Definitions.
Effective Jul 1, 202652 SDR 126Source: 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 ; 52 SDR 126, effective July 1, 2026 . | General Authority: SDCL 28-6-1 . | Law Implemented: SDCL 28-6-1 , 28-6-1.1 .
Terms used in this chapter mean:
- (1) "Cost outlier," a hospital claim 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;
- (2) "Diagnosis-related group," a classification assigned to an inpatient hospital service claim using the All Patient Refined Diagnosis Related Groups classification methodology;
- (3) "Emergency hospital care," the hospital 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;
- (4) "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;
- (5) "Inpatient," a patient who has been admitted to a hospital on the recommendation of a physician or a dentist; and
(6) "Outpatient," a patient who receives professional services at a hospital, but is not provided with room, board, and services on a twenty-four-hour basis.
Definitions, "Website" (FeeScheduleWebsite), subdivision 67:16:01:01(18).
Collateral Reference:
Solventum™ All Patient Refined Diagnosis Related Groups (APRDRGs) Classification System, https://www.solventum.com/en-us/home/health-information-technology/solutions/apr-drg/.
Source: 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 ; 52 SDR 126, effective July 1, 2026 .
General Authority: SDCL 28-6-1 .
Law Implemented: SDCL 28-6-1 , 28-6-1.1 .
Prior versions effective: 2015-10-13, 2010-09-23.