S.D. Admin. R. 67:16:40:06
Before the care manager authorizes care under this chapter, the hospital must provide the care manager with medical documentation which substantiates that the admission is medically necessary and that the applicable requirements of § 67:16:40:07, 67:16:40:08, 67:16:40:09, or 67:16:40:09.01 were met.
If the care manager is not able to determine whether the admission, continued stay, or discharge is justified, the care manager shall request a care management consultant to review the documentation and make the determination.
A care management consultant must review the documentation if the care manager determines that the admission is not justified, a continued stay is not warranted, or a patient should be discharged. The final decision as to the admission, continued stay, or discharge rests with the care management consultant. The care manager shall notify the hospital representative and the attending physician of the final determination within one working day after the final determination is made. The care manager may notify the hospital representative orally but must follow the oral notice with a written notice.
S.D. Admin. R. 67:16:40:06
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
Covered services must be medically necessary, § 67:16:01:06.02.