S.D. Admin. R. 67:16:39:08

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

Section 67:16:39:08 - Primary care provider to provide service or refer recipient for service

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

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

S.D. Admin. R. 67:16:39:08

20 SDR 135, effective 2/22/1994; 30 SDR 115, effective 2/4/2004; 46 SDR 050, effective 10/10/2019

General Authority: SDCL 28-6-1(1)(2)(4).

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

Recipient responsible for payment of noncovered services, § 67:16:39:04.