facility after December 31, 1988, and did not receive the\r\npreadmission screening as required by § 1919(b)(3)(F) of the Social\r\nSecurity Act as amended by § 4211 of Pub. L. No. 100-203, (101 Stat.\r\n1330-183), January 1, 1989.
\r\n\r\n\r\n\r\n
Source: 16 SDR 26, effective August 13,\r\n1989; transferred from § 67:16:04:30, 21 SDR 8, effective July 25, 1994;\r\n40 SDR 122, effective January 8, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
\r\n\r\n\r\n\r\n
67:16:04:62. Medicare Provider Reimbursement Manual. Provider reimbursement under the provisions of this chapter and chapter 67:16:44 is made by the department according to the Medicare Provider Reimbursement Manual (CMS Pub 15-1), (December 2021) available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals.
Source: 21 SDR 172, effective April 3, 1995; 23 SDR 109, effective January 5, 1997; 26 SDR 21, effective August 24, 1999; 26 SDR 168, effective July 1, 2000; 28 SDR 1, effective July 18, 2001; 29 SDR 177, effective July 1, 2003; 35 SDR 312, effective July 6, 2009; 46 SDR 50, effective October 10, 2019; 50 SDR 11, effective August 7, 2023.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
Cross-References:
Absence of regulations -- Allowable costs based on CMS-15, § 67:16:04:40.
Costs not allowed, § 67:16:04:47.
Reference:
Medicare Provider Reimbursement Manual (CMS Pub 15-1), March 31, 2023, published by the Centers for Medicare and Medicaid Services, available to download at no cost at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals.
67:16:04:63. Add-on payment –\r\nSpecialty bed. Repealed.
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Source: 24 SDR 185, effective July 6, 1998;\r\n35 SDR 312, effective July 6, 2009; 42 SDR 51, effective October 13, 2015; 44\r\nSDR 94, effective December 4, 2017.
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