The South Dakota Department of Social Services (DSS) is updating the quality incentive payment methodology for the health home program. A total of $500,000 in funds for the quality incentive payment were appropriated for in the 2020 state legislative session. The payment methodology continues the small clinic payment with a total payment pool of $75,000. The small clinic payment incentivizes health homes with small caseloads in rural and frontier areas to participate in the program. The clinical outcome payment pool is $425,000. This payment methodology has been updated based on provider and stakeholder group feedback. The updated methodology is calculated based on 10 weighted measures that are regarding improved outcomes, met and exceeded targets, and caseload severity.
DSS has submitted a state plan amendment (SPA) to the Centers for Medicare and Medicaid Services with a May 1 effective date. The SPA amends the health home payment methodology pages, Attachment 3.1-H, pages 11-19, of the South Dakota Medicaid State Plan. The SPA is available on the DSS website.