S.D. Admin. R. 67:16:05:05.01

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

Section 67:16:05:05.01 - Service restrictions

Home health services must meet the following criteria:

(1) They must be provided by a home health agency employee who is qualified to perform the required service;

(2) They must be prescribed by the attending physician or other licensed practitioner and contained in the home health agency's written plan of care;

(3) They must be provided at the individual's place of residence, which does not include a hospital, penal institution, detention center, school, nursing facility, intermediate care facility for individuals with intellectual disabilities, or an institution which treats individuals for mental diseases; and

(4) They must be provided intermittently but not more than once a day and no more frequently than five days a week, except as specified by subdivision 67:16:05:05(4).

If Medicare denies payment for a service because there is no medical necessity, the individual is ineligible for services under this chapter.

S.D. Admin. R. 67:16:05:05.01

16 SDR 111, effective 1/7/1990; 16 SDR 233, effective 7/1/1990; 18 SDR 203, effective 7/1/1992; 33 SDR 137, effective 3/7/2007; 40 SDR 122, effective 1/7/2014; 40 SDR 122, effective 1/7/2014; 40 SDR 122, effective 1/8/2014; 47 SDR 038, effective 10/6/2020

General Authority: SDCL 28-6-1.

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