Medical Services

Medicaid State Plan

The South Dakota Medicaid State Plan is a contract between the state of South Dakota and the Federal government describing how South Dakota administers its Medicaid Program. The plan information listed here is for informational purposes only. The official plan is maintained by the South Dakota Department of Social Services.

State Plan Amendment Information

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South Dakota Medicaid State Plan
Table of Contents

1.0 SINGLE STATE AGENCY ORGANIZATION

  • 1.1 Designation of Authority
  • 1.2 Organization for Administration
  • 1.3 Statewide Operations
  • 1.4 State Medical Care Advisory Committee
  • 1.5 Pediatric Immunization Program

2.0 COVERAGE AND ELGIBILITY

  • 2.1 Application, Determination of Eligibility and Furnishing Medicaid
  • 2.2 Coverage and Conditions of Eligibility
  • 2.3 Residence
  • 2.4 Blindness
  • 2.5 Disability
  • 2.6 Financial Eligibility
  • 2.7 Medicaid Furnished Out of State

3.0 SERVICES: GENERAL PROVISIONS

  • 3.1 Amount, Duration, and Scope of Services
  • 3.2 Coordination of Medicaid with Medicare Part B
  • 3.3 Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases
  • 3.4 Special Requirements Applicable to Sterilization Procedures
  • 3.5 Families Receiving Extended Medicaid Benefits

4.0 GENERAL PROGRAM ADMINISTRATION

  • 4.1 Methods of Administration
  • 4.2 Hearings for Applicants and Recipients
  • 4.3 Safeguarding Information on Applicants and Recipients
  • 4.4 Medicaid Quality Control
  • 4.5 Medicaid Agency Fraud Detection and Investigation Program
  • 4.6 Reports
  • 4.7 Maintenance of Records
  • 4.8 Availability of Agency Program Manuals
  • 4.9 Reporting Provider Payments to the Internal Revenue Service
  • 4.10 Free Choice of Providers
  • 4.11 Relations with Standard-Setting and Survey Agencies
  • 4.12 Consultation to Medical Facilities
  • 4.13 Required Provider Agreement
  • 4.14 Utilization Control
  • 4.15 Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases
  • 4.16 Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees
  • 4.17 Liens and Recoveries
  • 4.18 Cost Sharing and Similar Charges
  • 4.19 Payment for Services
  • 4.20 Direct Payments to Certain Recipients for Physicians' or Dentists' Services
  • 4.21 Prohibition Against Reassignment of Provider Claims
  • 4.22 Third Party Liability
  • 4.23 Use of Contracts
  • 4.24 Standards for Payments for Skilled Nursing and Intermediate Care Facility Services
  • 4.25 Program for Licensing Administrators of Nursing Homes
  • 4.26 Drug Utilization Review Program
  • 4.27 Disclosure of Survey Information and Provider or Contractor Evaluation
  • 4.28 Appeals Process
  • 4.29 Conflict of Interest Provisions
  • 4.30 Exclusion of Providers and Suspension of Practitioners Convicted and Other Individuals
  • 4.31 Disclosure of Information by Providers and Fiscal Agents
  • 4.32 Income and Eligibility Verification System
  • 4.33 Medicaid Eligibility Cards for Homeless Individuals
  • 4.34 Systematic Alien Verification for Entitlements
  • 4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that do not Meet Requirements of Participation
  • 4.36 Required Coordination between the Medicaid and WIC Programs
  • 4.37 Prescribed Drugs: Manufacturers' Rebates
  • 4.38 Nurse Aid Training and Competency Evaluations for Nursing Facilities
  • 4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities
  • 4.40 Survey and Certification Process
  • 4.41 Resident Assessment for Nursing Facilities
  • 4.42 False Claim Recoveries
  • 4.43 Medicaid Integrity Program Efforts
  • 4.44 Payments to Providers outside the United States
  • 4.46 Provider Screening and Enrollment

5.0 PERSONNEL ADMINISTRATION

  • 5.1 Standards of Personnel Administration
  • 5.2 RESERVED
  • 5.3 Training Programs; Subprofessional and Volunteer Programs

6.0 FINANCIAL ADMINISTRATION

  • 6.1 Fiscal Policies and Accountability
  • 6.2 Cost Allocation
  • 6.3 State Financial Participation

7.0 GENERAL PROVISIONS

  • 7.1 Plan Amendments
  • 7.2 Nondiscrimination
  • 7.4 State Governor's Review