Healthcare (Medicaid)

SB 211 prohibits ambulance providers from billing patients for out-of-network emergency services beyond required coinsurance, copayments, or deductibles. It requires health insurance plans to reimburse out-of-network ambulance providers at local rates (or 325% of Medicare rates if no local rate exists) within 30 days, and mandates clear billing explanations for patients. The law also establishes a complaint process through the Division of Insurance for violations and requires the division to post reimbursement rates online by 2027. It excludes self-funded employer plans, Medicaid, Medicare, and other federally regulated programs from these rules.

HB 1292 limits South Dakota health insurance companies' ability to take back payments they've already made for medical services. It requires insurers to provide written notice at least 30 days in advance if they seek to recoup a payment, and restricts such actions to claims paid within the previous 18 months (with exceptions for fraud, Medicare/Medicaid, workers' compensation, or duplicate payments). The bill establishes a dispute resolution process through the Division of Insurance for disagreements, preventing insurers from withholding future payments during the review. This directly affects healthcare providers (like doctors and clinics) who receive payments from insurers and the insurers themselves, applying to claims for services provided on or after July 1, 2026.

HB 1250 updates the list of community-based providers eligible for state-funded services, including Medicaid and other state programs. It adds a provision allowing the secretaries of the Department of Social Services or Human Services to approve new provider types beyond the current list (such as nursing homes, mental health centers, and federally qualified health centers). This change directly affects organizations providing care services that rely on state funding for operations. The key mechanism streamlines eligibility adjustments without requiring new legislation for each new provider type.

This bill creates a taskforce to study how South Dakota could establish Medicaid managed care entities specifically serving tribal communities, as defined under federal law. The taskforce includes representatives from all federally recognized South Dakota tribes, state health and social services agencies, healthcare providers, insurance companies, and tribal relations officials. It must gather input from stakeholders and submit findings and potential legislation to the Governor by December 2028. The bill does not implement new programs but sets a process for evaluating this option.

South Dakota's SB 87 ensures counties cover the full cost of forensic medical examinations for victims of sexual assault or rape, eliminating out-of-pocket expenses for victims. The bill specifies covered costs include physician services, necessary tests (like STD screenings and pregnancy tests), supplies, and medications, with payments capped at Medicaid rates. It allows minors aged 16+ to consent to exams without parental permission and permits exams for protected persons without guardian consent, provided informed consent is obtained. Hospitals and clinics cannot bill victims beyond these Medicaid-based limits, and must notify victims of their no-cost access regardless of cooperation with law enforcement.

SB 104 requires South Dakota's Medicaid program to reimburse licensed therapists for equine-assisted therapy. The bill mandates reimbursement for physical therapists, occupational therapists, or speech-language pathologists who provide therapy using horse-human interactions to help patients meet treatment goals. This applies to Medicaid recipients and requires the state to submit a federal plan amendment by August 1, 2026, to implement the coverage. The law specifically defines "therapy using equine movement" as therapeutic activities leveraging horse interactions to achieve clinical objectives.