MedicaidAdministrativeMedium impact
School Based Medicaid Program Updates
South Dakota Medicaid·SD · Occupational Therapy, Physical Therapy, Speech Therapy·Specialty Services
Effective date
Oct 1, 2025
We identified it
Jun 21, 2026
Summary
South Dakota Medicaid is updating its School-Based Medicaid program to comply with CMS regulations, including removal of non-sampled staff costs, updated RMTS requirements, new quarterly sampling periods, and mandatory annual Cost Settlement for schools submitting Direct Service claims. A new TM modifier will be required for services provided under 504 plans or other non-IEP/non-IFSP plans of care.
Action Required
By October 2025: School-based Medicaid providers must remove non-sampled staff from MAC claims and add TM modifier to Direct Service claims for students with 504 plans or other non-IEP/non-IFSP plans of care. Update billing system to apply TM modifier appropriately. By August 2026: Prepare for new quarterly sampling periods. By October 2026: Implement annual Cost Settlement submission process for any schools billing Direct Services.