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Hospital Information for Counties

Hospitals are required to complete the Hospital Statement of Costs form at least annually to participate in the Catastrophic County Poor Relief Program.


South Dakota counties may log in to access hospital cost share information. You will need to enter your Username and Password.

  • Call 605.773.3165 or email Denise Young for more information or to receive a Username and Password.

County Claims Manual

  • Hospital Statement of Cost Form
  • Mail your completed and signed form to:
    • South Dakota Department of Social Services
      Office of Provider Reimbursement and Audits
      700 Governors Drive
      Pierre, SD 57501
  • If you have any questions about this form or need assistance, please contact Provider Reimbursement and Audits at 605.773.3643.

Note: 28-13-28. Statement of costs required of hospital caring for indigent persons -- Frequency of statements. A hospital may avail itself of the provisions of this chapter for purposes of determining payment for hospitalization of a medically indigent person only if the hospital has filed a detailed statement of costs with the secretary of social services in the form prescribed by the secretary. The statement of costs shall compute and set forth the ratios of costs to charges for the hospital's fiscal year covered by the statement of costs. The statement of costs shall be filed with the secretary at least annually, unless such period is extended or otherwise provided by the secretary, but a hospital may file a detailed statement of costs or amendments to such a statement once every six months.

Note: 28-13-31. Continuation of statement in effect until withdrawn or amended -- Effective date of amendments -- Statements available for inspection. No statement of costs, or amendment thereto, may take effect until approved by the secretary of social services and the expiration of thirty days from the filing thereof, and thereafter, for purposes of this chapter, shall remain in full force and effect until the next statement of costs, or amendment thereto, filed by the hospital pursuant to § 28-13-28 is approved by the secretary. Any such statement of costs, or amendments thereto, shall be a public record and be available for inspection at any time in behalf of any board of county commissioners.