South Dakota

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

South Dakota Medicaid provides reimbursement for live video at the same rate as in-person services, under some circumstances. Reimbursement is not provided for store-and-forward or remote patient monitoring services.

 

Definitions

“Telemedicine is the use of an interactive telecommunications system to provide two-way, real-time, interactive communication between a provider and a Medicaid recipient across a distance.”

Source: SD Medical Assistance Program, Professional Svcs. Manual, p. 18 (Apr. 2019), & SD Medicaid Institutional Billing Manual, p.19 (Mar. 2019). (Accessed Apr. 2019).

 

Office of Adult Services and Aging
“Telehealth services” is a home-based health monitoring system used to collect and transmit an individual’s clinical data for monitoring and interpretation.

Source: : SD Regulation 67:40:19:01(21) (Accessed Apr. 2019).

Live Video

Policy

South Dakota Medicaid will reimburse for limited services at the same rate as in-person services. See manual for complete list of CPT codes.
All telemedicine services must comply with South Dakota Medicaid’s Out-Of-State Prior
Authorization Requirements

Source: SD Medical Assistance Program, Professional Svcs. Manual, p. 18-22 (Apr. 2019) & SD Medicaid Institutional Billing Manual, p. 19-22 (Mar. 2019).(Accessed Apr. 2019).
Eligible Services / Specialties

See manuals for specific CPT codes.

Source: SD Medical Assistance Program, Professional Svcs. Manual, p. 18-21 (Apr. 2019) & SD Medicaid Institutional Billing Manual, p. 19-22 (Mar. 2019). (Accessed Apr. 2019).
Geographic Limits

An originating site may not be located in the same community as the distant site, unless the originating site is a nursing facility.

Source: SD Medical Assistance Program, Professional Svcs. Manual, p. 18(Apr. 2019), & SD Medicaid Institutional Billing Manual, p. 19 (Mar. 2019). (Accessed Apr. 2019).
Facility/Transmission Fee

Certain originating sites are eligible for a facility fee and are:
• Office of a physician or practitioner
• Outpatient Hospital
• Critical Access Hospital
• Rural Health Clinic
• Federally Qualified Health Center
• Indian Health Services Clinic
• Community Mental Health Center
• Nursing Facilities
• Schools
The originating site may not be located in the same community as the distant site unless the originating site is a nursing facility

Source: SD Medical Assistance Program, Professional Svcs. Manual, p. 21-22 (Apr. 2019). & SD Medicaid Institutional Billing Manual, p. 22 (Mar. 2019). (Accessed Apr. 2019).

Store-and-Forward

Policy

Source: SD Medical Assistance Program, Professional Svcs. Manual, p. 21 (Apr. 2019). & SD Medicaid Institutional Billing
Manual, p. 19 (Mar. 2019). (Accessed Apr. 2019).

Email / Phone / Fax

No reimbursement for email.
No reimbursement for telephone.
No reimbursement for FAX.

 

Source: SD Medical Assistance Program, Professional Svcs. Manual, p. 18 (Apr. 2019). & SD Medicaid Institutional Billing Manual, p. 19 (Mar. 2019). (Accessed Apr. 2019). (Accessed Apr. 2019)

Professional Regulation /
Health & Safety

Definitions

“Telehealth services” is a home-based health monitoring system used to collect and transmit an individual’s clinical data for monitoring and interpretation.

Source: SD Regulation 67:40:19:01(21) (Accessed Apr. 2019).

 

Mental Health Procedures in Criminal Justice
“Telehealth” is a mode of delivering healthcare services that utilizes information and communication technologies to enable the diagnosis, consultation, treatment, education, care management and self-management of patients at a distance from heath care providers.

Source: SD Code 23A-50-1(6) (Accessed Apr. 2019).
Cross-State Licensing

An applicant who holds a valid medical license issued by another state can be licensed through reciprocity in South Dakota if:
• The applicant completed a residency program in the US or Canada;
• Has passed one of the listed licensure examinations (Please see rule for list);
• Is in good standing with their state’s professional board; and
• Has completed a state and federal criminal background investigation.

Source: SD Regulation 20:78:03:12. (Accessed Apr. 2019).

 

Member of Interstate Medical Licensure Compact.

Source: Interstate Medical Licensure Compact. (Accessed Apr. 2019).

 

Member of Nurse Licensure Compact.

Source: : Current NLC States & Status. Nurse Licensure Compact. (Accessed Apr. 2019).
Miscellaneous

Office of Adult Service and Aging
In-home services, which is defined as including “telehealth services”, may be provided to an individual who demonstrates a need for long-term supports and services through an assessment and the following criteria:
• The individual is residing at home;
• The individual is age 60 or older or is age 18 or older with a disability; and
• The individual is not eligible for other programs which provide the same type of service.

 

Source: SD Regulation 67:40:19:04. (Accessed Apr. 2019).

Contact us to discuss your telehealth initiatives in South Dakota


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