S.D. Admin. R. 67:16:03:07.02
If a patient is transferred between hospitals and the transfer is not medically necessary, the total reimbursement for the combined care may not exceed 100 percent of the payment the transferring hospital would have received had all the needed services been provided by the transferring hospital.
The rate of reimbursement for the receiving hospital is the difference between the transferring hospital's payment and the payment the transferring hospital would have received had the entire episode of care been provided by the transferring hospital. If the transferring hospital is eligible for 100 percent of the payment, no payment is made to the receiving hospital.
The cost of transporting the patient between hospitals is included in the maximum DRG reimbursement and is not payable as a separate service under the provisions of chapter 67:16:25.
This section does not apply if the transfer is from an out-of-state hospital to a South Dakota hospital as long as the hospital care is medically necessary.
S.D. Admin. R. 67:16:03:07.02
General Authority: SDCL 28-6-1(2).
Law Implemented: SDCL 28-6-1(2).