South Dakota Codified Laws 28-13-27.1. Medically necessary hospital services
Medically necessary hospital services are services provided in a hospital which meet the following criteria:
(1) Are consistent with the person‘s symptoms, diagnosis, condition, or injury;
Terms Used In South Dakota Codified Laws 28-13-27.1
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Person: includes natural persons, partnerships, associations, cooperative corporations, limited liability companies, and corporations. See South Dakota Codified Laws 2-14-2
(2) Are recognized as the prevailing standard and are consistent with generally accepted professional medical standards of the provider’s peer group;
(3) Are provided in response to a life–threatening condition; to treat pain, injury, illness, or infection; to treat a condition which would result in physical or mental disability; or to achieve a level of physical or mental function consistent with prevailing standards for the diagnosis or condition;
(4) Are not furnished primarily for the convenience of the person or the provider; and
(5) There is no other equally effective course of treatment available or suitable for the person needing the services which is more conservative or substantially less costly.
A county shall rely on the attending physician’s determination as to medical necessity of hospital services unless evidence exists to the contrary.
Source: SL 1997, ch 170, § 5.