The applicant shall submit a completed and signed application on a form provided by the division and shall include the following information:
(1) Documentation from the applicant's implant surgeon that one or two cochlear implants is medically recommended;(2) Documentation of a progressive hearing loss which led to deafness, if applicable;(3) A written quote of the provider's usual and customary charge for services listed in § 46:30:08:03; and(4) Proof of creditable coverage as defined in SDCL 58-18-44, if any. The division shall reject an application that fails to provide the required information.
S.D. Admin. R. 46:30:08:05
32 SDR 32, effective 8/29/2005; 34 SDR 179, effective 12/24/2007; 37 SDR 111, effective 12/7/2010.General Authority: SDCL 49-31-50.2.
Law Implemented: SDCL 49-31-50, 49-31-50.1, 49-31-51.
Creditable coverage defined, SDCL 58-18-44.