SD Medicaid Implementation
Implementation
Organizations working to implement Medicaid billing into their CHW/CHR Program should consult the policies and procedures submitted during the Medicaid Enrollment process to ensure that policies and procedures are being followed during the implementation and billing process.
CHW/CHR Care Plan
SD Medicaid requires a provider to draft a care plan before CHW services can take place. The attached draft care plan provides sample content that needs to be included within the provider care plan per the SD Medicaid Billing and Policy Manual. Please note: This content can be built into an EHR workflow and/or can be a “paper” referral document. It is dependent on the CHW program and the location of the referring provider(s) to identify the best practice for care plan delivery.
Please Note: A CHW/CHR Care Plan and Referral does not need to be as detailed as a nursing care plan. Please review the examples below to better understand what is required within a care plan and referral for CHW/CHR services.
Referrals
The above Care Plan templates provide the basic information needed for both the referral and care plan from the primary care provider (PCP). To view the full, detailed summary of referral requirements, view the SD Medicaid Billing and Policy Manual Regarding referrals.
Recipient Eligibility
South Dakota Medicaid allows CHW agencies to look up patient eligibility for Medicaid services. SD Medicaid provides a guide to check recipient eligibility.
Primary Care Provider Search
Organizations working with Medicaid recipients who do not receive a referral and care plan to provide services from a provider will need to seek out a referral and care plan from the recipients’ primary care provider (PCP) before providing CHW services for reimbursement. With the recipient eligibility instructions above, step 5 will display the recipient’s primary care provider and primary care location.
Documentation
The CHW Billing and Policy Manual summarizes the minimum requirements for documentation for CHW services once they are provided. To review the documentation specifics, view the section of the CHW Billing and Policy Manual titled “Documentation Requirements.”
Record Keeping
The General SD Medicaid Documentation and Record Keeping Manual offers comprehensive details concerning the basic requirements for SD Medicaid documentation and also outlines the timeline for maintaining records. This valuable resource equips users with essential guidelines to ensure proper documentation practices and adherence to the necessary record-keeping durations.