Covered services -- Limits -- Rate of payment. Covered dental services include those procedures and limitations listed on the department's fee schedule website.

The rate of payment is limited to the lesser of the provider's usual and customary fee or the fee listed on the department's fee schedule website.

The rate of payment is subject to review and amendment by the department under § 67:16:01:28.

The covered items and services provided in this chapter for children under the age of 21 are not subject to the established limits.

Coverage for nonemergency adult dental services is limited to $2,000 per fiscal year.

Cross-References:

Eligibility requirements, § 67:46:01:02.

Qualified Medicare Beneficiaries (QMB), ch 67:46:11.

Fee Schedule Website Definition, § 67:16:01:01(18).

Source: SL 1975, ch 16, § 1; 1 SDR 66, effective April 6, 1975; 4 SDR 10, effective August 28, 1977; 4 SDR 35, effective December 22, 1977; 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; 12 SDR 70, effective October 31, 1985; 15 SDR 167, effective May 11, 1989; 16 SDR 234, effective July 1, 1990; 18 SDR 198, effective June 3, 1992; 23 SDR 197, effective May 26, 1997; 35 SDR 88, effective October 23, 2008; 38 SDR 224, effective July 1, 2012; 42 SDR 51, effective October 13, 2015 ; 49 SDR 21, effective September 12, 2022 .

General Authority: SDCL 28-6-1 .

Law Implemented: SDCL 28-6-1 (1)(2) , 28-6-1 .1.

Prior versions effective: 2015-10-13, 2012-07-01.