S.D. Admin. R. 67:16:05:05

Current through Register Vol. 51, page 54, October 28, 2024

Section 67:16:05:05 - Covered services - Limits

Home health services are limited to the following:

(1) Skilled nursing services;

(2) Medical social services provided by a licensed social worker who is not an employee of the department;

(3) Medical supplies used incidental to the visit when necessary to administer the attending physician or other licensed practitioners prescribed plan of care;

(4) Multiple visits of the same discipline on the same day if the medical necessity for the multiple visits is documented by the attending physician or other licensed practitioner in the individual's medical record;

(5) Daily visits if the medical necessity for the visits is documented by the attending physician or other licensed practitioner in the individual's medical record. The daily visits are limited to four weeks but may be extended beyond the four-week period if the attending physician or other licensed practitioner documents the need for the visits in the individual's medical record;

(6) Therapy services unless restricted by § 67:16:05:05.05; and

(7) Postpartum services meeting the requirements of § 67:16:05:05.06.

The covered items and services provided under this chapter for children under the age of 21 are not subject to the limits contained in this section.

S.D. Admin. R. 67:16:05:05

SL 1975, ch 16; 44 SDR 94, effective 12/4/2017; 47 SDR 038, effective 10/6/2020

General Authority: SDCL 28-6-1.

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

Services not covered, § 67:16:05:06. Covered services must be medically necessary, § 67:16:01:06.02. Cost not to exceed institutional care, § 67:16:05:07.02. Covered services -- Limits, § 67:16:37:04.01.