South Dakota State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

South Dakota Medicaid

South Dakota
Medicaid Program: South Dakota Medicaid

Medicaid Program Administrator: South Dakota Dept. of Social Services

Regional Telehealth Resource Center:

Great Plains Telehealth Resource and Assistance Center
University of Minnesota/Institute for Health Informatics

330 Diehl Hall
505 Essex Street S.E.
Minneapolis, MN 55455

(888) 239-7092
www.gptrac.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telehealth services” is a home based health monitoring “Telemedicine is the use of an interactive
system used to collect and transmit an individual’s telecommunications system to provide two-way, real-
clinical data for monitoring and interpretation. time, interactive communication between a provider and
Source: SD Regulation 67:40:18. a Medicaid recipient across a distance.”

“Telehealth” is a mode of delivering healthcare services Source: SD Medical Assistance Program, Professional Svcs.
Manual, p. 22 (Aug. 2017), & SD Medicaid Institutional Billing
that utilizes information and communication technologies Manual, p. 26 (Jul. 2017). Accessed Oct. 2017.
to enable the diagnosis, consultation, treatment,
education, care management and self-management of
patients at a distance from heath care providers.
Source: HB 1183 (2017).

Live Video Reimbursement

No reference found. South Dakota Medicaid will reimburse for limited
services at the same rate as in-person services. See
(also see Medicaid column) 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. 23-24 (Aug. 2017) & SD Medicaid Institutional Billing
Manual, p. 27 (Jul. 2017). Accessed Oct. 2017.

Store and Forward Reimbursement

No reference found. South Dakota Medicaid defines telemedicine as
occurring in “real time”, excluding store and forward
applications.
Source: SD Medical Assistance Program, Professional Svcs.
Manual, p. 22 (Aug. 2017). Accessed Oct. 2017.

Remote Patient Monitoring Reimbursement

Office of Adult Service and Aging Please see “Comments” section below.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

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.

Email/Phone/FAX

No reference found. No reimbursement for phone.
No reimbursement for email.
No reimbursement for facsimile.
Source: SD Medical Assistance Program, Professional Svcs.
Manual, p. 22 (Aug. 2017), & SD Medicaid Institutional Billing
Manual, p. 27 (Jul. 2017). Accessed Oct. 2017.

Online Prescribing

No reference found. No reference found.

Consent

No reference found. No reference found.

Location

No reference found. An originating site may not be located in the same
community as the distant site, unless the originating site
is a nursing facility. Originating sites approved for a
facility fee include:
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
Source: SD Medical Assistance Program, Professional Svcs.
Manual, p. 23 (Aug. 2017). Accessed Oct. 2017.

Cross-State Licensing

An applicant who holds a valid medical license issued by No reference found.

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);

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

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.

South Dakota adopted the Federation of State Medical

Board (FSMB)’s model language for an interstate
medical licensure compact.

Source: SD Senate Bill 63 (2015).

Private Payers

No reference found. No reference found.

Site/Transmission Fee

No reference found. Originating sites are eligible for a facility fee.
Originating sites include:
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
Source: SD Medical Assistance Program, Professional Svcs.
Manual, p. 23 (Aug. 2017). Accessed Oct. 2017.

Miscellaneous

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