South Dakota Administrative Code

Rule 67:16:11:03.01 Repealed. 67:16:11:03.01. Psychological services. Repealed. Source: 15 SDR 68, effective November 7, 1988; 17 SDR 37, effective September 11, 1990; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:03.02 Repealed. 67:16:11:03.02. Liver transplants. Repealed. Source: 15 SDR 167, effective May 11, 1989; 17 SDR 200, effective July 1, 1991; 25 SDR 104, effective February 17, 1999; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:03.03 Repealed. 67:16:11:03.03. Psychiatric hospital services -- In-state -- Limits. Repealed. Source: 17 SDR 37, effective September 11, 1990; 18 SDR 209, effective June 23, 1992; 19 SDR 82, effective December 7, 1992; repealed, 35 SDR 88, effective October 23, 200…

Rule 67:16:11:03.04 Transferred. 67:16:11:03.04. Transferred to § 67:54:08:04.

Rule 67:16:11:03.05 Nutritional therapy and nutritional supplements. 67:16:11:03.05. Nutritional therapy and nutritional supplements. Nutritional therapy and nutritional supplements are covered under the provisions of §§ 67:16:42:02, 67:16:42:06, and 67:16:42:07. Source: 17 SDR 3…

Rule 67:16:11:03.06 Orthodontic treatment. 67:16:11:03.06. Orthodontic treatment. Orthodontic treatment is subject to prior authorization. The authorization is based on the results of an orthodontic evaluation and assessment completed by the treating dentist or orthodontist. In a…

Rule 67:16:11:03.07 Repealed. 67:16:11:03.07. Orthodontic treatment -- Treatment totals $500 or less. Repealed. Source: 17 SDR 184, effective June 6, 1991; 19 SDR 56, effective October 19, 1992; 23 SDR 197, effective May 26, 1997; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:03.08 Repealed. 67:16:11:03.08. Orthodontic treatment -- Treatment exceeds $500 -- Individual eligible after treatment started -- Medical assistance program not original provider -- Change in provider. Repealed. Source: 17 SDR 184, effective June 6, 1991; 19 SDR 56,…

Rule 67:16:11:03.09 Repealed. 67:16:11:03.09. Orthodontic treatment -- Treatment exceeds $500 -- Individual eligible before treatment started. Repealed. Source: 17 SDR 184, effective June 6, 1991; 19 SDR 56, effective October 19, 1992; 19 SDR 202, effective July 5, 1993; 23 SDR 1…

Rule 67:16:11:03.10 Repealed. 67:16:11:03.10. Home-based therapy services -- Prerequisites for services. Repealed. Source: 18 SDR 98, effective December 9, 1991; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:03.11 Repealed. 67:16:11:03.11. Home-based therapy services -- Mental disorders. Repealed Source: 18 SDR 98, effective December 9, 1991; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:03.12 Repealed. 67:16:11:03.12. Home-based therapy services -- Diagnostic assessment requirements. Repealed. Source: 18 SDR 98, effective December 9, 1991; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:03.13 Repealed. 67:16:11:03.13. Home-based therapy services -- Seriously emotionally disturbed -- Mandatory reviews. Repealed. Source: 18 SDR 98, effective December 9, 1991; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:03.14 Repealed. 67:16:11:03.14. Home-based therapy services -- Individual at risk -- Mandatory reviews. Repealed. Source: 18 SDR 98, effective December 9, 1991; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:03.15 Repealed. 67:16:11:03.15. Home-based therapy services -- Treatment plan -- Mandatory reviews. Repealed. Source: 18 SDR 98, effective December 9, 1991; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:03.16 Repealed. 67:16:11:03.16. Home-based therapy services -- Service requirements. Repealed. Source: 18 SDR 98, effective December 9, 1991; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:03.17 Transferred. 67:16:11:03.17. Transferred to § 67:54:08:06.

Rule 67:16:11:03.18 Repealed. 67:16:11:03.18. Medical equipment. Repealed. Source: 18 SDR 209, effective June 23, 1992; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:03.19 Repealed. 67:16:11:03.19. Home health services. Repealed. Source: 18 SDR 209, effective June 23, 1992; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:03.20 Private duty nursing services. 67:16:11:03.20. Private duty nursing services. Private duty nursing services for a technology-dependent individual are covered when the following requirements are met: (1) The services are medically necessary; (2) The services ar…

Rule 67:16:11:03.21 Extended home health aide services. 67:16:11:03.21. Extended home health aide services. Extended home health aide services are covered when the following requirements are met: (1) The services are medically necessary; (2) The services are provided to an indivi…

Rule 67:16:11:03.22 Private duty nursing services -- Extended home health aide services -- Prior authorization -- Reauthorization. 67:16:11:03.22. Private duty nursing services -- Extended home health aide services -- Prior authorization -- Reauthorization. A provider must have a…

Rule 67:16:11:03.23 Repealed. 67:16:11:03.23. Psychiatric hospital services -- Out-of-state -- Limits. Repealed. Source: 19 SDR 82, effective December 7, 1992; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:04 Screening services under EPSDT. 67:16:11:04. Screening services under EPSDT. A complete, comprehensive screening exam must include the following components: (1) A comprehensive health and developmental history, including an assessment of the physical and mental d…

Rule 67:16:11:04.01 Periodicity schedules for complete, comprehensive screenings. 67:16:11:04.01. Periodicity schedules for complete, comprehensive screenings. Complete, comprehensive screenings must be completed according to the following schedules: (1) For preventive pediatric …

Rule 67:16:11:05 Rate of payment -- Screening services. 67:16:11:05. Rate of payment -- Screening services. The rate of payment for screening services provided under the EPSDT program is covered under the provisions of chapter 67:16:02 or 67:16:44, as applicable. Source: SL 1975,…

Rule 67:16:11:05.01 Rate of payment -- Immunizations. 67:16:11:05.01. Rate of payment -- Immunizations. Payment for immunizations is limited to the lesser of the provider's usual and customary charge for the immunization provided or the amount specified on the department's fee sc…

Rule 67:16:11:06 Repealed. 67:16:11:06. Rate of payment -- Vision services. Repealed. Source: SL 1975, ch 16, § 1; 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 15 SDR 167, effective May 11, 1989; 17 SDR 37, effective September 11, 1990; 18 SDR 209…

Rule 67:16:11:06.01 Repealed. 67:16:11:06.01. Rate of payment -- Dental services. Repealed. Source: 17 SDR 37, effective September 11, 1990; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:06.02 Repealed. 67:16:11:06.02. Rate of payment -- Hearing tests and exams. Repealed. Source: 17 SDR 37, effective September 11, 1990; 18 SDR 209, effective June 23, 1992; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:06.03 Repealed. 67:16:11:06.03. Rate of payment -- Orthopedic shoes. Repealed. Source: 17 SDR 37, effective September 11, 1990; 18 SDR 209, effective June 23, 1992; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:06.04 Repealed. 67:16:11:06.04. Rate of payment -- Psychological services. Repealed. Source: 17 SDR 37, effective September 11, 1990; 17 SDR 184, effective June 6, 1991; 17 SDR 200, effective July 1, 1991; 25 SDR 104, effective February 17, 1999; repealed, 35 SDR 88…

Rule 67:16:11:06.05 Repealed. 67:16:11:06.05. Rate of payment -- Liver transplants. Repealed. Source: 17 SDR 37, effective September 11, 1990; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:06.06 Repealed. 67:16:11:06.06. Rate of payment -- Inpatient psychiatric hospital services. Repealed. Source: 17 SDR 37, effective September 11, 1990; 17 SDR 180, effective May 27, 1991; 18 SDR 209, effective June 23, 1992; 19 SDR 82, effective December 7, 1992; rep…

Rule 67:16:11:06.07 Transferred. 67:16:11:06.07. Transferred to § 67:54:08:10.

Rule 67:16:11:06.08 Rate of payment -- Nutritional therapy, nutritional supplements, and electrolyte replacements. 67:16:11:06.08. Rate of payment -- Nutritional therapy, nutritional supplements, and electrolyte replacements. Payment for nutritional items and services is made und…

Rule 67:16:11:06.09 Rate of payment -- Orthodontic treatment. 67:16:11:06.09. Rate of payment -- Orthodontic treatment. Payment for orthodontic treatment is limited to the lesser of the provider's usual and customary charge for the covered service provided or the amount specified…

Rule 67:16:11:06.10 Repealed. 67:16:11:06.10. Rate of payment -- Drugs. Repealed. Source: 17 SDR 37, effective September 11, 1990; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:06.11 Repealed. 67:16:11:06.11. Rate of payment -- Medical equipment. Repealed. Source: 17 SDR 37, effective September 11, 1990; 18 SDR 209, effective June 23, 1992; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:06.12 Repealed. 67:16:11:06.12. Rate of payment -- Other physician services. Repealed. Source: 17 SDR 37, effective September 11, 1990; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:06.13 Repealed. 67:16:11:06.13. Rate of payment -- Home-based therapy services. Repealed. Source: 18 SDR 98, effective December 9, 1991; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:06.14 Repealed. 67:16:11:06.14. Rate of payment -- Home health services. Repealed. Source: 18 SDR 209, effective June 23, 1992; repealed, 35 SDR 88, effective October 23, 2008.

Rule 67:16:11:06.15 Rate of payment -- Private duty nursing services. 67:16:11:06.15. Rate of payment -- Private duty nursing services. Payment for covered private duty nursing services is limited to the lesser of the provider's usual and customary charge or the fee contained on …

Rule 67:16:11:06.16 Rate of payment -- Extended home health aide services. 67:16:11:06.16. Rate of payment -- Extended home health aide services. Payment for covered extended home health aide services is limited to the lesser of the provider's usual and customary charge or the fe…

Rule 67:16:11:07 Repealed. 67:16:11:07. Dental services covered under EPSDT. Repealed. Source: SL 1975, ch 16, § 1; 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 11 SDR 26, effective August 21, 1984; 12 SDR 70, effective October 31, 1985; 15 …

Rule 67:16:11:08 Repealed. 67:16:11:08. Services not covered under EPSDT. Repealed. Source: SL 1975, ch 16, § 1; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 15 SDR 167, effective May 11, 1989; 17 SDR 37, effective September 11, 1990; 17 SDR 184, effective June 6, 1991; 23 SDR 197…

Rule 67:16:11:08.01 Cost not to exceed long-term institutional care. 67:16:11:08.01. Cost not to exceed long-term institutional care. When the actual or projected cost of all services provided in the home over a period of three months exceeds 135 percent of the cost of care if th…

Rule 67:16:11:08.02 Repealed. 67:16:11:08.02. Uncompleted orthodontic treatment subject to refund provisions. Repealed. Source: 19 SDR 56, effective October 19, 1992; repealed, 23 SDR 197, effective May 26, 1997.

Rule 67:16:11:09 Repealed. 67:16:11:09. Prior authorization for dental services under EPSDT. Repealed. Source: SL 1975, ch 16, § 1; 2 SDR 74, effective May 13, 1976; repealed, 7 SDR 23, effective September 18, 1980.

Rule 67:16:11:10 Repealed. 67:16:11:10. Claims for dental services and materials -- Payment limits. Repealed. Source: SL 1975, ch 16, § 1; 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 15 SDR 167, effective May 11, 1989; 16 SDR 64, effective Octobe…