Provider to maintain records. The provider prescribing medical equipment must document the medical necessity in the recipient's medical record. Unless otherwise specified in the department's coverage criteria, the provider shall update the medical necessity documentation annually or when the physician or other licensed practitioner's estimated quantity, frequency, or duration is changed prior to the annual renewal. Failure to properly document medical necessity is cause for nonpayment.

1. (1) Recipient name and Medicaid ID number;
2. (2) Diagnosis, including an explanation of the particular condition resulting from the diagnosis which relates to the equipment request;
3. (3) Prognosis;
4. (4) Length of time the item is expected to be required;
5. (5) Justification of medical necessity;
6. (6) Equipment prescribed;
7. (7) Prescribing provider's National Provider Identification number, signature, and date signed;
8. (8) Description of equipment; and
9. (9) Explanation of equipment functions.

The medical record must contain:

Source: 18 SDR 210, effective June 23, 1992; 41 SDR 93, effective December 3, 2014 ; 44 SDR 94, effective December 4, 2017; 47 SDR 38, effective October 6, 2020 ; 50 SDR 63, effective November 27, 2023 .

General Authority: SDCL 28-6-1 .

Law Implemented: SDCL 28-6-1 .

Prior versions effective: 2020-10-06, 2017-12-04, 2014-12-03, 1992-06-23.