Medicaid DSH Program Specialist

Activities include but are not limited to: Assess recent court decisions and changes/clarifications of federal policy and the potential impact to South Dakota Medicaid. Assess appropriateness of resubmissions for State Plan as necessary. Evaluate and recommend improvements to current administration of South Dakota Medicaid’s DSH supplemental payments, including potential changes to the size and scope of the program. Assist with DSH program audits. Collection of the necessary information and documents from qualified and eligible providers required to calculate DSH payments. Calculation of DSH rates and payments. Draft a DSH Payment Schedule for the upcoming State Fiscal Year. Develop and provide education to participating hospitals on DSH requirements, data, sources, and survey tools. Identify the necessary artifacts, information, and documentation necessary to calculate DSH payments according to federal and State rules and regulations. Provide the State with proposed communication to eligible hospitals regarding the proposed methodology, data collection process, and deadlines for hospitals to submit data for the DSH payment calculation. The State must approve all communication prior to outreach to hospitals. Gather necessary data applicable to the year under review from eligible hospitals, DSS, and other sources. Review data for reasonableness and accuracy. Resolve any discrepancies in data with hospitals and DSS. Calculate the DSH payment model for the year under review and review and discuss the draft payment model with DSS. Perform any modification to the payment model calculation requested by DSS. Provide DSS with final payment model calculations in the manner specified by DSS. Proposals to Work Orders will be reviewed for ability to meet the State needs and there is no guarantee of award. Develop and provide education to DSH eligible hospitals on DSH requirements, data sources, and survey tools, as well as best practices for hospitals related to documentation of DSH eligibility. Ensure overall project quality in adherence to proven standards and methodologies. Ensure the work activities are completed on time. Required At least 3 years of experience working with DSH rules, regulations and related issues. Experience working with Medicaid Data At least 3 years of experience in working with Medicaid rules, regulations and related issues. Understanding of the requirements and work to be performed. Responses must detail how both the core and optional requirements will be met.