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                                                                                 Center for Connected Health Policy

           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
                                                               an individual across a distance to access health
            Source: SD Regulation 67:40:18.                    assessment, diagnosis, intervention, consultations,
                                                               supervision and information services. The term
                                                               telehealth and telemedicine are used interchangeably by
                                                               South Dakota Medicaid.”

                                                               Source: SD Medical Assistance Program, Professional Svcs.
                                                               Manual, p. 26 (Nov. 2014).
            Live Video Reimbursement

            No reference found.                                South Dakota Medicaid will reimburse for the following
                                                               services at the same rate as in-person services:
            (also see Medicaid column)
                                                                   •   Patient office consultation
                                                                   •   Inpatient hospital consultation
                                                                   •   Pharmacologic management
                                                                   •   Office or other outpatient visit
                                                                   •   Diabetes outpatient self-management education
                                                                       services
                                                               All telemedicine services must comply with South
                                                               Dakota Medicaid’s Out-Of-State Prior Authorization
                                                               Requirements.

                                                               Source (authorization and eligible services): SD Medical
                                                               Assistance Program, Professional Svcs. Manual, p. 27 (Nov.
                                                               2014).

                                                               Source (pharmacological management): SD Administrative Rules
                                                               46:20:32:08.
            Store and Forward Reimbursement

            No reference found.                                South Dakota Medicaid defines telemedicine as
                                                               occurring in “real time”, excluding store and forward


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               applications.

                                                               Source: SD Medical Assistance Program, Professional Svcs.
                                                               Manual, p. 26 (Nov. 2014).
            Remote Patient Monitoring Reimbursement
                                                               Please see “Comments” section below.
            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.
            Email/Phone/FAX

            No reference found.                                No reference found.
            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.  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

                                                               Source: SD Medical Assistance Program, Professional Svcs.
                                                               Manual, p. 26 (Nov. 2014).

            Cross-State Licensing
                                                               No reference found.
            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);


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                                                                                 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.
            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

                                                               Source: SD Medical Assistance Program, Professional Svcs.
                                                               Manual, p. 26 (Nov. 2014).
            Miscellaneous



           COMMENTS:  South Dakota’s Department of Health and Human Services, Adult Services and Aging offers
                        reimbursement for a home based monitoring system that monitors an individual's clinical data daily;
                        such as heart rate, blood pressure, oxygen saturation, temperature, weight and can be a medication
                        reminder depending on the unit available.

                        Telehealth includes equipment rental and the set up and availability of a nurse's time to monitor and
                        provide feedback to the individual, their family, and/or consultation with the individual’s physician and
                        the Adult Services and Aging Specialist.

                        Source: SD Dept. of Social Services, Dept. of Adult Services & Aging, Telehealth Technology <
                        http://dss.sd.gov/asa/services/telehealth.aspx> (Accessed Feb. 2, 2015).






















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