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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. In order to bill for CHW services to South Dakota Medicaid, an agency 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.

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.

CHW Enrollment Checklist

This document summarizes the step-by-step process an organization must complete to become an enrolled CHW agency through South Dakota Medicaid.

Policies and Procedures Template and Checklist

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. 

Medicaid Fee Schedule

The following link provides the fee schedule for CHW services offered both individually and in a group setting.

Type 2 NPI Enrollment

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 NPI 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.

Provider 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. 

Sample CHW 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.

SD Medicaid 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.