South Dakota Medicaid Billing and Policy Manual — Personal Care Agency Services

What this rule requires your agency to do

• 1All eligible servicing and billing providers' NPIs must be enrolled with South Dakota Medicaid, and personal care agencies must undergo an onsite LTSS review and sign a Purchase of Services Agreement with LTSS (Eligible Providers).(South Dakota Medicaid Billing and Policy Manual — Personal Care Agency Services)
• 2South 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 — Personal Care Agency Services)
• 3A recipient is limited to 500 hours of agency-based personal care services in a plan year (July 1 – June 30); the limit does not apply to recipients age 20 or younger (Hours Limitation).(South Dakota Medicaid Billing and Policy Manual — Personal Care Agency Services)
• 4Personal Care Services must comply with federal Electronic Visit Verification (EVV) requirements (Documentation Requirements — EVV Requirements).(South Dakota Medicaid Billing and Policy Manual — Personal Care Agency Services)
• 5Providers must keep legible medical and financial records that fully justify and disclose the extent of services billed, 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 — Personal Care Agency Services)
• 6Personal care services cannot be provided by a recipient's legally responsible person, including parents of minor children or a spouse (Non-Covered Services).(South Dakota Medicaid Billing and Policy Manual — Personal Care Agency Services)
• 7In order for a recipient to receive personal care services, the recipient must participate in a needs assessment at least once every twelve months (Covered Services and Limits — Needs Assessment).(South Dakota Medicaid Billing and Policy Manual — Personal Care Agency Services)
• 8When a provider determines services to a critical needs recipient must be discontinued, the provider must notify LTSS and provide a written discharge notice at least 30 days before the recipient is discharged (Discontinuance and Denial of Services).(South Dakota Medicaid Billing and Policy Manual — Personal Care Agency Services)