HomeLatest NewsState NewsDSS Proposes Revisions to Traumatic Brain Injury Add-On Payment Criteria

DSS Proposes Revisions to Traumatic Brain Injury Add-On Payment Criteria

​The South Dakota Department of Social Services (DSS) intends to make a change to the South Dakota Medicaid State Plan concerning qualifying criteria for traumatic brain or spinal cord injury add-on payments for individuals residing in a nursing facility. The proposed State Plan Amendment (SPA) allows flexibility for individuals to qualify for this add-on payment in circumstances where completing an acute rehabilitation program is not appropriate. The new criteria is:
Individuals who have had an injury to the skull, brain, or spinal cord. The injury may produce a diminished or altered state of consciousness resulting in impairment in cognitive abilities or physical functioning, as well as behavioral and/or emotional functioning. The individual must have either 1) completed an acute rehabilitation program in another facility and be continuing the rehabilitation plan or, 2) if an individual does not qualify for an acute rehabilitation program, they must have a physiatry consultation documenting the ability and willingness to participate in and benefit from therapy. Documentation must also show that the individual is alert and able to follow simple directions, medically stable, and no longer needing acute level of care. If an individual already resides in a skilled nursing facility and is not able to receive a physiatry consultation (either face to face or virtual), a licensed therapist may also perform the assessment.

The SPA amends page 15 of Attachment 4.19-D. The Department intends to make this SPA effective June 1, 2021. The public comment period will be available until May 26, 2021.

A copy of the SPA is available on the DSS website.

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