Provider Information

Prior Authorization Request Services and Forms

Body Mass Reduction Procedures

Overview

The Office of Medical Services receives many requests for authorization of procedures for body mass reduction. The number of these requests has continued to escalate in relation to the national obesity epidemic. The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity has slated weight reduction as a primary intervention to optimize health for Americans. In response to this, we ask Primary Care Providers to facilitate the necessary structure & follow-up appointments to assist individuals to actively pursue health maintenance. Primary care case management includes providing direction/information to individuals and assigning priority to measures that will have the greatest impact on their overall health. These primary care evaluation and management services are a requirement prior to surgical intervention.

Applicable Administrative Rules of South Dakota (ARSD)

ARSD 67:16:39:01

1. Primary care case management," the management and treatment of a recipient's medical care by a single primary care provider, including necessary referrals by the primary care provider for specialty care or services;
2. Primary care provider" or "PCP," the physician or facility chosen by the recipient or assigned by the department under the provisions of §§ 67:16:39:05 and 67:16:39:06 to provide primary care case management services; and
3. Primary health care services," the prescribing of or directing the use for any person any drug, medicine, apparatus, or other agency for the cure, relief, or palliation of any ailment or disease of the mind or body or the cure or relief of any wound, fracture, bodily injury, or deformity.

ARSD 67:16:01:24 Application of chapter. The rules in this chapter apply to all enrolled providers and recipients.