67:16:03:06.06.  Reimbursement for in-state DRG-exempt hospitals and units.  Reimbursement to in-state DRG-exempt hospitals and units is based on reasonable and allowable costs following guidelines established in 42 C.F.R. §§ 413.1 to 413.179, inclusive, (October 1, 1990), with the following exceptions:

          (1)  Costs associated with certified registered nurse anesthetists that relate to exempt units of hospitals are included as allowable costs;

          (2)  Capital and education costs incurred for inpatient services are included as allowable costs;

          (3)  Psychiatric unit services are paid at the usual and customary charge for the services provided, the daily rate located on the department's website at http://www.dss.sd.gov/medicalservices/providerinfo/feeschedule.asp, or at the rate payable according to § 67:16:03:06.16, whichever is less. The daily rate of payment is subject to review and amendment by the department under the provisions of § 67:16:01:28;

          (4)  Rehabilitation hospital services are paid at the lesser of the usual and customary charge for the services provided or the daily rate located on the department's website at http://www.dss.sd.gov/medicalservices/providerinfo/feeschedule.asp; and

          (5)  Perinatal units, rehabilitation units, and children's care hospitals are reimbursed at a daily rate established by the department according to the guidelines provided in the South Dakota Medicaid State Plan. The daily rates are located on the department's website at http://www.dss.sd.gov/medicalservices/providerinfo/feeschedule.asp.

          Source: 17 SDR 180, effective May 27, 1991; 18 SDR 198, effective June 3, 1992; 19 SDR 128, effective March 10, 1993; 20 SDR 144, effective March 10, 1994; 21 SDR 172, effective April 3, 1995; 22 SDR 143, effective May 9, 1996; 23 SDR 192, effective May 22, 1997; 24 SDR 144, effective April 30, 1998; 26 SDR 157, effective June 7, 2000; 28 SDR 1, effective July 18, 2001; 28 SDR 115, effective February 27, 2002; 31 SDR 39, effective September 29, 2004; 35 SDR 49, effective September 10, 2008; 37 SDR 236, effective June 28, 2011; 37 SDR 236, adopted June 8, 2011, effective July 1, 2012; 38 SDR 224, effective July 1, 2012.

          General Authority: SDCL 28-6-1(2).

          Law Implemented: SDCL 28-6-1(2), 28-6-1.1.

          Reference: South Dakota Medicaid State Plan, Attachment 4.19A, pages 4-5. Copies may be obtained from the Department of Social Services, Division of Medical Services, 700 Governors Drive, Pierre, South Dakota 57501.