S.D. Admin. R. 67:16:03:14.02
A hospital must submit two separate claims for individuals who are subject to care management under the provisions of chapter 67:16:40 but who remained in the unit beyond the discharge date established by the care manager.
The first claim must meet the requirements of § 67:16:03:14 and must cover the length of stay authorized by the care manager. The claim must contain the unit's provider identification number, the provider's usual and customary charge, and a patient status code of "30."
The second claim must meet the requirements of § 67:16:03:14 and must cover the length of stay that is beyond the established discharge date to the date of actual discharge. The claim must contain the unit's provider identification number and the appropriate discharge status code.
For purposes of this rule, the established discharge date is the date set by the care manager for the individual's discharge from the unit. If the care manager changes that date, the new date becomes the established discharge date.
Services provided in an exempt unit that are not authorized by the care manager are not reimbursable.
S.D. Admin. R. 67:16:03:14.02
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
Rate of reimbursement if individual subject to care management remains in psychiatric unit beyond the established discharge date, § 67:16:03:06.16.