Best Practices in Medicaid - South Dakota
The Center for Health Transformation is inviting leaders from all 50 states to share their transforming solutions for the Medicaid program. In order that key decision-makers and industry leaders from around the country may learn from others’ successes, it is our intention to provide this interactive resource for showcasing the most innovative practices in the country. Please note that the following contributions have not been edited by CHT staff and will remain open indefinitely to future updates.
View South Dakota's Official Medicaid website >>
Use of health information technology (electronic health records, e-prescribing, electronic billing, etc)
Expanding coverage through private sector initiatives
The adult and children’s dental and orthodontic benefit program is administered through a contractual arrangement whereby the contractor processes all the dental claims and is responsible for program outreach, provider recruitment, and improvement in access to services. The contractor has purchased mobile dental clinics that provide services to the most under-served areas of the state and has developed a loan repayment program to encourage dentists to practice in rural areas and serve the Medicaid population. We have also formed a dental task force with the state’s dental association. The task force includes a variety of dental providers from across the state. The task force’s goal is to increase the scope of services covered, recommend targeted fee increases, and improve access to dental services for the Medicaid population. As a result of targeted fee increases and commitments from dental providers, access to services has recently increased by eight percent.
Efforts to combat fraud and abuse
We added additional staff to the Surveillance and Utilization Review (SUR) unit. Each investigator in the unit generates approximately $500,000 in recoveries of overpayments each year. The unit staff also conducts training for claims processing staff and encourages ongoing communication between the processing unit and the SUR unit. This has resulted in additional referrals of questionable billing practices from the claims processors to the SUR unit.
What changes would you make to the federal Title XIX so that you could provide better services to individuals and families on Medicaid in your state?
Reauthorize the SCHIP program with increased state allotments for states, such as South Dakota, who are already exceeding the current allotments.
What are your future plans?
In conjunction with the state’s Medicaid Pharmaceutical and Therapeutics Committee, South Dakota is developing a disease management program to target adults with asthma. There will be a pilot program involving one or two counties with an initial number of participants numbering approximately 200. The focus of the project will be patient education and monitoring of their adherence to specific asthma interventions – medications, recognition of early symptoms, and health lifestyle choices. The program will have the individual’s primary care provider and pharmacist working in conjunction to evaluate and develop a specific action plan for the Medicaid recipient, through a set schedule of physician and pharmacist consultations. An asthma nurse education will coordinate the program through tracking the patient’s claims data, asthma education, and follow-up.