Provider Reimbursements and Audits

Provider Reimbursement and Audits works with various programs within the Department of Social Services to establish reimbursement methodology and reimbursement rates.

This may include programs for:

• Hospitals
• Rural Health Clinics
• Medical Providers
• Nursing Facilities
• Assisted Living Facilities
• Group and Residential Treatment Facilities

We also provide auditing services for the Department. For those providers who have elected to participate in the Department's programs, the office is responsible for the verification of the provider's program costs and for compliance with the established reimbursement requirements.

Requested information based on interaction with health care providers includes:

• Long-Term Care Study: Nursing Home FTE Survey
  • Survey Cover
  • Staffing Survey
• Assisted Living Information:
  • Instructions for Report
  • Assisted Living Cost Report
  • Cost Report Training
  • Checklist
• South Dakota Financial Ratio Information:
  
  • Selected Financial Ratios: This document contains a summary of the ratios we will be collecting and outlines the sources you can use to compile the ratio information.
  • Financial Ratios Worksheet: This document should be used to report the source data and actual ratios.
  • Step-Down Instructions: This document contains instructions for using the Step-Down tool. This tool can be used by hospital or facility based providers to provide the information requested in the Financial Ratios Worksheet.
  • Step-Down Worksheet: This document can be used as a tool for hospital or facility based providers to obtain the ratio information.
  • HB 1156: An Act to require a study of the continuum of care needs for senior citizens.
• Other Information
  • State Plan Attachment 4.19D, Reimbursement for Nursing Facilities and Intermediate Care Facilities for the Mentally Retarded Under 16 Beds
    
  • Administrative Rules, Chapter 67:16:04, Reimbursement for Nursing Facilities
  • Medicaid Nursing Facility Clinical Classifications -- RUG's 34
  • Statistical & Cost Summary for Long-Term Care Facilities (Medicaid Cost Report and Instructions)
  • CMS Instructions for Minimum Data Set (MDS) Requirements for Nursing Facilities
  • Hospital Statement of Cost -- Catastrophic County Poor Relief Program
  • Group and Residential Child Care Facilities Cost Report and Instructions