Payment for the purchase or the monthly rental of medical equipment covered under this chapter is limited to the lesser of the provider's usual and customary charge or the fee established on the department's fee schedule website. If no fee is established, payment will be 75 percent of the provider's usual and customary charge. Payment for the purchase or monthly rental of medical equipment includes the following:

1. (1) The manufacturer and dealer warranty;
2. (2) Any cost associated with assembling an item or part used for the assembly of an item;
3. (3) Any adjustment and modification required within 90 days of the dispensing date for purchases or during the total rental period, except those due to a major change in the recipient's condition;
4. (4) Instruction to the recipient in the safe use of the medical equipment;
5. (5) Cost of delivery to the recipient's residence and, when appropriate, to the room in which the item will be used; and

6. (6) Cost of return to the provider if rented.

   Payment for supplies necessary for the effective use or proper functioning of covered medical equipment is 90 percent of the provider's usual and customary charge or the fee established on the department's fee schedule website.

   Payment for equipment maintenance and repairs is the lesser of the provider's usual and customary charge or the purchase price of a new piece of equipment. Purchase price is established according to this section.

   Payment may not exceed billed charges.

   The equipment and associated rates of payment are subject to review and amendment under the provisions of § 67:16:01:28.

Source: 14 SDR 46, effective September 28, 1987; 16 SDR 239, effective July 9, 1990; 17 SDR 194, effective July 1, 1991; 18 SDR 107, effective December 29, 1991; 18 SDR 210, effective June 23, 1992; 24 SDR 11, effective August 4, 1997; 35 SDR 49, effective September 10, 2008; 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) , 28-6-1.1.

Prior versions effective: 2015-10-13, 2008-09-10.