SKILLED NURSING SERVICES PROVIDER IN SOUTH DAKOTA

DELIVERING MEDICALLY NECESSARY CARE THROUGH LICENSED NURSING PROFESSIONALS IN HOME AND COMMUNITY SETTINGS

Skilled Nursing Services in South Dakota offer direct medical care to individuals with chronic conditions, complex needs, or disabilities. These services are delivered by licensed Registered Nurses (RNs) or Licensed Practical Nurses (LPNs) and are covered through the State Plan Medicaid Home Health Benefit, as well as the Medically Fragile Waiver, CHOICES Waiver, and Long-Term Services and Supports (LTSS) Waiver. Skilled nursing ensures that individuals can receive ongoing medical oversight and clinical interventions while remaining in their homes or community settings.

1. GOVERNING AGENCIES

Agency: South Dakota Department of Social Services (DSS) – Division of Long-Term Services and Supports (LTSS)

Role: Administers Medicaid State Plan Home Health and LTSS Waiver programs.

Agency: South Dakota Department of Human Services (DHS) – Division of Developmental Disabilities (DDD)

Role: Oversees waiver-based nursing services under the CHOICES Waiver.

Agency: South Dakota Board of Nursing

Role: Licenses RNs and LPNs, enforces nursing practice standards.

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Regulates Medicaid-funded home health and waiver-based nursing services at the federal level.

2. SKILLED NURSING SERVICES OVERVIEW

These are medically necessary services that must be provided by a licensed nurse under the direction of a physician or authorized provider.

Approved providers may deliver:

• Medication Administration (e.g., injections, IV therapy)

• Wound Care and Dressing Changes

• Tube Feedings and Tracheostomy Care

• Chronic Disease Monitoring (e.g., diabetes, seizures, respiratory conditions)

• Vital Signs and Symptom Monitoring

• Care Plan Development and Implementation

• Nursing Documentation and Health Status Reporting

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your agency with the South Dakota Secretary of State

• Obtain EIN and Type 2 NPI

• Apply to become a Medicaid Home Health or waiver-based skilled nursing provider through DSS or DHS-DDD

• Employ or contract licensed RNs and/or LPNs with active South Dakota licensure

• Develop a Skilled Nursing Policy & Procedure Manual

• Maintain malpractice, liability, and workers’ compensation insurance

• Comply with HIPAA and infection control protocols

4. SOUTH DAKOTA PROVIDER ENROLLMENT PROCESS

Step 1: Form your business entity and obtain NPI/EIN

Step 2: Apply through DSS for State Plan Home Health enrollment, or through DHS for CHOICES or LTSS Waiver provider approval

Step 3: Submit nursing staff credentials, supervision plan, and sample documentation

Step 4: Complete provider orientation and readiness review

Step 5: Begin service delivery once authorized and listed as an approved provider

5. REQUIRED DOCUMENTATION

• Articles of Incorporation, EIN, and NPI

• Active nursing licenses for all clinical staff

• Professional and general liability insurance

• Skilled Nursing Policy & Procedure Manual including:

  • Care plan development protocols

  • Medication administration policies and safety checks

  • Infection control, emergency procedures, and supervision plans

  • Daily nursing notes and progress documentation

  • Participant rights, HIPAA protocols, and critical incident reporting

  • Medicaid billing logs and service verification forms

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements: Active South Dakota RN license; oversees plan of care, supervises LPNs, provides complex medical interventions

Role: Licensed Practical Nurse (LPN)

Requirements: Active SD license; may provide services under RN supervision

Role: Nursing Supervisor (if agency-based model)

Requirements: Experienced RN responsible for compliance, case review, and quality assurance

All staff must complete:

• HIPAA and participant confidentiality training

• Skills assessment, CPR certification, and infection control training

• Annual competency reviews and emergency drills

• Documentation, medication safety, and care coordination protocols

7. MEDICAID WAIVER PROGRAMS

Skilled Nursing Services are authorized through:

• Medically Fragile Waiver – For individuals with high medical needs

• CHOICES Waiver – For adults with IDD who require ongoing medical oversight

• Long-Term Services and Supports (LTSS) Waiver – For aging adults needing intermittent nursing care

• State Plan Medicaid Home Health Benefit – Physician-ordered home-based skilled nursing for qualifying beneficiaries

• EPSDT (under 21) – For medically necessary skilled nursing for children

8. TIMELINE TO LAUNCH

Phase: Business Formation & Licensing

Timeline: 1–2 months

Phase: Medicaid Enrollment & Credential Submission

Timeline: 2–3 months

Phase: Staff Hiring, Training & Documentation Prep

Timeline: 1–2 months

Phase: Begin Services

Timeline: Once referrals and service authorizations are approved

9. CONTACT INFORMATION

South Dakota Department of Social Services – LTSS Division

Website: https://dss.sd.gov

South Dakota Department of Human Services – Division of Developmental Disabilities (DDD)

Website: https://dhs.sd.gov

South Dakota Board of Nursing

Website: https://doh.sd.gov/boards/nursing

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — SD SKILLED NURSING PROVIDER

WCG helps licensed clinicians and agency founders establish high-quality, compliant skilled nursing services through streamlined policy, enrollment, and documentation support.

Scope of Work:

• Medicaid enrollment for State Plan and waiver-based nursing

• Skilled Nursing Policy & Procedure Manual development

• Staff credentialing checklists and clinical supervision forms

• Daily nursing note templates and care plan tools

• Billing documentation and compliance audit support

• HIPAA, safety, and infection control training tools

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