The South Dakota Department of Social Services has submitted its provider revalidation strategy to the Centers for Medicare and Medicaid Services (CMS).
The plan is in response to a call from CMS to all state Medicaid agencies to address areas of emerging risk for fraud, waste, and abuse and strengthen the array of safeguards used today to protect taxpayer resources. South Dakota’s plan is accelerated and goes beyond CMS requirements.
South Dakota’s plan expands how providers are categorized, with some groups receiving a more thorough review process based on identified risk factors. This would include more frequent renewals and recertifications, along with occasional onsite visits as part of routine oversight.
South Dakota has historically had a strong Payment Error Rate Measurement (PERM), which is used to measure improper payments in Medicaid and CHIP. The latest PERM rate, audited in State Fiscal Year 2024 (SFY24) for claims billed during SFY23, showed a rate of 1.15 percent for CHIP and 0 percent for Medicaid, compared to the national average of 6.1 percent and 5.1 percent.
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