South Dakota June 2019 Fact Sheet

South Dakota state legislature passed revisions to SB136 to update the state code surrounding payment and coverage for telemedicine services for private payors.  Updated statutes go into effect on January 1, 2020.

Statutes
  • Defines “telehealth” to include HIPAA-compliant, interactive audio-video services.  SB136 elaborates further to include store-and-forward and remote patient monitoring.
    • “Telehealth,” the use of secure electronic information, imaging, and communication technologies by a healthcare professional to deliver health care services to a patient, including interactive audio-video, interactive audio with store-and-forward, store-and-forward technology, and remote patient monitoring. Telehealth does not include the delivery of health care services through an audio-only telephone, electronic mail message, text message, mail service, facsimile transmission, or any combination thereof.”
  • Implements complete telemedicine service parity for services deemed medically necessary and in accordance with South Dakota law.
    • No health insurer may exclude a service for coverage solely because the service is provided through telehealth and not provided through in-person consultation or contact between a health care professional and a patient.”
  • Requires commercial health plans to provide service parity and permits health plans to enter into contracts with telehealth providers.
  • Does not mandate payment parity for telemedicine services.  Meaning the law requires that patients be covered by insurers but doesn’t dictate reimbursement for providers.
  • Originating site is broadly defined, allowing for significant flexibility and interpretation, where the home could be legally acceptable.  Coverage requirements by health insurance companies could, however, allow the exclusion of the home.
  • Specifies these updates for telemedicine are only applicable for whole health insurance policies.

The expansion of telemedicine service parity in South Dakota is significant for increasing patient access throughout the state.  For more information on telemedicine reimbursement, including Medicare and Medicaid, click our South Dakota State Reimbursement Map.