Medicaid Telehealth Reimbursement
Summary
South Dakota Medicaid provides reimbursement for live video at the same rate as in-person services, under some circumstances. Reimbursement is not provided for store-and-forward or remote patient monitoring services.
Definitions
“Telemedicine is the use of an interactive telecommunications system to provide two-way, real-time, interactive communication between a provider and a Medicaid recipient across a distance.”
Live Video
Policy
South Dakota Medicaid will reimburse for limited services at the same rate as in-person services. See manual for complete list of CPT codes.
Eligible Services/Specialties
See manuals for specific CPT codes.
Eligible Providers
No reference found.
Eligible Sites
No reference found.
Geographic Limits
An originating site may not be located in the same community as the distant site, unless the originating site is a nursing facility.
Facility/Transmission Fee
Originating sites are eligible for a facility fee. Click to see list of sites eligible for fee.
Store-and-Forward
Policy
South Dakota Medicaid defines telemedicine as occurring in “real-time”, excluding store-and-forward applications.
Eligible Services/Specialties
No reference found.
Geographic Limits
No reference found.
Transmission Fee
No reference found.
Remote Patient Monitoring
Policy
The Office of Adult Services and Aging defines “telehealth services” as a home-based health monitoring system used to collect and transmit an individual’s clinical data for monitoring and interpretation. However, no further information is provided.
Conditions
No reference found.
Provider Limitations
No reference found.
Other Restrictions
No reference found.
Email/Phone/Fax
No reimbursement for phone. No reimbursement for email. No reimbursement for facsimile.
Consent
No reference found.
Out of State Providers
No reference found.
Miscellaneous
No reference found.
Private Payer Laws
Definitions
No reference found.
Requirements
No reference found.
Parity
No reference found.
Professional Regulation/Health & Safety
Definitions
“Telehealth services” is a home-based health monitoring system used to collect and transmit an individual’s clinical data for monitoring and interpretation.
Consent
No reference found.
Online Prescribing
No reference found.
Cross State Licensing
Click to review criteria for an applicant to be licensed through reciprocity.
Miscellaneous
Office of Adult Service and Aging: In-home services, which is defined as including “telehealth services”, may be provided to an individual who demonstrates a need for long-term supports and services through an assessment. Click to see the criteria.
Source: Center for Connected Health Policy
https://www.cchpca.org