South Dakota Administrative Code

Rule 67:16:25:04 Secure medical transportation -- Covered services. 67:16:25:04. Secure medical transportation -- Covered services. A participating secure medical transportation provider is eligible to receive payment for nonemergency transportation services. Recipients being tra…

Rule 67:16:25:04.01 Secure medical transportation -- Qualifications of driver. 67:16:25:04.01. Secure medical transportation -- Qualifications of driver. A secure medical transportation provider must ensure that the driver providing the transportation service meets the following …

Rule 67:16:25:04.02 Secure medical transportation -- Required training for driver and attendant. 67:16:25:04.02. Secure medical transportation -- Required training for driver and attendant. A secure medical transportation provider must ensure that each driver and attendant is abl…

Rule 67:16:25:04.03 Secure medical transportation -- Required vehicle equipment. 67:16:25:04.03. Secure medical transportation -- Required vehicle equipment. Each vehicle used for secure medical transportation services must be equipped with vehicle safety equipment and a first ai…

Rule 67:16:25:04.04 Secure medical transportation -- Securement devices. 67:16:25:04.04. Secure medical transportation -- Securement devices. A vehicle used for secure medical transportation must be equipped with a securement device and an occupant restraint system for each occup…

Rule 67:16:25:04.05 Secure medical transportation -- Vehicle inspections -- Vehicle operation. 67:16:25:04.05. Secure medical transportation -- Vehicle inspections -- Vehicle operation. Each day before a secure medical transportation vehicle is used to transport a recipient, the …

Rule 67:16:25:04.06 Secure medical transportation -- Liability insurance. 67:16:25:04.06. Secure medical transportation -- Liability insurance. At a minimum, the provider shall have liability insurance coverage in the amount of $1,000,000 for bodily injury to or death of any pers…

Rule 67:16:25:04.07 Secure medical transportation -- Complaints -- Inspection. 67:16:25:04.07. Secure medical transportation -- Complaints -- Inspection. If the department receives a complaint concerning the condition of a vehicle used to transport recipients or the vehicle's equ…

Rule 67:16:25:04.08 Secure medical transportation -- Provider to maintain certain records. 67:16:25:04.08. Secure medical transportation -- Provider to maintain certain records. A provider must maintain the following written documents and must make them available to the departmen…

Rule 67:16:25:05 Rate of payment for secure medical transportation services. 67:16:25:05. Rate of payment for secure medical transportation services. The rate of payment for secure medical transportation services is limited to the lesser of the provider's usual and customary char…

Rule 67:16:25:06 Repealed. 67:16:25:06. Other transportation services covered. Repealed. Source: 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 16 SDR 234, effective July 1, 1990; 20 SDR 126, effective February 10, 1994; 25 SDR 69, effective N…

67:16:25:06.01. Transportation services provided by community transportation provider. Community transportation services are covered if the following requirements are met: (1) The transportation provider is a governmental entity, secure medical transportation provider, or registe…

Rule 67:16:25:06.02 Reimbursable services -- Community transportation provider. 67:16:25:06.02. Reimbursable services -- Community transportation provider. If the requirements of § 67:16:25:06.01 are met, reimbursable community transportation services are limited to the following…

Rule 67:16:25:06.03 Repealed. 67:16:25:06.03. Non-emergency transportation services provided by commercial carrier. Repealed. Source: 35 SDR 253, effective May 12, 2009; 44 SDR 94, effective December 4, 2017.

Rule 67:16:25:06.04 Repealed. 67:16:25:06.04. Transportation services provided by recipient, escort, or volunteer driver. Repealed. Source: 35 SDR 253, effective May 12, 2009; 40 SDR 122, effective January 7, 2014; 44 SDR 94, effective December 4, 2017.

Rule 67:16:25:06.05 Repealed. 67:16:25:06.05. Transportation expenses advanced by non-profit service organization. Repealed. Source: 35 SDR 253, effective May 12, 2009; 44 SDR 94, effective December 4, 2017.

Rule 67:16:25:06.06 Repealed. 67:16:25:06.06. Covered services -- Commercial carrier. Repealed. Source: 35 SDR 253, effective May 12, 2009; 44 SDR 94, effective December 4, 2017.

Rule 67:16:25:06.07 Repealed. 67:16:25:06.07 Covered services -- Recipient, escort, or volunteer driver. Repealed. Source: 35 SDR 253, effective May 12, 2009; 40 SDR 122, effective January 7, 2014; 41 SDR 218, effective June 30, 2015; 44 SDR 94, effective December 4, 2017.

Rule 67:16:25:06.08 Repealed. 67:16:25:06.08. Covered services -- Non-profit service organization. Repealed. Source: 35 SDR 253, effective May 12, 2009; 44 SDR 94, effective December 4, 2017.

Rule 67:16:25:07 Repealed. 67:16:25:07. Rate of payment for other transportation services. Repealed. Source: 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 11 SDR 26, effective August 21, 1984; 16 SDR 234, effective July 1, 1990; 17 SDR 201, e…

Rule 67:16:25:07.01 Rate of payment for community transportation services. 67:16:25:07.01. Rate of payment for community transportation services. The rate of payment for community transportation services is available on the department's fee schedule website. Reimbursement for loa…

Rule 67:16:25:07.02 Repealed. 67:16:25:07.02. Rate of payment -- Commercial carrier. Repealed. Source: 35 SDR 253, effective May 12, 2009; 44 SDR 94, effective December 4, 2017.

Rule 67:16:25:07.03 Repealed. 67:16:25:07.03. Rate of payment -- Recipient, escort, or volunteer driver. Repealed. Source: 35 SDR 253, effective May 12, 2009; 42 SDR 51, effective October 13, 2015; 44 SDR 94, effective December 4, 2017.

Rule 67:16:25:07.04 Repealed. 67:16:25:07.04. Rate of reimbursement -- Non-profit service organization. Repealed. Source: 35 SDR 253, effective May 12, 2009; 42 SDR 51, effective October 13, 2015; 44 SDR 94, effective December 4, 2017.

Rule 67:16:25:08 Billing requirements -- Ground ambulance. 67:16:25:08. Billing requirements -- Ground ambulance. A claim for ground ambulance transportation service must be submitted at the provider's usual and customary charge. A provider may bill for services only if a recipie…

Rule 67:16:25:08.01 Billing requirements -- Secure medical transportation. 67:16:25:08.01. Billing requirements -- Secure medical transportation. A claim for secure medical transportation service must be submitted at the provider's usual and customary charge. A provider may bill …

Rule 67:16:25:08.02 Repealed. 67:16:25:08.02. Billing requirements -- Other transportation services. Repealed. Source: 16 SDR 234, effective July 1, 1990; 20 SDR 126, effective February 10, 1994; 22 SDR 20, effective August 24, 1995; repealed, 35 SDR 253, effective May 12, 2009.

Rule 67:16:25:08.03 Billing requirements -- Air ambulance. 67:16:25:08.03. Billing requirements -- Air ambulance. A claim for air ambulance must be submitted at the provider's usual and customary charge. A provider may bill for services only if a recipient was actually transporte…

Rule 67:16:25:08.04 Billing requirements -- Community transportation services. 67:16:25:08.04. Billing requirements -- Community transportation services. A claim submitted for community transportation services must be at the provider's usual and customary charge. A provider may n…

Rule 67:16:25:09 Utilization review. 67:16:25:09. Utilization review. Utilization review for transportation services may be conducted on the following levels: (1) Computerized claims processing; (2) Postpayment review; and (3) Peer review. Source: 7 SDR 23, effective September 18…

Rule 67:16:25:10 Claim requirements -- Ambulance. 67:16:25:10. Claim requirements -- Ambulance. A claim for air or ground ambulance services provided under this chapter must be submitted on a form or in an electronic format that contains the following information: (1) The recipie…

Rule 67:16:25:11 Claim requirements -- Secure medical transportation. 67:16:25:11. Claim requirements -- Secure medical transportation. A claim for secure medical transportation services provided under this chapter must be submitted on a form or in an electronic format that conta…

Rule 67:16:25:12 Repealed. 67:16:25:12. Claim requirements -- Other transportation services. Repealed. Source: 17 SDR 4, effective July 16, 1990; repealed, 35 SDR 253, effective May 12, 2009. Rule 67:16:25:12.01 Claim requirements -- Community transportation services. 67:16:25:12…

Rule 67:16:25:12.01 Claim requirements -- Community transportation services. 67:16:25:12.01. Claim requirements -- Community transportation services. A claim for community transportation services provided under this chapter must be submitted on a form or in an electronic format t…

Rule 67:16:25:12.02 Repealed. 67:16:25:12.02. Claim requirements -- Commercial carrier. Repealed. Source: 35 SDR 253, effective May 12, 2009; 44 SDR 94, effective December 4, 2017.

Rule 67:16:25:12.03 Repealed. 67:16:25:12.03. Claim requirements -- Recipient, escort, or volunteer driver. Repealed. Source: 35 SDR 253, effective May 12, 2009; 44 SDR 94, effective December 4, 2017.

Rule 67:16:25:12.04 Repealed. 67:16:25:12.04. Claim requirements -- Non-profit service organization. Repealed. Source: 35 SDR 253, effective May 12, 2009; 44 SDR 94, effective December 4, 2017.

Rule 67:16:25:12.05 Claim requirements -- Modifier codes -- Ambulance, secure medicval, and community transportation services. 67:16:25:12.05. Claim requirements -- Modifier codes -- Ambulance, secure medical, and community transportation services. A modifier code provides the me…

Rule 67:16:25:13 Application of other chapters. 67:16:25:13. Application of other chapters. In addition to the rules contained in this chapter, providers and recipients must meet the requirements of chapters 67:16:01, 67:16:26, 67:16:33, 67:16:34, and 67:16:35. Source: 17 SDR 184…

Rule 67:16:25:14 Recovery of amounts overpaid. 67:16:25:14. Recovery of amounts overpaid. The department considers a payment made on behalf of a recipient for non-emergency transportation assistance that exceeds the amount reimbursable under this chapter to be an overpayment and …

Rule 67:16:26:01 Definitions. 67:16:26:01. Definitions. Terms used in this chapter mean: (1) "Private health insurance," medical or hospital insurance coverage with benefits payable to or in behalf of an eligible recipient; (2) "Probable existence of third-party liability," an in…

Rule 67:16:26:02 Responsibility for reporting of third-party liability -- Recipients. 67:16:26:02. Responsibility for reporting of third-party liability -- Recipients. As a condition of eligibility, a recipient must report to and cooperate with the department in securing informat…

Rule 67:16:26:03 Responsibility for reporting of third-party liability -- Applicants. 67:16:26:03. Responsibility for reporting of third-party liability -- Applicants. As a condition of eligibility, an applicant must provide information about the existence of any third-party paym…

Rule 67:16:26:04 Provider notification of third-party liability. 67:16:26:04. Provider notification of third-party liability. If the department has knowledge that a third-party liability source exists for a particular recipient, the department shall notify providers of such cover…

Rule 67:16:26:05 Provider must collect from third-party source before submitting claim to department -- Medical assistance program payer of last resort -- Payment provision. 67:16:26:05. Provider must collect from third-party source before submitting claim to department -- Medica…

Rule 67:16:26:06 Repealed. 67:16:26:06. Contested third-party liability -- Payment by department. Repealed. Source: 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; repealed, 16 SDR 226, effective June 24, 1990.

Rule 67:16:26:07 Department determination of possible existence of third-party source -- Claim denial. 67:16:26:07. Department determination of possible existence of third-party source -- Claim denial. When a provider has requested payment of a claim and the department has docume…

Rule 67:16:26:07.01 Payment provisions when third-party source involves Medicare. 67:16:26:07.01. Payment provisions when third-party source involves Medicare. If a recipient is eligible for Medicare, the provider must submit a completed claim for payment of services to the Medic…

Rule 67:16:26:07.02 Certain claims eligible for payment before third-party benefits recovered -- Department to pursue reimbursement. 67:16:26:07.02. Certain claims eligible for payment before third-party benefits recovered -- Department to pursue reimbursement. A provider is elig…

Rule 67:16:26:07.03 Provider may not pursue payment from recipient when third-party liability established. 67:16:26:07.03. Provider may not pursue payment from recipient when third-party liability established. When third-party liability has been established and the amount of the …