SD Medicaid Reimbursement
SD Medicaid Reimbursement Enrollment
South Dakota is fortunate to be one of a handful of states that have fee-for-service Medicaid reimbursement for CHW services. To bill for CHW services to South Dakota Medicaid, an organization must become a CHW Agency with SD Medicaid. The following documents are shared below to help organizations become a CHW agency.
For questions regarding the CHW agency application process, please contact Ashley Lauing, Policy Strategy Manager, SD Department of Social Services, Division of Medical Services.
All sites interested in seeking Medicaid reimbursement for CHW services should email here to request a recommended orientation of the application process.
Frequently Asked Questions
SD Medicaid General Information
This document summarizes the step-by-step process an organization must complete to become an enrolled CHW agency through South Dakota Medicaid.
Medicaid Fee Schedule
The following link provides the fee schedule for CHW services offered both individually and in a group setting.
Billing and Policy Manual
Medicaid’s Billing and Policy Manual provides a comprehensive overview of CHW reimbursement including scope of work, reimbursement rates, limitations, etc. To access this manual, click the button below, scroll down to Professional Provider Manuals and click Community Health Worker Services.
To enroll as a CHW Agency with South Dakota Medicaid, organizations will need to register for an NPI Type 2 number through the National Plan & Provider Enumeration System. Organizations should apply for this early on in the enrollment process as it can take up to 6 weeks to obtain an NPI number.
Type-2 Enrollment Form
The following form can be used as a draft for organizations to use to ensure the appropriate information is prepared before completing the NPI enrollment online. Please Note: CHW organizations need to enroll to obtain a Type 2 NPI. CHW organizations should use the taxonomy code: 172V00000X.
SD Medicaid Enrollment
SD Medicaid has an online enrollment process for providers/agencies meeting the eligibility criteria who are providing eligible services. Organizations enrolling as a CHW Agency will need to complete provider enrollment as part of the enrollment process.
SD Provider Enrollment Portal User Guide
The South Dakota Medicaid Provider Enrollment Portal (PE Portal) was designed to increase a provider’s ability to self-control who has access to its data. The PE Portal is the entry point for an eligible provider to enroll as a SD Medicaid provider. It is also the entry point and system of record for enrolled providers to update and maintain their enrollment records.
Templates and Supporting Documents
Policies & Procedures
To assist organizations in applying to become a CHW Agency, the CHWSD has worked with SD Medicaid to develop a CHW Policies and Procedures Checklist as well as provide a sample draft of each required policy.
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.
Below are other documents to complete during the application process.
– PROVIDER AGREEMENT
– BANK LETTER
NOTE: Include name of institution, routing number, account number, and account type.
– CHW Addendum
NOTE: For the field requesting Application ID – disregard/leave blank.
– CURRENT 638 CONTRACT (for non-IHS tribal providers)
South Dakota Medicaid will recognize certified CHWs beginning January 1, 2023. This means that CHWs and CHRs will need to become certified if their organization is looking to receive Medicaid reimbursement for services provided. Click below for more information on CHW/CHR certification.