ARSD 67:16:03:06.01
Reimbursement for all outpatient hospital services for prospective payment system hospitals are paid using the medicaid agency's outpatient prospective payment system (OPPS).
(2) The inpatient and outpatient services are provided by the same hospital.
Except for medicare prospective payment system hospitals, outpatient laboratory services are excluded from the provisions of this rule and are payable according to § 67:16:03:06.07.
Cross-Reference:
Definitions, "Website" (FeeScheduleWebsite), subdivision 67:16:01:01(18).
Reimbursement for in-state non-prospective payment system hospitals is made using a percent of charge rate that approximates a minimum of one hundred percent of cost, not to exceed ninety percent of billed charges. The percent of charge rates are published on the department's fee schedule website.
Out-of-state hospital outpatient services must be paid using the medicaid agency's OPPS.
Outpatient hospital dialysis services are reimbursed at the reimbursement rate published on the department's fee schedule website.
Costs for outpatient services incurred within the three days immediately preceding the inpatient stay are included in the inpatient charges if:
Source: 12 SDR 6, effective July 28, 1985; 15 SDR 2, effective July 17, 1988; 16 SDR 235, effective July 5, 1990; 17 SDR 180, effective May 27, 1991; 18 SDR 198, effective June 3, 1992; 22 SDR 143, effective May 9, 1996; 23 SDR 232, effective July 10, 1997; 25 SDR 116, effective March 24, 1999; 30 SDR 26, effective September 3, 2003; 31 SDR 107, effective February 1, 2005; 36 SDR 215, effective July 1, 2010; 36 SDR 215, adopted June 11, 2010, effective July 1, 2011; 37 SDR 236, effective June 28, 2011; 37 SDR 236, adopted June 8, 2011, effective July 1, 2012; 39 SDR 15, effective August 6, 2012; 40 SDR 15, effective July 31, 2013 ; 43 SDR 80, effective December 5, 2016; 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: 2016-12-05, 2013-07-31.