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SD Medicaid Updates

Care Management Programs This edition of the provider newsletter begins a series of information about South Dakota Medicaid Care Management Programs. South Dakota Medicaid has two care management programs. Both programs establish a medical home for recipients and helps recipients develop a good relationship with their provider.

  •  Primary Care Provider Program (formerly known as Managed Care)- Helps recipients establish a regular place to receive care and a provider to help ensure recipients have received all the required well checks and immunizations.
  •  Health Home Program – Helps recipients who have multiple chronic conditions and or  behavioral health conditions coordinate their care with the goal of improving health and decreasing costs. Providers can learn more about the Home Health Program here.

Next up in this series is information about the caseload lists available for both of the care management programs, the types of caseload lists, where you find them and what you should do with them.

Inflationary Rate Increases

The General Appropriations Act provided a 2.4% rate increase for most Medicaid services. Rate increases for Medicaid providers are effective July 1, 2021 for services provided in FY 2022. The revised fee schedules that reflect these rate increases are available online. Child private duty nursing services, select community mental health center services, and select substance use disorder agency services also received targeted rate increases in addition to the 2.4% inflationary increase.

Money Follows the Person Update 

Money Follows the Person (MFP) helps individuals living in an institutional setting return to their home. MFP was reauthorized by Congress in December 2020 to continue to allow MFP services for 5 additional years. The reauthorization included changing the eligibility requirements for MFP services for individuals in a long-term care facility from 90 residency days to 60 days residency days. To make a MFP referral or for more information about the program please contact the MFP Program Director at Sara.Spisak@state.sd.us.

Tips for Submitting Claims 

The following are quick tips for submitting claims correctly:

  • Patient’s last and first name must be separated by a comma. Long spaces are not accepted.
  •  Locator 50 on a UB-04 claim – only use the 3-digit payer code for the payer name. If the payer name does not match the code provided, South Dakota Medicaid will use the 3-digit payer code.
  • Insured’s ID Number – Box 1a on a CMS 1500 and Box 60 on a UB-04 claim need to be 9 digits long and should consist of numbers only, no letters. The recipient’s ID number can be found on their South Dakota Medicaid ID card.

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