South Dakota Medicaid Billing and Policy Manual — Home Health Agency Services

What this rule requires your agency to do

• 1South Dakota Medicaid must receive a provider's completed claim form within 6 months following the month the service was provided (Reimbursement and Claim Instructions — Timely Filing).(South Dakota Medicaid Billing and Policy Manual — Home Health Agency Services)
• 2All home health services in this manual are subject to Electronic Visit Verification; providers must collect EVV data at the time services are rendered and comply with EVV for no less than 75% of all services requiring EVV (Documentation Requirements — EVV Requirements).(South Dakota Medicaid Billing and Policy Manual — Home Health Agency Services)
• 3A home health agency must maintain a medical record for each recipient documenting that the claimed service was performed and authorized by the attending physician or other licensed practitioner, and records must be retained at least 6 years after the last date a claim was paid or denied (Documentation Requirements).(South Dakota Medicaid Billing and Policy Manual — Home Health Agency Services)
• 4Eligible providers must be recognized as a Medicare certified home health agency for each location enrolled with South Dakota Medicaid (Eligible Providers).(South Dakota Medicaid Billing and Policy Manual — Home Health Agency Services)
• 5A supervisory visit by a registered nurse must be conducted at least once every two weeks with the home health aide present; supervisory visits may not be billed as a home health service (Supervisory Visits).(South Dakota Medicaid Billing and Policy Manual — Home Health Agency Services)
• 6Home health services may be provided no more than once a day and no more frequently than five days a week, absent documented medical necessity for multiple or daily visits (Visit Limits).(South Dakota Medicaid Billing and Policy Manual — Home Health Agency Services)
• 7Before providing services, the agency must have the attending physician or other licensed practitioner's order, and a face-to-face encounter must occur within the 90 days before or 30 days after the start of services in compliance with 42 CFR 440.70 (Initial Order for Services).(South Dakota Medicaid Billing and Policy Manual — Home Health Agency Services)
• 8The home health agency must prepare a plan of care for each Medicaid recipient, based on prescribed services, and the attending physician or other licensed practitioner must review and sign the plan; recertification is required at least every 30 days for medical social work and at least every 60 days for nursing, home health aide, and therapy services (Plan of Care).(South Dakota Medicaid Billing and Policy Manual — Home Health Agency Services)