Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form - South Dakota

Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form - South Dakota

Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form is a legal document that was released by the South Dakota Department of Social Services - a government authority operating within South Dakota.

FAQ

Q: What is Long Term Acute Care (LTAC)?A: LTAC refers to a specialized type of hospital care for patients who require extended hospitalization.

Q: What is an Out-of-State Rehab Prior Authorization Request Form?A: It is a form used to request permission from the state of South Dakota for an individual to receive rehabilitation services in a facility located outside of the state.

Q: When is the Out-of-State Rehab Prior Authorization Request Form required?A: The form is required when an individual who is covered by South Dakota Medicaid desires to receive rehabilitation services in an out-of-state facility.

Q: Why is prior authorization needed for out-of-state rehab?A: Prior authorization is needed to ensure that the requested services are medically necessary and appropriate for the individual's condition.

ADVERTISEMENT

Form Details:

  • The latest edition currently provided by the South Dakota Department of Social Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the South Dakota Department of Social Services.

Download Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form - South Dakota

4.5 of 5 (26 votes)
  • Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form - South Dakota

    1

  • Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form - South Dakota, Page 2

    2

  • Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form - South Dakota, Page 3

    3

  • Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form - South Dakota, Page 4

    4

  • Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form - South Dakota, Page 5

    5

  • Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form - South Dakota, Page 1
  • Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form - South Dakota, Page 2
  • Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form - South Dakota, Page 3
  • Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form - South Dakota, Page 4
  • Long Term Acute Care (Ltac) and Out-of-State Rehab Prior Authorization Request Form - South Dakota, Page 5
Prev 1 2 3 4 5 Next
ADVERTISEMENT