South Dakota Administrative Code

Rule 47:03:01:19 Notification. 47:03:01:19. Notification. The division shall, by registered or certified mail, notify any adverse parties of the filing of the petition for small claims hearing. Any adverse party or its agent has 20 days after the party's receipt of the notice to …

Rule 47:03:01:20 Setoff or counterclaim. 47:03:01:20. Setoff or counterclaim. An adverse party may assert a claim for setoff or counterclaim in its answer. The setoff or counterclaim shall be in writing, and be stated clearly and concisely. If the department deems the claim for o…

Rule 47:03:01:21 Amending petition or answer. 47:03:01:21. Amending petition or answer. The department may at any time allow any small claim petition for hearing or answer to be amended when justice requires. Source: 33 SDR 43, effective September 20, 2006. General Authority: SDC…

Rule 47:03:01:22 Multiple defendants. 47:03:01:22. Multiple defendants. A petitioner may name more than one defendant in a small claims petition for hearing, but only if the claims against each adverse party are related to or connected with each other. Source: 33 SDR 43, effectiv…

Rule 47:03:01:23 Adding parties. 47:03:01:23. Adding parties. The department may add parties to a small claims proceeding in the manner prescribed in § 47:03:01:06. Source: 33 SDR 43, effective September 20, 2006. General Authority: SDCL 62-2-13. Law Implemented: SDCL 62-2-14.

Rule 47:03:01:24 Continuances. 47:03:01:24. Continuances. The department may grant continuances in its discretion. Source: 33 SDR 43, effective September 20, 2006. General Authority: SDCL 62-2-13. Law Implemented: SDCL 62-2-14.

Rule 47:03:01:25 Petitioner's failure to appear. 47:03:01:25. Petitioner's failure to appear. If the petitioner fails to appear at the time and place specified for the hearing, the department is satisfied that proper notice has been given, and the defendant makes the minimum show…

Rule 47:03:01:26 Defendant's failure to appear. 47:03:01:26. Defendant's failure to appear. If the defendant fails to appear at the time and place specified for the hearing, the department is satisfied that proper notice has been given, and the petitioner makes the minimum showin…

Rule 47:03:01:27 Setting aside default. 47:03:01:27. Setting aside default. Upon good cause shown the department may, within thirty days after entering a default order, vacate such order and reschedule the hearing of the original claim. Following the expiration of thirty days, th…

Rule 47:03:01:28 Conduct of hearings. 47:03:01:28. Conduct of hearings. The department shall conduct the hearing on a small claim in as informal a manner as possible. The department may allow a party to participate by telephone or Dakota Digital Network. Source: 33 SDR 43, effect…

Rule 47:03:02:01 Application fee for self-insurance. 47:03:02:01. Application fee for self-insurance. The application fee for self-insurance under SDCL 62-5-5 is $2,250. Source: 17 SDR 37, effective September 10, 1990; transferred from § 47:03:01:10, effective July 29, 1992; 21 S…

Rule 47:03:03:01 Safety posters. 47:03:03:01. Safety posters. Employers shall display one or more posters promoting safety in the workplace in a place or places visible to all employees. Source: 19 SDR 8, effective July 29, 1992. General Authority: SDCL 62-2-5, 62-2-11. Law Imple…

Rule 47:03:04:01 Definitions. 47:03:04:01. Definitions. Terms used in this chapter mean: (1) "Assigned risk pool," the plan by which employers who are unable to procure workers' compensation policies by ordinary methods receive workers' compensation insurance coverage under SDCL …

Rule 47:03:04:02 Application. 47:03:04:02. Application. Any person or entity may apply in writing to the department to have a plan certified that provides management of medical services or treatment to employees for injuries and diseases compensable under SDCL title 62. A certifi…

Rule 47:03:04:02.01 Renewal process. 47:03:04:02.01. Renewal process. Any case management plan which has previously been certified in this state shall, by July 1 of each year, renew and file any changes to the annual registration for the case management plan. Failure to file the …

47:03:04:03. Certification. The department shall certify a case management plan if the department finds that the plan meets the following requirements: (1) Provides access to all the medical and health care services required by SDCL title 62 in a prompt, effective, and convenient…

Rule 47:03:04:04 Access to medical providers and other case management services. 47:03:04:04. Access to medical providers and other case management services. The case management plan satisfies the requirements of subdivisions 47:03:04:03(1) and (2) by either of the following meth…

Rule 47:03:04:05 Access to outside medical providers. 47:03:04:05. Access to outside medical providers. A medical provider who is not a participating provider in the case management plan may provide medical services to an employee in any of the following circumstances: (1) When t…

Rule 47:03:04:06 Provision of services by outside medical providers. 47:03:04:06. Provision of services by outside medical providers. To provide medical services under subdivisions 47:03:04:05(1), (2), and (3), the medical provider must comply with the following requirements: (1)…

Rule 47:03:04:07 Access to all health care disciplines. 47:03:04:07. Access to all health care disciplines. The department may deny certification or may revoke or suspend the certification of a case management plan that unfairly restricts access within the case management plan to…

Rule 47:03:04:08 Case management. 47:03:04:08. Case management. Case management includes the following: (1) Developing a treatment plan to provide medical services to an injured or disabled employee; (2) Systematically monitoring the treatment rendered and the medical progress of…

Rule 47:03:04:09 Repealed. 47:03:04:09. Record and reporting requirements. Repealed. Source: 20 SDR 45, effective October 6, 1993; 26 SDR 10, effective August 3, 1999; repealed, 34 SDR 310, effective June 19, 2008.

Rule 47:03:04:10 Dispute resolution. 47:03:04:10. Dispute resolution. Any person or entity aggrieved by the action of a certified case management plan must exhaust the dispute resolution procedure of the plan prior to filing a petition or otherwise seeking relief from the departm…

Rule 47:03:04:11 Revocation, suspension, and denial of certification. 47:03:04:11. Revocation, suspension, and denial of certification. The department shall deny the certification or shall revoke or suspend the certification of a case management plan if the department finds that …

Rule 47:03:04:12 Conduct of hearings. 47:03:04:12. Conduct of hearings. When a petition for a hearing is filed under § 47:03:04:10 or 47:03:04:11, the following procedures apply in addition to those set forth in SDCL chapter 1-26. The department may resolve the dispute through me…

Rule 47:03:04:13 Repealed. 47:03:04:13. Compliance with SDCL 58-20-24. Repealed. Source: 20 SDR 45, effective October 6, 1993; 26 SDR 10, effective August 3, 1999; repealed, 34 SDR 310, effective June 19, 2008. Rule 47:03:04:13.01 Repealed. 47:03:04:13.01. Compliance with SDCL 62…

Rule 47:03:04:13.01 Repealed. 47:03:04:13.01. Compliance with SDCL 62-5-21. Repealed. Source: 21 SDR 225, effective July 5, 1995; 26 SDR 10, effective August 3, 1999; repealed, 34 SDR 310, effective June 19, 2008.

Rule 47:03:04:14 Charges and fees. 47:03:04:14. Charges and fees. Participating and nonparticipating medical providers are not entitled to payment from an insurer or employee for fees or services determined to be excessive under SDCL 62-7-8, medically unnecessary under the provis…

Rule 47:03:04:15 Repealed. 47:03:04:15. Effective dates. Repealed. Source: 20 SDR 45, effective October 6, 1993; 21 SDR 225, effective July 5, 1995; 26 SDR 10, effective August 3, 1999; repealed, 38 SDR 105, effective December 12, 2011.

47:03:05:01. Definitions. Terms used in this chapter mean: (1) "Anesthesia services," administration of any drug or combination of drugs with the purpose of creating sedation or analgesia; (2) "Base unit value," the number value assigned to services in Relative Values for Physici…

47:03:05:02. Incorporation of Relative Values for Physicians. Except as otherwise provided in this chapter, the definitions and procedures for determining reimbursement for medical services or treatment are those set forth in Relative Values for Physicians. Source: 21 SDR 67, eff…

47:03:05:02.01. Incorporation of Relative Values for Dentists. The definitions and procedures for determining reimbursement for dental services or treatment are those set forth in Relative Values for Dentists, 2024. Source: 25 SDR 72, effective November 22, 1998; 31 SDR 220, effe…

Rule 47:03:05:03 Repealed. 47:03:05:03. Determining reimbursement -- Conversion factors.Repealed. Source: 21 SDR 67, effective October 13, 1994, and July 1, 1995; 21 SDR 225, effective July 5, 1995; repealed, 23 SDR 23, effective August 22, 1996.

Rule 47:03:05:04 Repealed. 47:03:05:04. Physical medicine.Repealed. Source: 21 SDR 67, effective October 13, 1994; 21 SDR 225, effective July 5, 1995; repealed, 23 SDR 23, effective August 22, 1996.

47:03:05:05. Reimbursement criteria. To be eligible for reimbursement, a charge must be for reasonable and necessary medical services. A health care provider is not entitled to payment from an insurer or employee for fees that exceed the maximum reimbursement allowed under this c…

Rule 47:03:05:06 Dispute resolution. 47:03:05:06. Dispute resolution. A person or entity aggrieved by the action of an insurer regarding medical fees must exhaust the dispute resolution procedure of the insurer before filing a petition or otherwise seeking relief from the departm…

Rule 47:03:05:07 Mediation. 47:03:05:07. Mediation. When a petition for a hearing is filed under § 47:03:05:06, the Department may grant a request for mediation before conducting a hearing under SDCL chapter 1-26 on the matter if the department determines that a party will not be…

Rule 47:03:05:08 Reimbursement for evaluation and management services. 47:03:05:08. Reimbursement for evaluation and management services. Repealed. Source: 21 SDR 225, effective July 5, 1995; repealed, 38 SDR 105, effective December 12, 2011.

Rule 47:03:05:09 Reimbursement for copies. 47:03:05:09. Reimbursement for copies. The maximum reimbursement for copies of provider records is ten dollars for the first ten pages, and thirty-three cents for each additional page. Source: 21 SDR 225, effective July 5, 1995; 23 SDR 2…

Rule 47:03:05:10 Repealed. 47:03:05:10. Reimbursement for physician, technical, or professional services. Repealed. Source: 23 SDR 23, effective August 22, 1996; 24 SDR 7, effective July 30, 1997; repealed, 38 SDR 105, effective December 12, 2011. Rule 47:03:05:10.01 Reimbursemen…

Rule 47:03:05:10.01 Reimbursement for anesthesia services. 47:03:05:10.01. Reimbursement for anesthesia services. The reimbursement for anesthesia services may not exceed the amount determined by adding the base unit value, the physical status modifier unit value, and the qualify…

Rule 47:03:05:11 Repealed. 47:03:05:11. Reimbursement for professional or technical services rendered by a hospital or ambulatory surgical center. Repealed. Source: 23 SDR 23, effective August 22, 1996; 24 SDR 7, effective July 30, 1997; repealed, 38 SDR 105, effective December 1…

Rule 47:03:05:12 Reimbursement for other medical services. 47:03:05:12. Reimbursement for other medical services. The maximum reimbursement for medical services not otherwise identified in this chapter is eighty percent of the amount charged. Only those medical facilities identif…

47:03:05:13. Reimbursement for dental services. To determine the maximum reimbursement for dental services, the unit value for a procedure code is multiplied by a factor of $70.26. Source: 25 SDR 72, effective November 22, 1998; 29 SDR 55, effective October 28, 2002; 33 SDR 226, …

Rule 47:03:05:14 Reimbursement for drugs. 47:03:05:14. Reimbursement for drugs. The reimbursement for drugs may not exceed the provider's usual and customary charge. Source: 25 SDR 72, effective November 22, 1998. General Authority: SDCL 62-7-8. Law Implemented: SDCL 62-7-8.

Rule 47:03:07:01 Definitions. 47:03:07:01. Definitions. Terms used in this chapter mean: (1) "Department," the Department of Labor and Regulation; (2) "Owner-operator," an individual, partner, or corporate shareholder who owns a vehicle licensed and registered as a truck, road tr…

Rule 47:03:07:02 Application. 47:03:07:02. Application. An owner-operator may apply in writing to the department to be certified as an independent contractor. The application must be made on a form provided by the department. Source: 21 SDR 225, effective July 5, 1995. General Au…

Rule 47:03:07:03 Certification as independent contractor. 47:03:07:03. Certification as independent contractor. If the department grants certification to an owner-operator, the department shall issue a certificate verifying the owner-operator's status. The certificate is valid fo…

Rule 47:03:07:04 Revocation, suspension, and denial of certification. 47:03:07:04. Revocation, suspension, and denial of certification. The department shall deny the certification or shall revoke or suspend the certification of an owner-operator if the department finds that the o…

Rule 47:03:08:01 Definitions. 47:03:08:01. Definitions. Terms used in this chapter mean: (1) "Academic year," two consecutive semesters, three consecutive trimesters, or four consecutive quarters; (2) "Cost of attendance," tuition, educational fees, supplies, and housing expenses…