Skip to main content

South Dakota

States

Click here to download the COVID-19 Virtual Visit & Reimbursement Guide for South Dakota

Medicaid Policies

TELEHEALTH DEFINITION: “The delivery of health care services through the use of HIPAA-compliant interactive audio-video.” Does not include audio-only, email, text, mail, or fax.

SERVICE PARITY: “No health insurer may 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.” Additionally, insurers “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.”

  • These requirements DO NOT apply to policies that ONLY provide coverage for: Specified disease; Hospital indemnity; Fixed indemnity; Accident-only; Credit accident and health insurance; Vision; Prescription drug; Medicare supplement; Long-term care; Disability income insurance; Coverage issued as a supplement to liability insurance; Workers' compensation or similar insurance; Automobile medical payment insurance; or Individual health benefit plans of six-months or less duration that are not renewable.

REMOTE MONITORING: Not covered outside of public health emergency

ORIGINATING SITES: Practitioner office, outpatient hospital, CAHs, RHCs, FQHCs, IHS clinics, CMHCs, nursing facilities, schools

PROVIDERS AT DISTANT SITES: Certified social workers, clinical nurse specialists, community health workers, community mental health center, diabetes edu program, dietician, FQHC, IHS clinics, marriage & family therapists, professional counselors, NPs, nutritionists, physicians, PAs, podiatrists, psychologist, RHCs, speech language pathologists*, SUD agencies, tribal 638 facilities

* Speech therapy services can be provided via telemedicine AFTER an initial face-to-face visit

FQHCs & RHCs:

  • PROSPECTIVE PAYMENT SYSTEM (PPS) REIMBURSEMENT STRUCTURE
  • Can bill for telephonic evaluation and management services using codes 98966, 98967, 98968 and be reimbursed at the fee schedule rate. Submit using the FQHC/RHCs non-PPS billing NPI.
  • Alternatively, FQHC/RHC and IHS/Tribal 638 providers may bill for evaluation and management services performed telephonically using CPT codes 99201 - 99215 with the modifier 52 appended. Providers will be reimbursed at 75 percent of the applicable encounter rate. Submit using the PPS NPI. Cost-sharing applies. Provider must utilize telemedicine technology with both real time video/audio if the recipient is able to access such technology. The provider must document in the medical record that the use real time video/audio technology was not possible or was unsuccessful.

OTHER SD MEDICAID POLICIES:

  • HIPAA compliant technology must be used
  • There are telehealth coverage limitations based on patient’s medicaid coverage
  • Same community limitation: Originating site and distant site may not be located in the same community UNLESS the originating site is a nursing facility
  • Mental health services:
    • Telemedicine services may be provided for outpatient services, child or youth & family services, comprehensive assistance with recovery and empowerment, or community support services program - individualized mobile programs of assertive community treatment “may be reimbursable as identified on the division's fee schedule.”

Temporary COVID-19 Policies (SD Medicaid)

NEWLY ELIGIBLE SERVICES:

  • Applied Behavior Analysis Services (if the recipient and provider have previously met for in-person services)
  • Remote patient monitoring IF the patient was hospitalized for COVID, is at risk for illness due to being 65+ or in assisted living facility, or is at risk for illness due to underlying condition
  • Teledentistry 
  • Telephonic evaluation/management for patients experiences symptoms of COVID-19

NEWLY ELIGIBLE PROVIDERS AT DISTANT SITES: Audiologist, OTs, optometrists, physical therapists

WAIVED REQUIREMENTS: No penalty for using non-HIPAA compliant technology

OTHER TEMPORARY SD MEDICAID POLICIES:

  • Same community limitation: Originating site and distant site may not be located in the same community UNLESS the originating site is a nursing facility OR telemedicine is being used to reduce risk of exposure to COVID-19
  • Suspends initial face-to-face visit requirement for speech therapy
  • FQHCs and RHCs: 
    • FQHCs, RHCs, and IHS/Tribal 638 providers may provide audio-only Independent Mental Health Practitioner (IMHP) services (and SUD services, if properly accredited) IF the provider or patient is at risk for COVID/under quarantine/social distancing AND the recipient does not have access to face-to-face audio/visual technology
      • Audio-only services are reimbursed at the encounter rate
    • Well child check-ups: bill a check-up delivered via telemedicine with “52” modifier
      • Maximum reimbursement rate is 75% of encounter rate for FQHCs/RHCs and IHS/Tribal 638 providers
    • Telephonic evaluation and management: FQHCs/RHCs/IHS/Tribal 638 providers bill 98966, 98967, 98968
      • Reimbursed at fee schedule rate OR
    • Telephonic evaluation and management: Billed with CPT codes 99201 - 99215 with the modifier 52 appended
      • Reimbursed at 75% of applicable encounter rate
      • Providers must utilize real-time audio/visual technology for evaluation and management services if the patient has access. If not, the provider must document that use of real-time audio/visual technology was not possible or unsuccessful.
    • Remote patient monitoring (for patients at risk of severe illness or hospitalized due to COVID and requiring further monitoring): FQHCs and RHCs can bill on a fee-for-service basis using non-PPS NPI (if service is ordered by one of the allowable practitioner types)


Commercial Payer Policies

TELEHEALTH DEFINITION: “The delivery of health care services through the use of HIPAA-compliant interactive audio-video.” Does not include audio-only, email, text, mail, or fax.

SERVICE PARITY: “No health insurer may 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.” Additionally, insurers “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.”

  • These requirements DO NOT apply to policies that ONLY provide coverage for: Specified disease; Hospital indemnity; Fixed indemnity; Accident-only; Credit accident and health insurance; Vision; Prescription drug; Medicare supplement; Long-term care; Disability income insurance; Coverage issued as a supplement to liability insurance; Workers' compensation or similar insurance; Automobile medical payment insurance; or Individual health benefit plans of six-months or less duration that are not renewable.

Temporary COVID-19 Policies (SD Commercial Payers)

WAIVED REQUIREMENTS: Audio-only telehealth can be used 

OTHER TEMPORARY SD COMMERCIAL PAYER POLICIES:

  • Telehealth may be used before patient-provider relationship has been established
  • Providers can prescribe medication via telehealth


Medical Board Policies

Rules governing HEALTH CARE PROFESSIONALS:

  • Examinations must be face-to-face using real-time audio and visual technology
  • Health care professionals treating patients via telehealth must be fully licensed in South Dakota
  • Telehealth may NOT be utilized in the absence of a pre-established provider-patient relationship
    • This includes obtaining patient consent, establishing a diagnosis, discussing diagnosis with patient, ensuring appropriate follow-up care
    • WITHOUT a provider-patient relationship, a health care professional MAY NOT prescribe a controlled drug or substance (as defined by § 34-20B-3), based on a telephone encounter
    • EXCEPTIONS: on-call, cross coverage situations, and consultation with another health care professional who has an ongoing health care provider relationship with the patient

Practice of medicine or osteopathy in South Dakota while located outside of state: “Any nonresident physician or osteopath who, while located outside this state, provides diagnostic or treatment services through electronic means to a patient located in this state under a contract with a health care provider… is engaged in the practice of medicine or osteopathy in this state.”

Telemedicine abortions are prohibited

South Dakota Professional Licensure Compacts

Interstate Medical Licensure Compact

Temporary COVID-19 Policies (SD Medical Board)

Suspends certain regulatory provisions of ARSD 67:16 (“Covered Medical Services”), 67:61 (“Substance Use Disorders”), and 67:62 (“Mental Health) which limit or restrict the provision of telehealth and which require face-to-face treatment, visits, interviews, and sessions with providers. Many services require face-to-face contact between patients and providers for reimbursement.

Licenses by medical professionals in other states will be fully recognized in SD  both for in-person and remote work

Telehealth may be used before the patient-provider relationship has been established in person

Providers can prescribe certain medications via telehealth (Schedules I through IV drugs, see SDCL 34-52-6)

Audio-only technology can be used for telehealth services

 


Mid-Level Providers

Rules governing HEALTH CARE PROFESSIONALS *

  • Examinations must be face-to-face using real-time audio and visual technology
  • Health care professionals treating patients via telehealth must be fully licensed in South Dakota
  • Telehealth may NOT be utilized in the absence of a pre-established provider-patient relationship
    • This includes obtaining patient consent, establishing a diagnosis, discussing diagnosis with patient, ensuring appropriate follow-up care
    • WITHOUT a provider-patient relationship, a health care professional MAY NOT prescribe a controlled drug or substance (as defined by § 34-20B-3), based on a telephone encounter
    • EXCEPTIONS: on-call, cross coverage situations, and consultation with another health care professional who has an ongoing health care provider relationship with the patient

* HEALTH CARE PROFESSIONALS are defined in § 58-17F-1 (“a physician or other health care practitioner licensed, accredited, or certified to perform specified health services consistent with state law”)

South Dakota Mid-Level Professional Licensure Compacts

Enhanced Nurse Licensure Compact

Temporary COVID-19 Policies (SD Mid-Levels)

Suspends certain regulatory provisions of ARSD 67:16 (“Covered Medical Services”), 67:61 (“Substance Use Disorders”), and 67:62 (“Mental Health) which limit or restrict the provision of telehealth and which require face-to-face treatment, visits, interviews, and sessions with providers. Many services require face-to-face contact between patients and providers for reimbursement.

Licenses by medical professionals in other states will be fully recognized in SD, both for in-person and remote work

Telehealth may be used before the patient-provider relationship has been established in person

Providers can prescribe certain medications via telehealth (Schedules I through IV drugs, see SDCL 34-52-6)

Audio-only technology can be used for telehealth services


Behavioral Health Providers

Delivery of emergency intervention exam by mental health professional can be done via telemedicine

According to the South Dakota Board of Examiners of Psychologists: “Telehealth/telepsychology are not currently addressed in Statues and Rules for the South Dakota Board of Examiners of Psychologists. However, Psychologists could reasonably be considered a “Health Care Professional” pursuant to 34-52-1(1) as defined in 58-17F-1.” This implies that the following rules (seen in the Medical Board and Mid-Levels sections) apply:

Rules governing HEALTH CARE PROFESSIONALS *

  • Examinations must be face-to-face using real-time audio and visual technology
  • Health care professionals treating patients via telehealth must be fully licensed in South Dakota
  • Telehealth may NOT be utilized in the absence of a pre-established provider-patient relationship
    • This includes obtaining patient consent, establishing a diagnosis, discussing diagnosis with patient, ensuring appropriate follow-up care
    • WITHOUT a provider-patient relationship, a health care professional MAY NOT prescribe a controlled drug or substance (as defined by § 34-20B-3), based on a telephone encounter
    • EXCEPTIONS: on-call, cross coverage situations, and consultation with another health care professional who has an ongoing health care provider relationship with the patient

* HEALTH CARE PROFESSIONALS are defined in § 58-17F-1 (“a physician or other health care practitioner licensed, accredited, or certified to perform specified health services consistent with state law”) 

South Dakota Mental Health Professional Licensure Compacts

None

Temporary COVID-19 Policies (SD Mental Health)

Psychologists licensed in Emergency Management Assistance Compact member states are recognized in SD during emergency order

Close