ARSD 67:16:03:06.01. Basis of reimbursement -- Outpatient services

Reimbursement for all outpatient hospital services for prospective payment system hospitals are paid using the medicaid agency's outpatient prospective payment system (OPPS). Reimbursement for in-state non-prospective payment system hospitals is made using a percent of charge rate that approximates a minimum of one hundred percent of cost, not to exceed ninety percent of billed charges. The percent of charge rates are published on the department's fee schedule website. Out-of-state hospital outpatient services must be paid using the medicaid agency's OPPS. Outpatient hospital dialysis services are reimbursed at the reimbursement rate published on the department's fee schedule website. Costs for outpatient services incurred within the three days immediately preceding the inpatient stay are included in the inpatient charges if: (1) The outpatient service is related to the inpatient stay; and (2) The inpatient and outpatient services are provided by the same hospital. Except for medicare prospective payment system hospitals, outpatient laboratory services are excluded from the provisions of this rule and are payable according to § 67:16:03:06.07.