ARSD Chapter 67:16:05 — Home Health Services (South Dakota Medicaid)

What this rule requires your agency to do

• 1Before beginning services the agency must have the physician or other licensed practitioner's orders prescribing the needed services (67:16:05:05.02).(ARSD Chapter 67:16:05 — Home Health Services (South Dakota Medicaid))
• 2If actual or projected cost of all home health services over three months exceeds 135 percent of institutionalized long-term care cost, the department shall issue notice of intent to discontinue or deny further service (67:16:05:07.02).(ARSD Chapter 67:16:05 — Home Health Services (South Dakota Medicaid))
• 3Supervisory visits when home health aide services are provided must follow 42 C.F.R. § 484.80(h) and may not be billed as a home health service (67:16:05:05.03).(ARSD Chapter 67:16:05 — Home Health Services (South Dakota Medicaid))
• 4Services provided outside South Dakota are covered only if covered under the chapter, the agency has a signed provider agreement with the department, and the agency participates in Medicaid in the state where services are provided (67:16:05:07.03).(ARSD Chapter 67:16:05 — Home Health Services (South Dakota Medicaid))
• 5The agency shall prepare a plan of care for each individual, which the attending physician or other licensed practitioner must review and sign; recertification must be completed at least every 30 days for medical social work and at least every 60 days for nursing, home health aide, and therapy services, and the agency must obtain the recertification (67:16:05:05.02).(ARSD Chapter 67:16:05 — Home Health Services (South Dakota Medicaid))
• 6Home health services must be provided by a qualified home health agency employee, be prescribed by the attending physician or other licensed practitioner and contained in the agency's written plan of care, be provided at the individual's place of residence, and be provided intermittently not more than once a day and no more than five days a week except as specified in 67:16:05:05(4) (67:16:05:05.01).(ARSD Chapter 67:16:05 — Home Health Services (South Dakota Medicaid))
• 7Claims must be submitted at the provider's usual and customary charge with applicable procedure codes, include the number of 15-minute units, and include Medicare/insurance denial or payment evidence where applicable (67:16:05:07.01, 67:16:05:09).(ARSD Chapter 67:16:05 — Home Health Services (South Dakota Medicaid))
• 8The agency must maintain a medical record for each individual documenting that the claimed service was performed and authorized; records must be made available to the department, the Medicaid fraud control unit, or HHS on request and retained for six years (67:16:05:06.01).(ARSD Chapter 67:16:05 — Home Health Services (South Dakota Medicaid))