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Department of Social Services

Medical Services - Nursing facility rate setting & case mix validation

The effect of the rule changes will be to update the nursing facility rate setting and case mix validation process. The case mix calculation will now use the Patient-Driven Payment Model (PDPM) instead of the M3PI. Nursing facility rates will be rebased to use current cost data to match with PDPM case mix data. Other methodology changes include removing the occupancy rule from direct care, removing the overall rate limit increase, and moving to inflation calculations based on the nursing facility market basket index. The rule changes will also update the depreciation edition referenced in rule, reflect a change in cost ceilings for capital costs, update the case mix validation process, remove the on-site requirement for classification reviews conducted by the department, remove outdated provisions, update Medicaid provider reimbursement manual citation, and repeal outdated provisions.

New content is added below as the draft rules move through the rule-making process.

Agency Rules Hearing

Interim Rules Hearing

Important Dates
Public Hearing:
Comment Deadline:
Interim Rules Committee Hearing:
Filed-Secretary of State:
Rule Effective:

06/22/2023
07/02/2023
07/18/2023
07/18/2023
08/07/2023

Agency Contact: Teresa Schulte mail to: DSSAdminRules@STATE.SD.US