South Dakota

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: No
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: EMS, IMLC, NLC, PTC
  • Consent Requirements: No

STATE RESOURCES

  1. Medicaid Program: South Dakota Medicaid
  2. Administrator: South Dakota Dept. of Social Services
  3. Regional Telehealth Resource Center: Great Plains Telehealth Resource and Assistance Center

Last updated 01/26/2022

Audio-Only Delivery

Medicaid: South Dakota Provider Manual

STATUS: Permanent, some sections only apply during PHE

Medicaid: COVID-19 FAQs

STATUS: Some policies permanent while others contingent on PHE.

Medicaid: Telemedicine and Telephonic Services Update (July 2, 2021)

STATUS: Active

Medicaid: COVID-19 Telemedicine Updates

STATUS: Active

Medicaid 1915(c) Waiver: Appendix K – CHOICES

STATUS: Active, Expires 6 months after end of PHE

Medicaid 1915(c) Waiver: Appendix K – CHOICES

STATUS: Active, Addendum expires 6 months after end of PHE

Office of the Governor: Executive Order 2020-34 (extending telehealth flexibilities in prior EOs)

STATUS: Active, Extended by EO 2021-01.

Office of the Governor: Executive Order (suspends Medicaid telemedicine restrictions)

STATUS: Active, until SD state of emergency ends

Medicaid 1915(c) Waiver: Appendix K – Assistive Daily Living Services

STATUS: Active, Expires 6 months after end of PHE

Medicaid 1915(c) Waiver: Appendix K – Assistive Daily Living Services

STATUS: Active, Addendum expires 6 months after end of PHE

Medicaid 1915(c) Waiver: Appendix K – Home and Community-Based Options and Person-Centered Excellence (HOPE) Waiver

STATUS: Active, Expires 6 months after end of PHE

Medicaid 1915(c) Waiver: Appendix K- Home and Community-Based Options and Person-Centered Excellence (HOPE) Waiver

STATUS: Active, Addendum expires 6 months after  end of PHE

 

Last updated 01/26/2022

Cross State Licensing

Board of Social Work Examiners: Telehealth COVID-19 Update

STATUS: Active

Last updated 01/26/2022

Easing Prescribing Requirements

No Reference Found

Last updated 01/26/2022

Miscellaneous

Board of Examiners of Psychologists:  Telehealth COVID-19 Update

STATUS: Active

Limited Liability for Exposure to COVID-19 South Dakota Codified Laws 21-68-1-4

STATUS: Enacted

Last updated 01/26/2022

Originating Site

Medicaid: South Dakota Provider Manual

STATUS: Permanent, some sections only apply during PHE. SD Medicaid will notify providers when flexibilities no longer allowed.

Medicaid: COVID-19 FAQs

STATUS: Some policies permanent while others contingent on PHE.

Medicaid: COVID-19 Telemedicine Updates

STATUS: Active

Last updated 01/26/2022

Private Payer

No Reference Found

Last updated 01/26/2022

Provider Type

Medicaid: South Dakota Provider Manual

STATUS: Permanent, some sections only apply during PHE

Medicaid: COVID-19 FAQs

STATUS: Some policies permanent while others contingent on PHE.

Medicaid: COVID-19 Telemedicine Updates

STATUS: Active

Medicaid: IHS and Tribal Providers

STATUS: Active, during PHE

Last updated 01/26/2022

Service Expansion

Medicaid: South Dakota Provider Manual

STATUS: Permanent, some sections only apply during PHE

Medicaid: COVID-19 FAQs

STATUS: Some policies permanent while others contingent on PHE.

Medicaid: Telemedicine and Telephonic Services Update (July 2, 2021)

STATUS: Active

Medicaid: COVID-19 Telemedicine Updates

STATUS: Active

Medicaid: Telehealth Flexibilities Align with Medicare

STATUS: Active, during PHE

Medicaid: IHS and Tribal 638 Providers Home to Home Telemedicine Services (pg. 5)

STATUS: Active

Medicaid: Remote Patient Monitoring (pg. 8)

STATUS: Active

Office of the Governor: Executive Order 2020-34 (extending telehealth flexibilities in prior EOs)

STATUS: Extended by EO 2021-01.

Office of the Governor: Executive Order (suspends Medicaid telemedicine restrictions)

STATUS: Active, until SD state of emergency ends

Medicaid 1915(c) Waiver: Appendix K – Assistive Daily Living Services

STATUS: Active, Expires 6 months after end of PHE

Medicaid 1915(c) Waiver: Appendix K – Assistive Daily Living Services

STATUS: Active, Addendum expires 6 months after end of PHE

Medicaid 1915(c) Waiver: Appendix K – Home and Community-Based Options and Person-Centered Excellence (HOPE) Waiver

STATUS: Active, Expires 6 months after end of PHE

Medicaid 1915(c) Waiver: Appendix K- Home and Community-Based Options and Person-Centered Excellence (HOPE) Waiver

STATUS: Active, Addendum expires 6 months after  end of PHE

Last updated 01/21/2022

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.”

Telehealth is a method of delivering services, including interactive audio-visual or audio-only technology, in accordance with SDCL chapter 34-52.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 11-12 (Jan. 2022), SD Regulations 67:16:44:01, SD Regulations 67:61:01(45), SD Regulations 67:62:01(35), & Community Health Worker, pg. 9 (Oct. 2021). (Accessed Jan. 2022).

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 Jan. 2022).

Teledentistry

“Teledentistry”, the delivery of dental care while the patient and the dentist are in different locations via synchronous telecommunication technology or the transmission and review of recorded health information collected by another oral health professional and transmitted via asynchronous communication to create a treatment plan.

SOURCE: SD Medicaid Billing and Policy Manual, Teledentistry Services, p. 4, (Oct. 2021), (Accessed Jan. 2022).

Last updated 01/25/2022

Email, Phone & Fax

Telephones, facsimile machines, and electronic mail systems do not meet the definition of an interactive telecommunications system.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 12 (Jan. 2022) (Accessed Jan. 2022).

Audio-Only Behavioral Health Services

Effective August 22, 2021, South Dakota Medicaid covers real time, two-way audio-only behavioral health services delivered by a Substance Use Disorder (SUD) Agency or a Community Mental Health Center (CMHC) when the recipient does not have access to face-to-face audio/visual telemedicine technology.

Effective October 3, 2021, South Dakota Medicaid covers real-time, two-way audio-only behavioral health services delivered by an Independent Mental Health Practitioner (IMHP) when the recipient does not have access to face-to-face audio/visual telemedicine technology.

SUD agencies and CMHCs, and IMHPs must utilize traditional audio/visual telemedicine technology when possible. Audio-only services are not covered when used for the convenience of the provider or recipient. The provider must document in the medical record that the use real time video/audio technology was not possible or was unsuccessful.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4 (Jan. 2022) (Accessed Jan. 2022).

Telephonic Evaluation and Management Services

Audio-only evaluation and management services are covered for established patients if the recipient does not have access to face-to-face audio/visual telemedicine technology. The provider must document in the medical record that the use real time video/audio technology was not possible or was unsuccessful.

The service must be initiated by the patient. The service should include patient history and/or assessment, and some degree of decision making. Telephonic evaluation and management services are only allowed to be provided by a physician, podiatrist, nurse practitioner, physician assistant, or optometrist. The service must be 5 minutes or longer. Services may be provided via telephone or via another device or service that allows real-time audio communication.

Audio-only evaluation and management services are not to be billed if clinical decision-making dictates a need to see the patient for an office visit, including a telemedicine office visit, within 24 hours or at the next available appointment time. In those circumstances, the telephone service is considered a part of the subsequent office visit. If the telephone call follows a billable office visit performed in the past seven calendar days for the same or a related diagnosis, then the telephone services are considered part of the previous office visit and are not separately billable. Telephone services provided by an RN or LPN are not billable. See manual for other conditions and requirements.

CMHCs may provide all covered services via audio-only technology when coverage requirements are met. SUD agencies may only provide covered SUD agency services listed in the Audio-Only Procedure Code table in Appendix via audio-only technology when the coverage requirements are met. Contact the Division of Behavioral Health for questions regarding unlisted codes.

For FQHCs/RHCs and IHS/Tribal 638 Providers, SUD agency services may also be provided via audio-only if the provider is an accredited and enrolled agency. Audio-only behavioral health services are reimbursed at the encounter rate.

Services other than those specifically stated as covered when provided via an audio-only modality are considered non-covered if provided via an audio-only modality and must not be billed to South Dakota Medicaid.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 5 (Jan. 2022), (Accessed Jan. 2022).

Crisis assessment and intervention services are covered which includes an immediate therapeutic response available 24 hours a day 7 days a week that involves direct telephone or face-to-face contact with a recipient exhibiting acute psychiatric symptoms and/or inappropriate behavior that left untreated, presents an immediate threat to the recipient or others.

SOURCE: SD Medicaid Billing and Policy Manual: Community Mental Health Center Services, p. 6 (Dec. 2021), (Accessed Jan. 2022).

Collateral contacts is covered which involves Telephone or face-to-face contact with an individual other than the identified recipient to plan appropriate treatment, assist others so they can respond therapeutically regarding the recipient’s difficulty or illness, or link the recipient, family, or both, to other necessary and therapeutic community support.

SOURCE: SD Medicaid Billing and Policy Manual: Community Mental Health Center Services, p. 6 (Dec. 2021) & Substance Use Disorder Agency Services, p. 4 (Oct. 2021) (Accessed Jan. 2022).

SD Medicaid does not cover physician telephone patient services, online medical evaluation, interprofessional telephone/internet/electronic health record consultations (CPT codes 99441-99443, 99444, 99446- 99449 and 99451-99452).

SOURCE: SD Medicaid Billing and Policy Manual: Physician Services, p. 9 (Oct. 2021), (Accessed Jan. 2022).

Teledentistry

Synchronous teledentistry services may not be provided via email, audio-only, or facsimile transmissions.

SOURCE: SD Medicaid Billing and Policy Manual, Teledentistry Services, p. 3, (Oct. 2021), (Accessed Jan. 2022).

Last updated 01/25/2022

Live Video

POLICY

Services provided via telemedicine are subject to the same service requirements and limitations as in-person services.

These coverage requirements apply for telemedicine services in SD Medicaid:

  • The provider must be properly enrolled;
  • Services must be medically necessary;
  • The recipient must be eligible; and
  • If applicable, the service must be prior authorized.

Providers must bill for services at their usual and customary charge. Providers are reimbursed the lesser of their usual and customary charge or the fee schedule rate.  Reimbursement for distant site telemedicine services is limited to the individual practitioner’s professional fees or the encounter rate if the service qualifies as an FQHC/RHC or IHS/Tribal 638 clinic service. The maximum allowable amount for services provided via telemedicine is the same as services provided in-person.

See Appendix of manual for complete list of CPT codes, but please note that current version of this manual includes services that are only being covered on a temporary basis.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 3 & 11 (Jan. 2022) (Accessed Jan. 2022).


ELIGIBLE SERVICES/SPECIALTIES

See manuals for specific CPT codes in Appendix.  Services not specifically listed as covered in the procedure code table in the Appendix are considered non-covered.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 8, 13-22 (Jan. 2022) (Accessed Jan. 2022).

Community health worker services can be provided via telemedicine.

SOURCE: SD Medicaid Billing and Policy Manual: Community Health Worker, pg. 9-10, (Oct. 2021). (Accessed Jan. 2022).

Speech language pathologist services can be provided via telemedicine for adults, in schools, and for infants ages 0-3.

SOURCE: SD Medicaid Billing and Policy Manual:  Birth to Three Non-School District Providers, p. 3, (Oct. 2021), School Districts, pg. 4, (Oct. 2021), & Therapy Services (Oct 2021). (Accessed Jan. 2022)

Psychotherapy is allowed to be provided via telehealth.

SOURCE: SD Medicaid Billing and Policy Manual: Independent Mental Health Practitioners, pg. 13, (Dec. 2021), (Accessed Jan. 2022).

An encounter for the initial ordering of durable medical equipment may occur through telehealth.

SOURCE: SD Medicaid Billing and Policy Manual: Durable Medical Equipment, Prosthetics, Orthotics and Supplies, pg. 2. Oct. 2021. (Accessed Jan. 2022).

Speech therapy services may be provided via telemedicine after an initial face-to-face contact and once every 90 days thereafter.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4 (Jan. 2022). (Accessed Jan. 2022).

A face-to-face encounter for physician recertification for hospice may occur via telemedicine.

SOURCE: SD Medicaid Billing and Policy Manual: Hospice, p. 2 (Oct. 2021), (Accessed Jan. 2022).

Telemedicine consultations are covered as outpatient hospital services.

SOURCE: SD Medicaid Billing and Policy Manual: Outpatient Hospital Services, p. 2 (Jan. 2022), (Accessed Feb. 2022).

Applied Behavior Analysis

South Dakota Medicaid has added temporary coverage of ABA services provided via telemedicine for recipients and providers at high risk for COVID-19, under quarantine, or social distancing during a declared emergency for COVID-19.

SOURCE: SD Medicaid Billing and Policy Manual: Applied Behavior Analysis, p. 7 (October 2021). (Accessed Feb. 2022).

Therapy Services

South Dakota Medicaid has added temporary coverage of therapy services provided via telemedicine for recipients and providers at a high risk for COVID-19, under quarantine, or social distancing during a declared emergency for COVID-19, only if the recipient and provider have previously met for in-person services.

SOURCE: SD Medicaid Billing and Policy Manual: Therapy Services, p. 8 (October 2021). (Accessed Feb. 2022).

Teledentistry

Services provided via teledentistry must meet the applicable standard of care. When reporting a service completed via teledentistry, providers are certifying the services rendered to the recipient were functionally equivalent to services provided through a face-to-face visit. Services provided via teledentistry must be provided in accordance with the coverage criteria in the dental provider manuals. Synchronistic services must be of sufficient audio and visual fidelity and clarity to be functionally equivalent to a face-to-face encounter.  See manual for limitations and covered CDT codes.

SOURCE: SD Medicaid Billing and Policy Manual, Teledentistry Services, p. 2, (Oct. 2021), & Telemedicine and Telephonic Services Updates Bulletin July 2, 2021, (Accessed Jan. 2022).

Home Health

For the initial order for home health services, a physician or other licensed practitioner must document a face-to-face encounter related to the primary reason the beneficiary requires the services. The encounter may occur through telehealth.

SOURCE: SD Medicaid Billing and Policy Manual: Home Health Agency Services, p. 2-3 (Oct 2021). (Accessed Feb. 2022).


ELIGIBLE PROVIDERS

The following providers can provide services via telemedicine at a distant site:

  • Certified Social Worker (PIP or PIP Candidate)
  • Clinical Nurse Specialist
  • Community Health Worker
  • Community Mental Health Centers (CMHC)
  • Dentists
  • Diabetes Education Programs
  • Dietitians
  • Federally Qualified Health Centers (FQHC)
  • Indian Health Services Clinics
  • Licensed Marriage and Family Therapists
  • Licensed Professional Counselor (MH or working toward MH designation)
  • Nurse Practitioners
  • Nutritionists
  • Physicians
  • Physician Assistants
  • Podiatrists
  • Psychologist
  • Rural Health Clinic (RHC)
  • Speech Language Pathologists
  • Substance Use Disorder Agencies
  • Tribal 638 facilities

* Audiologists, occupational therapists, physical therapists and optometrists are listed as temporarily allowed during COVID-19 PHE in the provider manual, but are not permanent eligible providers.

Unless prohibited by law or regulation the distant site location may be a provider’s home. South Dakota Medicaid does not require the distant site location be listed on their provider enrollment record. All services provided via telemedicine at a distant site must be billed with the GT modifier in the first modifier position to indicate the service was provided via telemedicine.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 1 – 4 (Jan. 2022). (Accessed Jan. 2022).

Speech therapy services may be provided via telemedicine once an initial in-person contact has been completed. An in-person contact must occur every 90 days thereafter. The telemedicine service must be provided by means of “real-time” interactive telecommunications system. The recipient (patient) and provider cannot be in the same community.

SOURCE: SD Medicaid Billing and Policy Manual: Therapy Services, pg. 7,  (Oct. 2021), (Accessed Jan. 2022).

Indian Health Services and Tribal 638 Providers

IHS/Tribal 638s may also provide distant site telemedicine services. The services rendered by the contracted provider are reimbursed through their contract with IHS.

“Encounter,” a face-to-face or telemedicine contact between a health care professional and a Medicaid recipient for the provision of Medicaid or CHIP services through an IHS or Tribal 638 facility within a 24-hour period ending at midnight.

SOURCE: SD Medicaid Billing and Policy Manual:  IHS and Tribal 638 Providers, p. 5 & 12 & 14, (Nov. 2021), (Accessed Jan. 2022).

FQHC/RHCs are eligible to serve as an originating site for telemedicine services and may also provide distant site telemedicine services. An originating site is the physical location of the Medicaid recipient at the time the service is provided. A distant site is the physical location of the practitioner providing the service via telemedicine.

SOURCE: SD Medicaid Billing and Policy Manual:  FQHC and RHC Services, pg. 6, (Oct. 2021)  (Accessed Jan. 2022).


ELIGIBLE SITES

Effective July 1, 2021, South Dakota Medicaid removed the same community restrictions for telemedicine services. Previously if a provider and recipient were both located in the same community, services were not covered via telemedicine unless one of the stated exceptions was met. The decision of whether it is appropriate to deliver the service via telemedicine should be determined by the provider and the recipient.

Originating sites listed in the eligible provider section are eligible to receive a facility fee for each completed telemedicine transaction for a covered distant site telemedicine service. Sites not listed may also serve as an originating site but are not eligible for a facility fee reimbursement. Originating site are not reimbursed for any additional costs associated with equipment, technicians, technology, or personnel utilized in the performance of the telemedicine service. Originating sites must be enrolled with South Dakota Medicaid.

A home can be an originating site but is not eligible for reimbursement of the originating site fee.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 1, 3 & 11 (Jan. 2022). (Accessed Jan. 2022).

FQHC/RHCs are eligible to serve as an originating site for telemedicine services. An originating site is the physical location of the Medicaid recipient at the time the service is provided.

SOURCE: SD Medicaid Billing and Policy Manual:  FQHC and RHC Services, pg. 6, 14, (Oct. 2021)  (Accessed Jan. 2022).

Indian Health Services and Tribal 638 Providers

IHS and Tribal 638 facilities are eligible to serve as an originating site for telemedicine services.

SOURCE: SD Medicaid Billing and Policy Manual:  IHS and Tribal 638 Providers, p. 5, (Nov. 2021), (Accessed Jan. 2022).


GEOGRAPHIC LIMITS

Effective July 1, 2021, South Dakota Medicaid removed the same community restrictions for telemedicine services. Previously if a provider and recipient were both located in the same community, services were not covered via telemedicine unless one of the stated exceptions was met. The decision of whether it is appropriate to deliver the service via telemedicine should be determined by the provider and the recipient.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 3 (Jan. 2022), & Telemedicine and Telephonic Services Updates Bulletin July 2, 2021, (Accessed Jan. 2022).


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
  • Substance use disorder agency
  • Nursing Facilities
  • Schools
Originating site are not reimbursed for any additional costs associated with equipment, technicians, technology, or personnel utilized in the performance of the telemedicine service. A recipient’s home is not eligible for reimbursement of an originating site facility fee. For group services with multiple recipients in the same originating site location, only one originating site fee is billable per physical location of the recipients. For Division of Behavioral Health block grant contract providers, the originating site fee should only be billed to Medicaid if the group includes both Medicaid recipients and individuals ineligible for Medicaid. The originating site fee is not reimbursable for audio-only services and should not be billed for these services. An originating site fee also is not reimbursable if the service could be provided onsite at the originating site, but the service is being provided via telemedicine solely due to patient preference to see a provider that is not located at the originating site.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 2-3; 9, 11. (Jan. 2022). (Accessed Jan. 2022).

Skilled Nursing Facility and Nursing Facility Services

The telemedicine originating site fee is reimbursed at the lesser of the provider’s usual and customary charge and the fee for HCPCS code Q3014 listed on the Physician Services Fee Schedule.  The telemedicine originating site fee must be billed using revenue code 780.

SOURCE: SD Medicaid Billing and Policy Manual: Skilled Nursing Facility and Nursing Facility Services, p. 10, (Oct. 2021), (Accessed Jan. 2022).

Teledentistry

Enrolled dental providers, such as a dental office, FQHC/RHC, or IHS facility, are eligible to receive an originating site facility fee for acting as an originating site if the service being provided from the distant site is a covered teledentistry service. Other sites not listed may also serve as an originating site but are not eligible for an originating site facility fee reimbursement. Asynchronous services are not eligible for an originating site fee. The maximum rate for originating site facility fee is listed on the physician fee schedule under procedure code Q3014. The facility fee is reimbursed on a fee for service basis for eligible encounter-based providers. There is no additional reimbursement for equipment, technicians, technology, or personnel utilized during services provided via teledentistry.  Originating site are not reimbursed for any additional costs associated with equipment, technicians, technology, or personnel utilized in the performance of the teledentistry service.

SOURCE: SD Medicaid Billing and Policy Manual, Teledentistry Services, p. 5 &6, (Oct. 2021), (Accessed Jan. 2022).

FQHC/RHC

A claim for a telemedicine originating site fee should be billed under the FQHC/RHC’s NPI. Payment is limited to the fee schedule amount.

SOURCE: SD Medicaid Billing and Policy Manual: FQHC and RHC Services, p. 10 (Oct 2021). (Accessed Feb. 2022).

Last updated 01/25/2022

Miscellaneous

Originating sites eligible for reimbursement must bill for the service using HCPCS Q3014.

Telemedicine and audio-only services provided at a distant site must be billed with the GT modifier in the first modifier position to indicate the service was provided via telemedicine/audio-only.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 11 (Jan. 2022). (Accessed Jan. 2022).

The initial face-to-face encounter for home health services may occur via telehealth.

SOURCE: SD Medicaid Billing and Policy Manual: Home Health Agency Services, p. 2-3. (Oct. 2021). (Accessed Jan. 2022).

The telemedicine provider manual lists temporary COVID-19 specific policies. Please reference manual for additional information.

See telemedicine provider manual for specific documentation requirements.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, pg. 10 (Jan. 2022), (Accessed Jan. 2022).

See list of recipients in manual that are eligible for medically necessary services covered in accordance with the limitations of the telemedicine chapter.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 1-2 (Jan. 2022) (Accessed Jan. 2022).

See manual for documentation requirements for originating and distant sites.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 10 (Jan. 2022) (Accessed Jan. 2022).

Teledentistry

See manual for documentation, reimbursement and claim requirements.

SOURCE: SD Medicaid Billing and Policy Manual, Teledentistry Services, p. 3-4, (Oct. 2021) (Accessed Jan. 2022).

Last updated 01/25/2022

Out of State Providers

The out-of-state prior authorization requirement does not apply if the recipient is located in South Dakota at the time of the service and the provider is located outside of the State. If the service otherwise requires a prior authorization, the provider is still required to obtain prior authorization prior to providing the service.

The distant site provide does not need an out-of-state prior authorization for services delivered via telemedicine. If the service otherwise requires a prior authorization, the provider is still required to obtain prior authorization prior to providing the service.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4 & 12 (Jan. 2022), & Telemedicine and Telephonic Services Updates Bulletin July 2, 2021, (Accessed Jan. 2022).

Last updated 01/26/2022

Overview

South Dakota Medicaid provides reimbursement for live video services under some circumstances. Reimbursement is not provided for store-and-forward or remote patient monitoring services.

Except for behavioral health services delivered by a Substance Use Disorder Agency, Community Mental Health Center or Independent mental Health Practitioner when the patient does not have access to face-to-face audio/visual telemedicine technology, South Dakota discontinued coverage of telephonic and audio only services that were covered on a temporary basis. The department will be bringing forth an administrative rules package in the coming months that is intended to enable certain services to be provided via telephone or other audio-only modalities on a permanent basis.

Last updated 01/25/2022

Remote Patient Monitoring

POLICY

The Office of Adult Services and Aging defines “telehealth services” as 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 Jan. 2022).

The initial order encounter for home health services may occur through telehealth.

SOURCE: SD Medicaid Billing and Policy Manual: Home Health Services, p. 3 (Oct. 2021). (Accessed Jan. 2022).

SD Medicaid does not cover remote monitoring (CPT codes 99091,99453, 99454, and 99457).

SOURCE: SD Medicaid Billing and Policy Manual: Physician Services, p. 9 (Oct. 2021), (Accessed Jan. 2022).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 01/25/2022

Store and Forward

POLICY

Reimbursement for services provided via teledentistry is the same as reimbursement for services provided at a face-to-face visit. When services are provided via teledentistry, CDT D9995 or D9996 must be reported with the CDT codes for the services provided on the date of service.

“Asynchronous (store and forward)”, transmission of recorded health information (for example, radiographs, photographs, video, digital impressions and photomicrographs of patients) through a secure electronic communications system to a dentist, who uses the information to evaluate a patient’s condition or render a service outside of a real-time or live interaction.

“Teledentistry”, the delivery of dental care while the patient and the dentist are in different locations via synchronous telecommunication technology or the transmission and review of recorded health information collected by another oral health professional and transmitted via asynchronous communication to create a treatment plan.

SOURCE: South Dakota Medicaid Billing and Policy Manual, Teledentistry Services, pg. 4. (Accessed Jan. 2022).


ELIGIBLE SERVICES/SPECIALTIES

Services provided via teledentistry must meet the applicable standard of care. When reporting a service completed via teledentistry, providers are certifying the services rendered to the recipient were functionally equivalent to services provided through a face-to-face visit.

The following coverage limitations apply:

  • Reimbursement is limited to only one reading or interpretation of diagnostic tests such a x-rays, lab tests and diagnostic assessment.
  • Transmission of materials is not separately reimbursable.
  • Only D0140, limited oral exam, is covered for providers that primarily or only see South Dakota Medicaid recipients via teledentistry.

In addition to the applicable CDT code(s), a claim for services provided via teledentistry must include one of the following codes:

  • D9995 – Teledentistry, synchronistic; real-time encounter; and
  • D9996 – Teledentistry, asynchronistic; information stored and forwarded to dentist for subsequent review.

D9995 and D9996 should never be reported alone on a claim form. Services that are not covered when provided via teledentistry must not be reported on the same claim as D9995 or D9996.

See manual for a list of covered services.

SOURCE: South Dakota Medicaid Billing and Policy Manual, Teledentistry Services, pg. 2 & 4. (Accessed Jan. 2022).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 01/25/2022

Definitions

“Telehealth,” the delivery of health care services through the use of HIPAA-compliant interactive audio-video. The term does not include the delivery of health care services through audio-only telephone, electronic mail message, text message, mail service, facsimile transmission, or any combination thereof.

SOURCE: SD Codified Laws Sec. 58-17-167. (Accessed Jan. 2022).

Last updated 01/25/2022

Parity

SERVICE PARITY

A health insurance policy, contract, or plan providing for third-party payment may not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth as long as the services are appropriate to be provided through telehealth. Nothing in §§ 58-17-167 to 58-17-170, inclusive, prohibits a health insurer and a health care professional from entering into a contract for telehealth with terms subject to negotiation.

Health insurers cannot exclude a service for coverage solely because the service is provided through telehealth and not provided through in-person consultation or contact between a health care professional and a patient.

Health insurers are not required to provide coverage for health care services that are not medically necessary.

Health insurers are NOT prohibited from:

  • Establishing criteria that a health care professional must meet to demonstrate the safety and efficacy of delivering a particular health care service via telehealth that the health insurer does not already reimburse other health care professionals for delivering via telehealth so long as the criteria are not unduly burdensome or unreasonable for the particular services;
  • Requiring a health care professional to agree to certain documentation or billing practices designed to protect the health insurer or patients from fraudulent claims so long as the practices are not unduly burdensome or unreasonable for the particular services;
  • Including a deductible, copayment, or coinsurance requirement for a health care service provided via telehealth, if the deductible, copayment, or coinsurance is not in addition to and does not exceed the deductible, copayment, or coinsurance applicable if the same services were provided through in-person contact.

SOURCE: SD Codified Laws Ann. § 58-17-168 &  58-17-169. (Accessed Jan. 2022).


PAYMENT PARITY

No Reference Found

Last updated 01/25/2022

Requirements

Health insurers are prohibited from excluding a service from coverage solely because it was provided through telehealth.  Health care services delivered by telehealth must be appropriate and delivered in accordance with applicable law and generally accepted health care practices and standards prevailing at the time the health care services are provided.

SOURCE: SD Codified Laws Ann. § 58-17-168. (SB – 137). (Accessed Jan. 2022).

Last updated 01/26/2022

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 Jan. 2022).

Any health care professional treating a patient in the state through telehealth shall be fully licensed to practice in the state or employed by a licensed health care facility, an accredited prevention or treatment facility, a community support provider, a nonprofit mental health center, or a licensed child welfare agency and subject to any rule adopted by the applicable South Dakota licensing body.

SOURCE: SD Codified Laws Sec. 34-52-2. (Accessed Jan. 2022).

Last updated 01/26/2022

Definitions

“Telehealth,” the use of secure electronic information, imaging, and communication technologies by a health care professional to deliver health care services to a patient, including interactive audio-video, interactive audio with store and forward, store-and-forward technology, and remote patient monitoring. Telehealth does not include the delivery of health care services through electronic means under the provisions of chapter 27A-10.

SOURCE: SD Codified Laws Sec. 34-52-1  (Accessed Jan. 2022).

“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 Jan. 2022).

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 Codified Laws Ann. § 23A-50-1(6) (Accessed Jan. 2022).

Speech-language Pathology

“Telepractice,” “telespeech,” “telespeech-language pathology,” or “telehealth” is the application of telecommunication technology to delivery speech-language pathology at a distance for assessment, intervention, or consultation.

SOURCE: SD Regulation 20:79:01:01(9) (Accessed Jan. 2022).

Last updated 01/26/2022

Licensure Compacts

Member of Physical Therapy Compact.

SOURCE:  PT Compact.  (Accessed Jan. 2022). 

Member of Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. (Accessed Jan. 2022).

Member of Nurse Licensure Compact.

SOURCE: Nurse Licensure Compact. (Accessed Jan. 2022).

Member of the EMS Compact.

SOURCE: EMS Compact Map. (Accessed Jan. 2022).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 01/26/2022

Miscellaneous

A health care professional or the originating site treating a patient through telehealth shall:

  • Maintain a complete record of the patient’s care;
  • Disclose the record to the patient consistent with state and federal laws; and
  • Follow applicable state and federal statutes and regulations for medical record retention and confidentiality.

SOURCE: SD Codified Laws Sec. 34-52-8. (Accessed Jan. 2022).

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 Jan. 2022).

Mental Health

Reimbursable services are limited to faceto-face and telehealth contacts for the purpose of providing comprehensive mental health treatment pursuant to § 67:62:10:02. (Outpatient)

SOURCE: SD Regulation 67:62:10:03. (Accessed Feb. 2022).

Substance Use Disorder

Telehealth interaction included in the definition for “family counseling,” “group counseling,” and “individual counseling.”

SOURCE: SD Regulation 67:61:01:01. (Accessed Feb. 2022).

Last updated 01/26/2022

Online Prescribing

Executive Order 2021-12 directs SD Department of Health to begin emergency rule-making to prohibit abortion-inducing drugs to be provided via telemedicine. Effective until such time as the State Legislature passes legislation to revise statute.

SOURCE: Office of the Governor Executive Order 2021-12. (Accessed Jan. 2022).

Any health care professional who utilizes telehealth shall ensure that a proper health provider-patient relationship is established and includes:

  • Verifying and authenticating the location and, to the extent reasonable, identifying the requesting patient;
  • Disclosing and validating the health care professional’s identity and applicable credentials, as appropriate;
  • Obtaining appropriate consent for treatment from a requesting patient after disclosure regarding the delivery models and treatment methods or limitations;
  • Establishing a diagnosis through the use of acceptable medical practices, including patient history, mental status examination, physical examination, and appropriate diagnostic and laboratory testing;
  • Discussing with the patient the diagnosis and its evidentiary basis and the risks and benefits of various treatment options;
  • Ensuring appropriate follow-up care for the patient;
  • Providing a visit summary to the patient or consult note; and
  • Utilizing technology sufficient to evaluate or diagnose and appropriately treat a patient for the condition as presented in accordance with the applicable standard of care.

Exceptions to the requirements of this section include on-call, cross coverage situations, and consultation with another health care professional who has an ongoing health care provider relationship with the patient and agrees to supervise the patient’s care and emergency treatment.

SOURCE: SD Codified Laws Sec. 34-52-3  (Accessed Jan. 2022).

A health care professional using telehealth to provide medical care to any patient located in the state shall provide an appropriate face-to-face examination using real-time audio and visual technology prior to diagnosis and treatment of the patient, if a face-to-face encounter would otherwise be required in the provision of the same service not delivered via telehealth.

SOURCE: SD Codified Laws Sec. 34-52-5. (Accessed Jan. 2022).

Without a proper provider-patient relationship, a health care professional using telehealth may not prescribe a controlled drug or substance, as defined by § 34-20B-3, solely in response to an internet questionnaire or consult, including any encounter via telephone.

SOURCE: SD Codified Laws Sec. 34-52-6. (Accessed Jan. 2022).

 

Last updated 01/26/2022

Professional Board Standards

No Reference Found