Medically necessary covered services provided under the primary care provider program must be provided by the recipient's primary care provider or by another enrolled medical assistance provider to whom the primary care provider referred the recipient.

Medical services provided by someone other than the recipient's primary care provider or services provided without referral and authorization by the primary care provider are noncovered services and may be cause for denial by the department.

Source: 20 SDR 135, effective February 22, 1994; 30 SDR 115, effective February 4, 2004; 46 SDR 50, effective October 10, 2019.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1 (1)(2)(4) .

Prior versions effective: 2004-02-04.