Physician's services covered.
Effective Dec 4, 201744 SDR 94Source: SL 1975, ch 16, § 1; 4 SDR 88, effective June 26, 1978; 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 11 SDR 26, effective August 21, 1984; 15 SDR 204, effective July 6, 1989; 16 SDR 234, effective July 2, 1990; 17 SDR 200, effective July 1, 1991; 19 SDR 26, effective August 23, 1992; 20 SDR 144, effective March 10, 1994; 40 SDR 122, effective January 8, 2014; 42 SDR 51, effective October 13, 2015; 44 SDR 94, effective December 4, 2017. | General Authority: SDCL 28-6-1 (1)(2) . | Law Implemented: SDCL 28-6-1 (1)(2) .
Physician's services covered are limited to the following professional services, which must be medically necessary and provided by a physician or other licensed practitioner to a recipient:
- (1) Medical and surgical services;
- (2) Services and supplies furnished incidental to the professional services of a physician or other licensed practitioner;
- (3) Psychiatric services;
- (4) Drugs and biologicals administered in a physician or other licensed practitioner's office which cannot be self-administered;
- (5) Routine physical examinations;
- (6) Routine visits to a nursing facility, a home and community-based service provider, an intermediate care facility for individuals with intellectual disabilities, or a home and community-based waiver service provider;
- (7) Cosmetic surgery when incidental to prompt repair following an accidental injury or for the improvement of the functioning of a malformed body member;
- (8) Family planning services;
- (9) Pap smears;
- (10) Dialysis treatments;
- (11) Hysterectomies as authorized under 42 C.F.R. §§ 441.250 to 441.259, inclusive, as amended to April 1, 2017; and
(12) Hyperbaric oxygen therapy if the requirements listed on the department's prior authorization website are met.
Cross-References:
Home and community-based services, ch 67:54:04.
HCBS Waiver operated by the Division of Adult Services and Aging, ch 67:44:03.
Covered services must be medically necessary, § 67:16:01:06.02.
Source: SL 1975, ch 16, § 1; 4 SDR 88, effective June 26, 1978; 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 11 SDR 26, effective August 21, 1984; 15 SDR 204, effective July 6, 1989; 16 SDR 234, effective July 2, 1990; 17 SDR 200, effective July 1, 1991; 19 SDR 26, effective August 23, 1992; 20 SDR 144, effective March 10, 1994; 40 SDR 122, effective January 8, 2014; 42 SDR 51, effective October 13, 2015; 44 SDR 94, effective December 4, 2017.
General Authority: SDCL 28-6-1 (1)(2) .
Law Implemented: SDCL 28-6-1 (1)(2) .
Prior versions effective: 2015-10-13, 2014-01-08.