South Dakota Telehealth Policy
South Dakota does not currently have an active PHE.
South Dakota is a non-expansion state with full coverage parity.
South Dakota Medicaid pays a facility fee to the following originating sites: Practitioner office, outpatient hospital, CAHs, RHCs, FQHCs, IHS clinics, CMHCs, nursing facilities, schools, substance use disorder agencies
Eligible distant site providers include: Certified Social Worker – PIP, Certified Social Worker – PIP Candidate, Clinical Nurse Specialists, Community Health Worker (CHW), Community Mental Health Centers, Dentists, Diabetes Education Program, Dieticians, FQHCs, Indian Health Services (IHS) Clinics, Licensed Marriage and Family Therapist, Licensed Professional Counselor – MH, Licensed Professional Counselor – working toward MH designation, Nurse Practitioners, Nutritionists, Physicians, Physician Assistants, Podiatrists, Psychologist, RHCs, Speech Language Pathologists, Substance Use Disorder Agencies, Tribal 638 facilities
Medicaid pays FQHCs a PPS rate and does not cover RPM services.
South Dakota participates in the following interstate licensure compacts: Medical, eRN, PT, and EMS
*Effective January 1, 2021 (retroactive)* ORIGINATING SITES: The South Dakota Medicaid State Plan was altered to allow substance use disorder agencies to be reimbursed an originating site fee for acting as a telemedicine originating site.
*Effective July 1, 2021* South Dakota Medicaid has removed the "same community limitation" that previously prohibited previously did not allow telemedicine services to be covered if patient and provider were both located in the same community.
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
E-VISITS: nothing in private payer or Medicaid rules
- PPS rate
- Evaluation & management services (most FQHC services) billed with codes 98966, 98967, 98968 - Reimbursed at fee schedule rate (PPS). Submit using FQHC non-PPS billing NPI.
- Bill for TELEPHONIC eval & management using CPT codes 99201 - 99215 with modifier 52 - Reimbursed at 75% of applicable encounter rate. Cost-sharing applies (bill using PPS NPI).
- Provider must utilize telemedicine tech with REAL TIME VIDEO/AUDIO if recipient has access to such tech (provider otherwise must document that use of real time a/v was unsuccessful or impossible)
OTHER:
HIPAA compliant technology must be used
There are telehealth coverage limitations based on patient’s medicaid coverage
2021 - South Dakota Medicaid has removed the "same community limitation" that previously prohibited telemedicine services from being covered if the patient and provider were both located in the same community
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.”
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.
*Signed by the Governor March 28, 2022* Prohibits medical abortion by telemedicine, to increase the penalty for the unlicensed practice of medicine when performing a medical abortion, and to declare an emergency.
*Signed by the Governor March 9, 2021* Health care providers offering telehealth (which does not include audio-only services) must establish an appropriate patient-provider relationship in the course of telehealth treatment.
*Effective January 1, 2020 (retroactive)* COVID-19 liability protection for health care providers.
Rules governing HEALTH CARE PROFESSIONALS as 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”)
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.”
* 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”)
*Effective January 1, 2020 (retroactive)* COVID-19 liability protection for health care providers.
*Signed by the Governor March 9, 2021* Health care providers offering telehealth (which does not include audio-only services) must establish an appropriate patient-provider relationship in the course of telehealth treatment.
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
* 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”)
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”)
*Signed by the Governor March 9, 2021* Health care providers offering telehealth (which does not include audio-only services) must establish an appropriate patient-provider relationship in the course of telehealth treatment.
*Effective January 1, 2021 (retroactive)* ORIGINATING SITES: The South Dakota Medicaid State Plan was altered to allow substance use disorder agencies to be reimbursed an originating site fee for acting as a telemedicine originating site.*
*Effective January 1, 2020 (retroactive)* COVID-19 liability protection for health care providers.
Delivery of emergency intervention exam by mental health professional can be done via telemedicine
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”)
PARTNER TELEHEALTH RESOURCE CENTERS
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant numbers U1UTH42525 and G01RH32157. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.