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South Dakota MedicaidMedicaid · Reimbursement · Claims & Billing · SDHigh impact

SFY27 Reimbursement

Act
by Jun 30, 2026
Effective date
Jul 1, 2026
Identified
Jul 7, 2026

Summary

South Dakota Medicaid is implementing comprehensive reimbursement rate increases effective July 1, 2026, including hospital methodology changes (MS-DRG to APR-DRG), FQHC alternative payment methodology, Care Connect tier rate adjustments, and 1.4% inflationary increases across professional services capped at 100% of Medicare. Billing teams must update fee schedules, verify rate changes for specific procedure codes, and align claims submission to new reimbursement methodologies.

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What to do

by Jun 30, 2026 · 8 steps
01Billing team must download and implement updated fee schedules from https://dss.sd.gov/medicaid/providers/feeschedules/.
02Update billing system to reflect new Care Connect PMPM rates (Tier 1: $35.15, Tier 2: $58.99, Tier 3: $99.54, Tier 4: $166.35).
03Verify all professional service rates have been increased to minimum 96.5% of Medicare or capped at 100% of Medicare using South Dakota non-qualifying APM conversion factor.
04Update transportation service codes (A0100, A0120, A0130, S0209, S0215, T2001, T2005, T2049) with new rates in billing software.
05Update G9151 (prenatal care enhanced payment) rate to $333.30.
06Coordinate with hospital billing if applicable regarding transition from MS-DRG to APR-DRG methodology.
07For FQHCs, confirm alternative cost-based weighted average payment methodology is active in claims processing system.
08Verify all changes are live before July 1, 2026.
If missed: Failure to update rates will result in underpayment or claim denials due to rate mismatches with payer records.

Codes mentioned

G9151A0100A0120A0130S0209S0215T2001T2005T2049

Original notice

SFY27 Reimbursement
dss.sd.gov · Always check the source before changing claims.
View original ↗

Related changes

See all South Dakota Medicaid changes →
Medicaid Reimbursement and Care Management Referral UpdatesMediumEffective Jul 1, 2025 · Claims & BillingSpring Provider NewsletterMediumEffective Apr 1, 2024 · EducationJuly 1 2024 Fee SchedulesHighEffective Jul 1, 2024 · Provider CommunicationBrowse every South Dakota Medicaid change in the policy list

Related policy hubs

South Dakota Medicaid policiesSD policy changesCode G9151Code A0100Code A0120Code A0130Code S0209Code S0215Code T2001Code T2005Code T2049

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