South Dakota Medicaid Billing and Policy Manual — Private Duty Nursing

What this rule requires your agency to do

• 1PDN agencies must submit the Prior Authorization Request Form, Parent/Guardian Attestation Form, medical record documentation, and practitioner-signed plan of care with each prior authorization request; authorizations are limited to a maximum of two months (Prior Authorization Requests).(South Dakota Medicaid Billing and Policy Manual — Private Duty Nursing)
• 2PDN services are covered only for recipients age 20 or younger, with a prescribing physician's written order and a physician-signed plan of care, and the service must be prior authorized by South Dakota Medicaid (Covered Services and Limits — Service Eligibility).(South Dakota Medicaid Billing and Policy Manual — Private Duty Nursing)
• 3All Private Duty Nursing services are subject to EVV requirements; providers must collect EVV data (service type, individual served, date, location, individual providing service, begin and end times) at the time services are rendered (Documentation Requirements — EVV Requirements).(South Dakota Medicaid Billing and Policy Manual — Private Duty Nursing)
• 4PDN services are limited to one nurse or nursing intervention per recipient in the residence at a time, except where all recipients in the residence require intensive nursing interventions with a frequency of every 2 hours or more (Covered Services and Limits — Limitations).(South Dakota Medicaid Billing and Policy Manual — Private Duty Nursing)
• 5The provider must comply with EVV requirements for no less than 75% of all services that require EVV; manually entered EVV or EVV with an exception is not considered compliant (EVV Requirements, provider expectation 1).(South Dakota Medicaid Billing and Policy Manual — Private Duty Nursing)
• 6South 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 — Private Duty Nursing)
• 7All eligible servicing and billing providers' NPIs must be enrolled with South Dakota Medicaid as a Private Duty Nursing agency, and nursing services must be provided by a properly licensed individual acting within their scope of practice under SDCL Title 36 (Eligible Providers).(South Dakota Medicaid Billing and Policy Manual — Private Duty Nursing)
• 8Providers must keep legible medical and financial records retained for at least 6 years after the last date a claim was paid or denied (Documentation Requirements — General Requirements).(South Dakota Medicaid Billing and Policy Manual — Private Duty Nursing)