South Dakota Health Homes

Program Location: 
Pierre, SD
Payer Type: 

Reported Outcomes


South Dakota's 2703 Health Home State Plan Amendment was approved 11/22/2013. South Dakota is implementing Health Homes to improve health outcomes and experience of care for eligible Medicaid recipients, while also realizing cost savings from better coordinated care for that population.

The work began as a recommendation of the Medicaid Solutions Workgroup.  The Medicaid Solutions Workgroup, convened by Governor Dennis Daugaard during legislative session 2011,  was tasked with identifying ways Medicaid could realize cost savings and better serve recipients.   The Final Report of the Medicaid Solutions Workgroup can be viewed here.

South Dakota has two types of Health Homes -- those led by Primary Care Providers and those led by a Community Mental Health Centers -- to serve Medicaid recipients with complex health care needs resulting in high costs to Medicaid. Individuals who are eligible for these two health homes include:

  1. Medicaid recipients with two or more chronic conditions or recipients with one chronic condition who are at risk for a second chronic condition.
    1. Chronic conditions include: Mental Health Condition, Substance Use Disorder Asthma, COPD, Diabetes, Heart Disease, Hypertension, Obesity, Musculoskeletal and Neck/Back disorders. 
    2. At-risk conditions include: Pre-Diabetes, tobacco use, Cancer, Hypercholesterolemia, Depression, and use of multiple medications (6 or more classes of drugs). 
  2. Recipients who have a Severe Mental Illness or Emotional Disturbance
Payment Model: 

Health Homes are paid on a Per Member Per Month (PMPM) basis for providing the 6 core services.  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.

CMHC Health Homes
Tier 1 – 9.00
Tier 2 – 33.00
Tier 3 – 48.00
Tier 4 – 160.00

PCP Health Homes
Tier 1 – 9.00
Tier 2 – 29.00
Tier 3 – 49.00
Tier 4 – 250.00

Health Home services will be provided by Community Mental Health Centers (CMHC) and Primary Care Providers (PCP).  The agency’s rates were set on July 1, 2015 and are effective for services on or after that date. The state developed fee schedules are the same for both governmental and private providers.

Other Outcomes: 

South Dakota has about 5,800 patients enrolled in the Health Home program with high cost chronic conditions and risk factors. This program resulted in increased primary care visits and reduced emergency department use and inpatient stays, yielding cost avoidance of $7.7 million in CY2017.

Last updated March 2019
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