SPECIALIZED THERAPY SERVICES PROVIDER IN SOUTH DAKOTA

DELIVERING LICENSED THERAPEUTIC INTERVENTIONS TO SUPPORT FUNCTIONAL INDEPENDENCE AND ENHANCED QUALITY OF LIFE

Specialized Therapy Services in South Dakota include clinical interventions provided by licensed professionals such as physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs). These services are covered through the State Plan Medicaid Home Health Benefit, as well as the CHOICES Waiver, Medically Fragile Waiver, and Family Support 360 Waiver. The goal is to help individuals achieve developmental milestones, regain or improve functional skills, and live more independently in their homes and communities.

1. GOVERNING AGENCIES

Agency: South Dakota Department of Social Services (DSS) – Medical Services Division

Role: Administers State Plan Medicaid therapy benefits and reimburses Medicaid-authorized therapy claims.

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

Role: Oversees therapy services authorized under the CHOICES and Family Support 360 Waivers.

Agency: South Dakota Board of Examiners for PT, OT, and SLPs

Role: Licenses and regulates therapy professionals.

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

Role: Enforces federal Medicaid therapy service guidelines and provider compliance.

2. SPECIALIZED THERAPY SERVICES OVERVIEW

These services address medical and developmental needs through direct, goal-driven therapeutic interventions.

Approved providers may offer:

• Physical Therapy (PT): Mobility training, strength, balance, and gait intervention

• Occupational Therapy (OT): Fine motor skills, daily living activities, sensory integration

• Speech-Language Pathology (SLP): Communication skills, feeding therapy, and augmentative communication support

• Therapy Assessments & Plan of Care Development

• Collaboration with Case Managers and Direct Care Providers

• Therapy Documentation, Progress Reporting, and Re-Evaluations

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the South Dakota Secretary of State

• Obtain EIN and Type 2 NPI

• Apply to DSS (for State Plan therapy) or DHS-DDD (for waiver therapy) as an authorized provider

• Employ or contract only licensed PTs, OTs, or SLPs

• Maintain liability, malpractice, and workers’ compensation insurance

• Develop a Specialized Therapy Services Policy & Procedure Manual

4. SOUTH DAKOTA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN/NPI

Step 2: Submit Medicaid enrollment application to DSS or waiver application to DHS-DDD

Step 3: Provide therapy credentials, sample care plans, and documentation templates

Step 4: Complete provider onboarding or readiness review

Step 5: Begin delivering services upon participant authorization

5. REQUIRED DOCUMENTATION

• EIN, NPI, and business registration

• Professional licenses for all therapists (PT, OT, SLP)

• Liability and malpractice insurance

• Specialized Therapy Services Policy & Procedure Manual, including:

  • Intake and assessment procedures

  • Plan of care development and clinical goal setting

  • Progress tracking and discharge criteria

  • Coordination with other providers and family members

  • HIPAA compliance and documentation standards

  • Medicaid billing and session verification forms

6. STAFFING REQUIREMENTS

Role: Licensed Therapist (PT, OT, SLP)

Requirements: Active South Dakota license in appropriate discipline; background check; CPR/First Aid

Role: Therapy Program Coordinator (optional)

Requirements: Supervises therapists, ensures compliance and ISP integration

All staff must complete:

• HIPAA and participant rights training

• Documentation standards and Medicaid billing training

• Clinical continuing education (as required by license)

• Annual evaluations and protocol refreshers

7. MEDICAID WAIVER PROGRAMS

Specialized Therapy Services are covered through:

• CHOICES Waiver – For adults with IDD

• Family Support 360 Waiver – For children and adults with disabilities in family homes

• Medically Fragile Waiver – For individuals with complex health needs

• State Plan Medicaid Home Health Benefit – For medically necessary therapy ordered by a physician

• EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) – For youth under 21 with developmental needs

8. TIMELINE TO LAUNCH

Phase: Business Registration & Licensing

Timeline: 1–2 months

Phase: Medicaid Enrollment & Documentation Submission

Timeline: 2–3 months

Phase: Staff Contracting and Care Plan Templates

Timeline: 30–60 days

Phase: Service Launch

Timeline: Begins after receiving plan authorizations

9. CONTACT INFORMATION

South Dakota Department of Social Services (DSS) – Medical Services Division

Website: https://dss.sd.gov

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

Website: https://dhs.sd.gov

South Dakota Licensing Boards (PT, OT, SLP)

Website: https://doh.sd.gov

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — SD SPECIALIZED THERAPY PROVIDER

WCG supports therapy providers with streamlined enrollment, compliant documentation systems, and best practices for outcome-based, participant-centered therapy delivery.

Scope of Work:

• Medicaid therapy enrollment support (State Plan and Waiver)

• Therapy Services Policy & Procedure Manual development

• Clinical assessment and progress note templates

• Coordination forms for multi-provider teams

• Session verification logs and billing documents

• HIPAA and compliance training resources

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.