67:16:04:60.  Basis of payment. Payment to participating providers of nursing facility services is made on the following basis:

          (1)  Payment to in-state facilities is calculated using the per diem rates that are established according to § 67:16:04:54, multiplying the case mix adjusted direct care per diem rate by the resident's M3PI weight established by the resident assessment, and adding the nondirect care rate for each day the Medicaid resident is an inpatient resident;

          (2)  Payment to out-of-state facilities providing nursing services to residents of South Dakota is the lesser of the Medicaid rate established by the state in which the facility is located or the South Dakota statewide average Medicaid rate for all instate facilities. Payment to out-of-state facilities for care not available at instate facilities is the rate recognized for the facility by the Medicaid agency in the state in which the facility is located;

          (3)  Payment for reserved bed days is governed by the provisions of § 67:45:02:04 and is based on the resident's latest resident assessment and M3PI classification at the time of the resident's absence;

          (4)  Swing-bed hospitals are reimbursed at a daily rate established by the department. The daily rates are located on the department's website at http://www.dss.sd.gov/medicalservices/providerinfo/feeschedule.asp. Swing-bed hospitals are reimbursed for assisted living at the current maximum rate paid for assisted living; and

          (5)  Coinsurance under the Medicare program is payable at the Medicare coinsurance rate.

          Source: SL 1975, ch 16, § 1; 2 SDR 16, effective September 4, 1975; 2 SDR 88, effective July 1, 1976; 7 SDR 23, effective September 18, 1980; 7 SDR 76, effective February 11, 1981; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 11, effective August 13, 1981; 11 SDR 26, effective August 21, 1984; 15 SDR 68, effective November 7, 1988; 16 SDR 26, effective August 13, 1989; 18 SDR 67, effective October 13, 1991; transferred from § 67:16:04:08, 21 SDR 8, effective July 25, 1994; 24 SDR 185, effective July 6, 1998; 26 SDR 21, effective August 24, 1999; 38 SDR 224, effective July 1, 2012.

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

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

          Cross-Reference: Payment adjustment due to review of resident assessment, § 67:45:03:08.