State Advocacy

SDAHO’s number one priority is advocacy, whether it’s at the local, state or federal level. During the year and specifically during the state legislative session, SDAHO continually represents the members to ensure a unified voice is heard regarding legislation that impacts South Dakota health care. It is also our priority to keep our members informed and involved in health care policy in the state. We also maintain a working relationship with the state department of health, the department of social services and department of human services to assist members in compliance with state regulations and facilitate conversations to ensure a members are recognized and heard as leaders within the healthcare continuum.

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SDAHO Advocacy

Legislative Update Podcast

Each week the SDAHO advocacy team will provide a weekly podcast update. Click the yellow button for the most recent podcast. To listen to past podcasts, click here .

State Priorities

The mission of our members and our organization is advancing the health of communities in South Dakota. Our vision is for a healthier South Dakota, where every person reaches their highest potential for health. SDAHO supports policy and efforts to advance the health of our communities across the healthcare continuum.
  • Decrease Infant Mortality: Decrease South Dakota’s infant mortality rate through increased access to timely prenatal care. Ensure adequate reimbursement for prenatal services and coverage for pregnancy interventions.
  • Increase Immunizations: Increase the number of individuals receiving flu shots and timely childhood and adolescent vaccinations to 85% through increased education and partnerships. Promote mass vaccine events like drive-through clinics. Ensure adequate or enhanced reimbursement for vaccine administration in Medicaid and private health insurance.
  • Promote Primary and Preventive Care: Increase the number of children in South Dakota receiving annual well-child visits by 15% through increased education and partnerships. Support enhanced reimbursement for well-child visits in Medicaid and private health insurance. Offer more opportunities for well-child visit scheduling.
  • Smoke-Free South Dakota: Restrict the use of vaping, tobacco, marijuana, and other harmful products in public areas. Educate about the harms of second and third hand smoke and vape. Support access to the South Dakota Quitline and integration of automatic referrals to the South Dakota Quitline in electronic health records across South Dakota.
  • Support Chronic Disease Prevention and Health Promotion: Ensure adequate staffing in the South Dakota Department of Health to address chronic disease and health promotion efforts, including areas like cancer, dementia, diabetes, heart disease and stroke, obesity and oral health.
  • Plan for Long Term Care: Promote statewide and community specific planning efforts for long term care that support aging in place models, home and community-based services, and adequate staffing, reimbursement, and resources to support aging South Dakotans.
Over 30,000 South Dakotans depend on the federal marketplace for coverage and 125,000 South Dakotans access coverage through Medicaid or CHIP. While the passage of Medicaid Expansion has helped thousands of South Dakotans obtain coverage, SDAHO supports access to affordable health care for all South Dakotans by ensuring adequate funding for state healthcare programs.
  • Strengthen State Healthcare Programs: Ensure essential health care services for South Dakota communities by strengthening reimbursement for Medicaid and CHIP across the healthcare continuum.
  • Improve Access to Behavioral Health Services: Support prevention and education related to mental illness and addiction in communities, increase partnerships between behavioral health and primary care, educate healthcare providers across the continuum on recognizing and addressing mental illness and addiction, expand access to professionals in underserved communities through telehealth. Decrease the rate of suicide and drug-related deaths in South Dakota.
  • Make Healthcare Affordable for Hardworking South Dakotans: Promote programs that ensure access to affordable healthcare so South Dakotans can get primary care when and where they need it instead of delaying care at higher costs.  
SDAHO aims to ensure South Dakotans can access health care when and where they need it in rural and frontier communities by strengthening our workforce.
  • Expand state training programs for health care workers: Promote opportunities for essential health care workers to be trained by South Dakota schools and institutions.
  • Fund scholarships and tuition programs to address health professional shortages: Incentivize the best of our healthcare workforce to stay in South Dakota through scholarship and tuition programs targeted towards addressing health professional shortages.
  • Support health professional recruitment programs: Fully fund physician and workforce recruitment programs for small and rural communities. Enhance opportunities for rural communities in Health Professional Shortage Areas to participate in the National Health Service Corp and Nurse Corp Programs.
  • Enhance rural residency programs: Support increases in the number of residency positions in South Dakota through the rural residency program in Pierre. 
  • Support Essential Workers: Ensure essential workers have the right tools to respond to public health crises through adequate reimbursement and robust investment in healthcare infrastructure that modernizes facilities and makes them safer for patients. Promote policies that create a more resilient healthcare workforce and reduce provider burnout.
South Dakota is a leader in telehealth innovation. SDAHO supports expanding telehealth and other health technology utilization by ensuring payment policies that incentivize innovation and ensure parity in payment.
  • Support Innovation in State Healthcare Programs: Fund innovation grants, pilot programs, and evidence-based programs that support improved health outcomes and care integration. Ensure reimbursement for programs recognize provider costs.
  • Invest in broadband and related infrastructure: South Dakota knows telehealth works and provides valuable resources to rural and frontier communities. Invest in health care infrastructure that expands our digital infrastructure and rural broadband while strengthening the capacity and capability for emergency preparedness and response.
  • Support reimbursement for innovative technology: Ensure payment in Medicaid and private health insurance for new or expanded technology that helps monitor chronic conditions to keep patients at home instead of in institutions.
Burdensome regulations for hospitals and health systems divert resources away from patient care. SDAHO supports policies that reduce administrative burdens and allow healthcare providers to focus on what matters most – caring for patients.
  • Patients over Paperwork: Allow providers to spend more time on patient care rather than paperwork. Continue to enhance licensure compacts that make providing care across states more efficient.
  • Advocate for Recovery Audit Contractor (RAC) Exemptions in the Medicaid Program: South Dakota is the only state with a continuous exemption from federal RAC requirements. Continue to request and advocate for this exemption from the Centers for Medicare and Medicaid services.
  • Standardization and Modernization: Safeguard against unnecessary burdens in billing, prior authorization, and other HIPAA standards by advocating for improvements in transmission and technology in state healthcare programs.
  • Reduce Measurement Burden: Advocate for state programs to use a common set of measures that align with federal outcome measures. Ensure measures are evidence based and demonstrate meaningful improvements in patient outcomes.
South Dakota healthcare providers strive to provide quality, safe, and effective care to patients. SDAHO advocates for a focus on measures that matter, so our providers can continue improving health outcomes while reducing the burden of reporting.
  • Focus on Measures that Matter: Continue to streamline and coordinate quality measures in state and federal programs to reduce burden on providers. Ensure patient access to accurate, meaningful quality information by suspending and modifying the faulty hospital star rating system.
  • Prepare for Public Health Emergencies: Ensure hospitals, health care providers, and communities are prepared to deal with public health emergencies including pandemics. Continue to fund appropriations for the Hospital Preparedness Program. Invest in infrastructure improvements and workforce training to ensure adequate resources for future public health emergencies.


Advancing Advocacy

SDAHO works collaboratively throughout the year with members, legislators, state agencies, and other associations to ensure positive outcomes that support our state priorities during the legislative session in Pierre.

  • Medicaid Rate Increases: The legislature appropriated a 5% increase for all Medicaid providers with additional targeted rate increases to take all community-based providers to 100% of methodology, including nursing homes, assisted living, and in-home services. For nursing homes, this meant a 49 million dollar increase and fully funding the new nursing home rate methodology.
  • Blocked Anti-Vaccine Legislation: SDAHO collaborated with other health organizations to protect vaccination requirements in South Dakota from two bills aimed at degrading vaccination requirements for school entry, including one for philosophical beliefs.
  • Long Term Care Summer Study: SDAHO, in partnership with key healthcare legislators, emphasized the need for a summer study focused on the long-term care model in South Dakota. SDAHO staff were able to provide valuable input through focused work groups and to the summer study committee.
  • Blocked Visitation Requirements: SDAHO worked to defeat a bill that would have created new requirements related to visitation policies at healthcare facilities because of federal policies enacted during the pandemic. This could have created issues with healthcare providers being compliant with federal policies in the event of any future public health emergencies.
  • Expansion of Adult Day Services: The legislature passed a House Bill 1078 that appropriated 2 million dollars in one-time funding to provide grants to support the development and expansion of adult day services and programs that serve adults living with dementia, or symptoms in alignment with dementia.
  • 2023 Bill Tracker
  • Legislative Impacts
  • 2022 Forum Presentation
  • Medicaid Rate Increases: When state-lawmakers wrapped up the general session on March 10, they approved a 6% increase for Medicaid reimbursement rates and $10.2 million in one-time general funds for nursing homes. However, as lawmakers returned to Pierre for VETO Day, SDAHO and the Department of Human Services worked with them to utilize a federal match to bring the total to $30 million, equating to a 20.3% ONE-TIME funding increase. The $30 million was used for a temporary increase on the FY22 base rate. The 6% increase to all Medicaid providers was in addition to targeted rate increases to take all community-based providers to 100% of methodology, which took effect July 1, 2022.
  • Medical Marijuana: Medical Cannabis was a hot topic in the 2022 legislative session, with 40 bills regarding Medical Cannabis and 27 that the SDAHO advocacy team followed. SDAHO advocated for bills that allow advance practice professionals to certify patients, strengthen the bona fide patient practitioner relationship, included protections for licensed healthcare workers engaging in medical cannabis to do so without fear of repercussion, and removed language that would have forced physicians to prescribe the number of plants a patient should grow.
  • Workforce Support: SDAHO was a strong advocate during the 2022 legislative session for the expansion of healthcare professional training facilities, including the West River Health Sciences Center, Northern State University’s accelerated nursing program, and Southeast Technical College’s new Healthcare Simulation Center. Additionally, SDAHO advocated for bills that established compact license privileges for Physical Therapists and Physical Therapist Assistants, streamlined the licensure process for optometrists, and allows advanced life support personnel, such as an emergency medical technician, to work with patients in more than just emergency situations.
  • Rural Emergency Hospital Designation: South Dakota was one of the first three states in the nation to add Rural Emergency Hospital as a licensure type. This has made it possible for any eligible South Dakota Hospital to pursue the new Centers for Medicare and Medicaid designation, another option for rural hospitals to consider.
  • Vaccination: SDAHO collaborated with other health organizations to protect vaccination practice in South Dakota from nine anti-vaccine bills, which ranged from issues dealing with COVID vaccinations to allowing medical practice based on conscious.
  • 2022 Bill Tracker
  • Crisis in Care
  • Medicaid FMAP in South Dakota
  • SNF Rate Methodology
  • Post-Acute Care in South Dakota
  • Conscience Protections
  • Blocked Anti-Vaccine Legislation: SDAHO collaborated with other health organizations to protect vaccination in South Dakota from two bills aimed at degrading vaccination requirements for school entry and the workforce.
  • Medicaid Rate Increases: The legislature appropriated a 2.4% increase to all Medicaid providers with additional targeted rate increases to take all community-based providers to 100% of methodology. Skilled Nursing Facilities received a 9.94% increase, assisted living providers received a 9.54% increase, personal care and homemaker aides received a 10.33% increase and nursing received an 18.5% increase.
  • Blocked Conscience Clause Legislation: SDAHO worked to defeat a bill that would have protected medical practitioners, health care institutions, and health care payers from participating in or paying for health care services that violate their conscience. Conscience was too broadly defined and provided no protection for patients or employers to reasonably accommodate a conscience objection.
  • Blocked Anti-Public Health Legislation: SDAHO also worked to defeat two measures that would have restricted the ability for counties and municipalities to respond to public health threats in their communities.
  • COVID-19 Liability Relief: SDAHO collaborated with a broad coalition of legislators and organizations to pass COVID liability relief that protections healthcare facilities and professionals for actions or inactions that occurred due to COVID-19 after January 1, 2020 including the use of pharmaceuticals for an unapproved use, screening, assessing, diagnosing, caring for, or treating persons with COVID-19, as well as delays or cancelling of non-urgent care, and diagnosing or treating patients outside the normal scope of care.
  • Infrastructure Investments: The legislature passed a variety of bills aimed at improving South Dakota’s infrastructure. Two bills targeted telehealth, expanding broadband access across the state while also broadening the definition of telehealth in state statute. The legislature also passed a bill creating a Regional Nursing Facility designation and Medicaid payment methodology to incentivize the construction or significant remodel of skilled nursing facilities to address best practices in aging.
  • 2021 Bill Tracker
  • 2021 Legislative Impacts
  • 2020 Forum Presentation
  • Post-Acute Care in South Dakota
  • House Bill 1154 Legislative Brief: Healthcare Non-Compete Contracts
  • Behavioral Health: As a result of collaborative mental health studies, the legislature updated regulations in mental health to emphasize alternatives to inpatient treatment and ensure efficient and appropriate access to services related to involuntary commitments and to offer additional treatment options across the state through appropriate regional treatment facilities. The legislature also directed the expansion of 211 to provide resource information related to behavioral health and will continue to study the delivery of mental health services in South Dakota in the interim.
  • Telehealth: The legislature updated 2019 telehealth language to improve flexibility and implement prescription safeguards and funded $418,000 to evaluate the use of telehealth for mental health assessments and services in jails and crisis response for law enforcement.
  • Health Promotion and Patient Safety: The legislature revised several state statutes related to improving safety by banning texting and driving and prohibiting the sale of tobacco products to individuals under age 21. Collaborative efforts also defeated legislation that would have rescinded vaccination requirements for school entry.
  • Healthcare Recruitment, Licensure, Training, and Practice: In 2020, the legislature approved almost $1 million in general funds for healthcare provider recruitment assistance programs and passed a Compact for physical therapy to improve access to physical therapy through mutual recognition of multi-state licenses. The legislature also authorized the Board of Regents to construct an Allied Health Facility building at the University of South Dakota, promoting workforce training for South Dakota students. The legislature also authorized the construction and operation of a new 50-bed nursing facility in Moody County on the Flandreau Santee Sioux Reservation.
  • Other 2020 Legislation: South Dakota implemented a 2% inflationary increase to Medicaid rates for all providers effective July 1, 2020. Collaborative efforts also defeated harmful legislation imposing burdensome restrictions on state agencies applying for grants, healthcare providers treating chronic pain, and patient payment of unpaid medical bills.
  • 2020 Bill Tracker
  • 10% Rate Increase for Skilled Nursing Facilities: The legislature approved a 10% increase to Medicaid rates for skilled nursing facilities in 2019, recognizing the needs of nursing facilities that depend on Medicaid reimbursement to provide long term care to aging South Dakotans.  
  • Healthcare Recruitment, Licensure, and Practice: In 2019, the legislature approved almost $1 million in general funds for healthcare provider recruitment assistance programs and made it easier for spouses of military professionals to transfer their healthcare license, certificate, or registration to South Dakota. South Dakota also enacted MOST legislation, allowing medical providers and patients to translate end of life treatment goals and preferences into actional medical orders transportable across all healthcare settings and facilities.
  • Medicaid Innovation Grants: The legislature approved $1 million in innovation grants for primary and prenatal care and $5 million in long term care innovation grants to pilot new ideas over three years and transform healthcare in South Dakota.
  • Telehealth: South Dakota passed two bills providing for utilization and payment of telehealth services in 2019. The bills defined telehealth scope of practice and set out that private health plans may not exclude telehealth services categorically from coverage.
  • Other 2019 Legislation: South Dakota implemented a 2.5% increase to Medicaid rates for all providers effective April 1, 2019, passed a law requiring all sexual assault kits to be tested, and provided an opportunity to construct replacement facilities within a certain distance of a nursing home closure.

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