South Dakota Administrative Code

Rule 67:54:09:14 Repealed. 67:54:09:14. Physician's statement. Repealed. Source: 34 SDR 271, effective May 7, 2008; repealed, SL 2013, ch 128, § 34, effective July 1, 2013.

Rule 67:54:09:15 Service coordinator to coordinate development of service plan. 67:54:09:15. Service coordinator to coordinate development of ISP. The participant's service coordinator shall coordinate the development of a written ISP according to § 46:10:07:20. The plan shall co…

67:54:09:16. Provider requirements. A provider of services under this chapter must be certified by the division under the applicable requirements contained in chapter 46:11:02 and must have a signed provider agreement with the department. Source: 34 SDR 271, effective May 7, 2008…

Rule 67:54:09:17 Rate of payment. 67:54:09:17. Rate of payment. The division shall establish and specify in the division's contract with the provider the rate of payment for service coordination. The participant's ISP shall document an established rate for respite, personal, and …

67:54:09:18. Billing requirements. A claim submitted for payment under this chapter must contain the following Health Care Common Procedure Coding System procedure codes, as applicable. PROCEDURE CODEDESCRIPTION T1020Companion careS5165Home modificationsB4222Nutritional supplemen…

Rule 67:54:09:19 Claim requirements. 67:54:09:19. Claim requirements. A claim for services provided under this chapter shall be submitted on a form or in an electronic format that contains the following information: (1) The participant's full name; (2) The participant's medical a…

Rule 67:54:09:20 Record retention. 67:54:09:20. Record retention. The provider must maintain or supervise the maintenance of records necessary to substantiate eligibility, the provision of services, the cost involved, and other records necessary for reporting and accountability. …

Rule 67:54:09:21 Access to records. 67:54:09:21. Access to records. The provider must allow the State of South Dakota and federal agencies access to and copies of all information, data, reports, and records maintained by the provider that relate to the services provided. Source: …

Rule 67:54:09:22 Application of other rules. 67:54:09:22. Application of other rules. Unless otherwise specified, the following chapters apply to this chapter: (1) Chapter 67:16:01 -- General provisions; (2) Chapter 67:16:26 -- Third-party liability; (3) Chapter 67:16:33 -- Provi…

Rule 67:54:09:23 Utilization review. 67:54:09:23. Utilization review. Services provided under this chapter are subject to the following utilization reviews: (1) At the time of eligibility determination; (2) During claim processing; (3) During postpayment reviews; and (4) At the t…

Rule 67:54:09:24 Right to request a fair hearing. 67:54:09:24. Right to request a fair hearing. A participant or a participant's parent or guardian who is dissatisfied with a determination regarding services under this chapter may request a fair hearing in accordance with chapter…

Rule 67:55:01:01 Repealed. 67:55:01:01. Pregnancy resulting from sexual assault. Repealed. Source: 19 SDR 121, effective February 21, 1993; transferred from § 17:11:01:01, effective July 1, 1997; repealed, 30 SDR 116, effective February 4, 2004.

Rule 67:55:01:02 Repealed. 67:55:01:02. Medical expenses defined. Repealed. Source: 19 SDR 121, effective February 21, 1993; transferred from § 17:11:01:02, effective July 1, 1997; repealed, 30 SDR 116, effective February 4, 2004.

Rule 67:55:01:03 Definitions. 67:55:01:03. Definitions. Terms used in this article have the same meaning as those terms defined in SDCL 23A-28B-1. In addition, the following definitions apply: (1) "Inmate," an individual as defined in § 17:10:01:10. Source: 30 SDR 116, effective …

Rule 67:55:01:04 Application. 67:55:01:04. Application. A claimant seeking compensation under this article must submit a completed application for compensation signed by the claimant. The application form is available from the department or any law enforcement agency. A claimant …

67:55:01:05. Circumstances when compensation not allowed. Repealed. Source: 30 SDR 116, effective February 4, 2004; 36 SDR 51, effective October 12, 2009; 48 SDR 18, effective August 30, 2021.

Rule 67:55:01:06 Payment not allowed if victim's conduct contributed substantially to victim's injury or death. 67:55:01:06. Payment not allowed if victim's conduct contributed substantially to victim's injury or death. Payment is not allowed if the victim's conduct contributed s…

Rule 67:55:01:07 Good cause criteria for failing to apply within one year. 67:55:01:07. Good cause criteria for failing to apply within one year. When determining whether good cause exists for failing to apply for assistance within one year, the department shall consider the foll…

Rule 67:55:01:08 Cooperation with law enforcement. 67:55:01:08. Cooperation with law enforcement. The department shall consider the following when determining whether the claimant cooperated with law enforcement: (1) Whether the claimant cooperated in both the investigation and p…

Rule 67:55:01:09 Eligibility if South Dakota resident victim of crime in another jurisdiction. 67:55:01:09. Eligibility if South Dakota resident victim of crime in another jurisdiction. If a resident of South Dakota is a victim of a crime that occurred in another jurisdiction out…

Rule 67:55:01:10 Payment to service provider. 67:55:01:10. Payment to service provider. The department shall make payment directly to the service provider unless the claimant provides proof that the services were paid by the claimant. Source: 30 SDR 116, effective February 4, 200…

Rule 67:55:01:11 Payment considered payment in full -- Exceptions. 67:55:01:11. Payment considered payment in full -- Exceptions. Payments made under this article are considered payment in full unless one of the following circumstances exists and the department paid only a portio…

Rule 67:55:01:12 Record retention. 67:55:01:12. Record retention. Unless the department has received notice of a claim, litigation, negotiation, or other action involving the record, the department is not required to retain a record of the application or related records for more …

Rule 67:55:01:13 Payment from fund if collateral source exists. 67:55:01:13. Payment from fund if collateral source exists. If a collateral source exists, either the service provider or the claimant must verify that the claim was submitted to the collateral source for payment. Be…

Rule 67:55:02:01 Transferred. 67:55:02:01. Transferred to § 67:55:04:24.

Rule 67:55:02:02 Transferred. 67:55:02:02. Transferred to § 67:55:04:25.

Rule 67:55:02:03 Repealed. 67:55:02:03. Order of business. Repealed. Source: 19 SDR 121, effective February 21, 1993; transferred from § 17:11:02:03, effective July 1, 1997; repealed, 30 SDR 116, effective February 4, 2004.

Rule 67:55:02:04 Repealed. 67:55:02:04. Evidence to verify claim. Repealed. Source: 19 SDR 121, effective February 21, 1993; transferred from § 17:11:02:04, effective July 1, 1997; repealed, 30 SDR 116, effective February 4, 2004.

Rule 67:55:02:05 Reserved. 67:55:02:05. Reserved.

Rule 67:55:02:06 Notice of hearing. 67:55:02:06. Notice of hearing. If a claimant requests a review of a claim under the provisions of SDCL 23A-28B-32, the department shall send the claimant and the claimant's authorized representative, if applicable, a written notice at least 30…

Rule 67:55:02:07 Claimant unable to attend hearing. 67:55:02:07. Claimant unable to attend hearing. If the claimant chose to appear either by telephone or in person but is unable to attend, the claimant must notify the commission at least five working days before the date of the …

Rule 67:55:02:08 Evidence. 67:55:02:08. Evidence. The commission shall receive as evidence any statement, document, or information necessary to afford the claimant a fair hearing. Evidence may include items such as hospital records or reports, physicians' reports, or mental healt…

Rule 67:55:02:09 Subpoenas. 67:55:02:09. Subpoenas. Subpoenas issued by the commission requiring the attendance of witnesses or for the production of documentary evidence shall be served according to SDCL 15-6-45. Witness fees and mileage are payable according to SDCL 19-5-1. Sou…

Rule 67:55:02:10 Final decision by commission. 67:55:02:10. Final decision by commission. Based on the testimony received, the evidence provided, and the results of any independent investigation, the commission shall enter its final decision as determined by a majority of the com…

Rule 67:55:02:11 Notice of final decision. 67:55:02:11. Notice of final decision. The department shall notify the claimant of the commission's final decision within 15 working days following the date of the hearing. The notice shall be in writing and shall be made by regular mail…

Rule 67:55:04:01 Definitions. 67:55:04:01 Definitions. As used in this chapter: (1) "Mental health services," means the assessment, diagnosis, and treatment of an individual's mental and emotional functioning that is required to alleviate the psychological trauma that resulted fr…

Rule 67:55:04:02 Limit of compensation. 67:55:04:02. Limit of compensation. Payment made to any claimant under the provisions of this chapter may not exceed the limit established in SDCL 23A-28B-21. Source: 30 SDR 116, effective February 4, 2004; 36 SDR 51, effective October 12, …

67:55:04:03. Mental health services. Payment for mental health services is limited to assessment, diagnosis, and treatment, including individual or group counseling sessions provided by a mental health professional for up to 24 months immediately following the date of the crime. …

Rule 67:55:04:04 Mental health services --Qualifications of a provider. 67:55:04:04. Mental health services -- Qualifications of a provider. Mental health services must be provided by an individual who meets one of the following requirements: (1) Holds a bachelor's degree in coun…

Rule 67:55:04:05 Transportation expenses. 67:55:04:05. Transportation expenses. Payment for transportation expenses is limited to the following: (1) Mileage accrued for the purpose of obtaining services located out of the claimant's city of residence. The department considers the…

Rule 67:55:04:06 Transportation expenses -- Good cause criteria for payment of out-of-state mileage. 67:55:04:06. Transportation expenses -- Good cause criteria for payment of out-of-state mileage. Good cause criteria for the payment of mileage to enable a claimant to obtain serv…

67:55:04:07. Transportation expenses -- Rate of payment. Mileage is reimbursed at the rate established for state employees in SDCL 3-9-1, as applicable, for the use of a privately owned automobile. Source: 30 SDR 116, effective February 4, 2004; 36 SDR 51, effective October 12, 2…

67:55:04:08. Lost earnings -- Payment limits. Payment for lost earnings or loss of future earnings is limited to the following: (1) If the claimant is the victim, the 12-month period immediately following the date of the crime; (2) If the claimant is the parent of a child who was…

Rule 67:55:04:09 Loss of support -- Victim's dependent. 67:55:04:09. Loss of support -- Victim's dependent. Loss of support may be paid to a victim's dependents if the victim was providing support before the date the crime occurred. Payment made for lost support is limited to the…

67:55:04:09.01. Loss of support -- Victim. Loss of support may be paid to a victim of the offender if the offender was providing support to the victim before the date the crime occurred. Payment made for lost support is limited to the 36-month period immediately following the dat…

Rule 67:55:04:10 Loss of personal property. 67:55:04:10. Loss of personal property. The replacement cost of personal property used for evidentiary purposes is payable if the property is not later returned. Source: 30 SDR 116, effective February 4, 2004; 36 SDR 51, effective Octob…

Rule 67:55:04:11 Child care expenses. 67:55:04:11. Child care expenses. Child care expenses are payable if the parent is unable to care for the child because the parent has sustained physical or emotional impairment as a direct result of a crime, if the parent is required to atte…

67:55:04:12. Security devices. Expenses for security devices, including digital security cameras, are payable. The monthly service cost, if any, of a security device installed for the benefit of a victim is the victim's responsibility. Payment for security devices may not exceed …

67:55:04:13. Medical expenses resulting from sexual assault. Bills for rape exams and related expenses must be submitted to collateral sources, including health insurance, before payment may be made under the provisions of this article. Reimbursement is not allowed for rape or se…

Rule 67:55:04:14 Homicide scene expenses. 67:55:04:14. Homicide scene expenses. Expenses associated with cleaning up or repairing a homicide scene are payable. Expenses may include needed repairs resulting from the removal of evidence. A victim's family member is not eligible to …