South Dakota Medicaid Billing and Policy Manual — Assistive Daily Living Services (ADLS) Waiver

What this rule requires your agency to do

• 1Manually entered EVV must be kept to no more than 25% of services provided, with backup documentation of required data elements readily available in the event of a review (Documentation Requirements — ADLS Documentation).(South Dakota Medicaid Billing and Policy Manual — Assistive Daily Living Services (ADLS) Waiver)
• 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 — Assistive Daily Living Services (ADLS) Waiver)
• 3ADLS provider agencies must be enrolled with South Dakota Medicaid and have a current contract with the Department of Human Services, Division of Rehabilitation Services (Eligible Providers).(South Dakota Medicaid Billing and Policy Manual — Assistive Daily Living Services (ADLS) Waiver)
• 4The provider must use EVV to substantiate all claims billed for personal attendant services, designating date of service, time in and out, type of service, participant, and location, and all EVV visits must be signed by the personal attendant (Documentation Requirements — ADLS Documentation).(South Dakota Medicaid Billing and Policy Manual — Assistive Daily Living Services (ADLS) Waiver)
• 5Providers must keep legible medical and financial records retained 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 — Assistive Daily Living Services (ADLS) Waiver)
• 6The provider agency must maintain a written grievance procedure, give a copy to the participant at the time services begin, and assist the participant in submitting a grievance if requested (Eligible Providers).(South Dakota Medicaid Billing and Policy Manual — Assistive Daily Living Services (ADLS) Waiver)
• 7Environmental accessibility adaptations are limited to $4,000 per service plan year, and any exception to exceed the limit must be approved prior to service commencement (Covered Services — Environmental Accessibility Adaptations).(South Dakota Medicaid Billing and Policy Manual — Assistive Daily Living Services (ADLS) Waiver)
• 8In-home nursing must be provided by a nurse holding a current license under SDCL chapter 36-9 and requires a physician order indicating diagnosis, frequency, and duration of services (Covered Services — In-Home Nursing).(South Dakota Medicaid Billing and Policy Manual — Assistive Daily Living Services (ADLS) Waiver)