Application

• Attachment 1 - Attestation
• Attachment 2 - Core Services Definitions
• Provider Standards

Application Submission

• After completing the application electronically, print it out and submit it with signed Attestation Forms for each designated provider to Health Homes, 700 Governors Dr, Pierre, SD 57501.
• Questions about the application can be emailed to CMforms@state.sd.us or calling 605.773.3495.
• Applications for new Health Homes are due one month prior to the start of the next quarter.  New quarters begin on April 1st, July 1st, October 1st and January 1st.  New applications must be received one month prior to that start date. 
• New Providers in existing Health Homes can be added at any time.

The following forms can be used as described below:

Selection and Change Form – Assist recipients with selecting or changing their health home provider.  The “Choose Your Provider” button above is the preferred method for changing a provider.

Decline to Participate Form – Assist recipients who do not wish to participate or as a provider you have met the requirements of the Disenrollment Processes for no contact or behavior issues.

Manual Tiering Document – Propose a Medicaid recipient for the Health Home Program or propose for review of a higher tier.

CMHC Health Home Referral Form - Assist recipients in receiving care from other providers for CMHCs.

Health Home Referral Form - Assist recipients in receiving care from other providers for Primary Care Providers.

South Dakota Medicaid’s Health Homes are a person-centered system of care focused on transforming care for high cost, high need Medicaid recipients to improve the patient experience, increase preventive and primary care services while improving outcomes for Medicaid recipients and managing costs to South Dakota’s Medicaid program.

December 26, 2024
Type	Tier 1	Tier 2	Tier 3	Tier 4	Total	142 Health Homes serving 146 locations
Community Mental Health Center (CMHC)	12	197	288	78	575
Indian Health Services (IHS)	231	1,274	578	265	2,348
Other	369	3,218	1,536	594	5,717
Total	612	4,689	2,402	937	8,640

CY23 Health Home Data Dashboard

Health Homes will be required to submit data elements to help the Department of Social Services determine if the Health Home model is successful in South Dakota. Health Home data will be shared with Health Homes after it is aggregated into a summary report. Data will also be submitted to the Centers for Medicaid and Medicare Services as required.

Outcome Measure Guidance

• Health Home Outcome Measures
• Person Centered Care Plan Definition
• Outcome Measure Training
• Health Management Associates Outcome Measure Training
  • PowerPoint | Recording

Directions for uploading the data to HMA

Providers will receive claims data for each of their recipients on a monthly basis.  This information can be downloaded from the South Dakota Medicaid - Provider Online Portal.

Historical Results

Results of the Health Home Outcome Measures for 2019-2023

Per Member Per Month (PMPM)

Health Homes are paid on a Per Member Per Month (PMPM) basis for providing the 6 core services. The payment is made on a retrospective basis every quarter for each recipient who is provided a core service during the quarter.  Each recipient is placed in one of 4 Tiers using the Chronic Illness and Disability Payment System (CDPS). Each Tier for each type of Health Home has a different PMPM payment as outlined below. Payments can be found on our Provider Fee Schedule page.

Quality Incentive Payments

DSS has made Quality Incentive Payments based on CY2020 and CY2021 data to the following clinic locations based on the results of their outcomes data.

Clinic Payments CY2020 | CY2021 | CY2022

The methodology used to calculate these payments is summarized in the documents below.

Methodology CY2020 | CY2021 | CY2022

Information about this payment can also be found on Health Home Quality Incentive Payments.

Fee Schedule CY2020 | CY2021 | CY2022

Summary Year	Agenda	Minutes/Summary	Meeting Materials
2022	Agenda	Summary	Health Home Implementation Work Group
2020 - 2021	Agenda	Summary	Health Home Update
2019	Agenda	Summary	Health Home Update
2018	Agenda	Minutes	Health Home Quality Incentive Payment
2017	Agenda	Minutes	Health Home Implementation Work Group Event Notification Medicaid South Dakota HealthLink Packet
2016	Agenda	Minutes	N/A