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South Dakota - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In South Dakota, Adult Companion Services are delivered under the HOPE Waiver, a Title XIX Medicaid program. These services provide non-medical assistance, supervision in place of nursing home care, and socialization to help older adults and individuals with disabilities remain safely in their homes and communities.

The single biggest structural barrier to entry for this service is a strict sequencing gatekeeper: providers cannot simply apply to become a Medicaid provider. A prospective agency must first secure a Purchase of Services Agreement (contract) and pass a Policy and Procedure Review directly through the Department of Human Services (DHS) Division of Long Term Services and Supports (LTSS). Any application submitted to the Medicaid enrollment portal before this LTSS contract is fully executed will be automatically denied.

1. Service Definition and Scope

Adult Companion Services in South Dakota are designed to help individuals living at home or in assisted living complete tasks that allow them to maintain their independence. The service is strictly non-medical and focuses on supervision and socialization.

Because this service is funded through the HOPE Waiver, all participants must be formally assessed by a state case manager to determine eligibility and need before services can be authorized and billed.

2. Regulatory and Oversight Agencies

Oversight of Adult Companion Services in South Dakota is bifurcated between two primary state departments. Programmatic approval, contracting, and quality assurance are handled by the Department of Human Services (DHS).

Meanwhile, the financial and formal enrollment aspects are managed by the Department of Social Services (DSS). Providers must interact with both agencies, but in a strictly mandated order.

3. Gatekeeping Prerequisites: Who Can Even Apply

South Dakota imposes a strict sequencing gatekeeper for HOPE Waiver services. There is no Certificate of Need (CON) required, but there is a mandatory prior-approval and contracting phase that blocks access to the Medicaid enrollment portal.

You must first obtain a DHS LTSS contract. According to the LTSS HCBS Provider Enrollment Manual, failure to complete the LTSS Initial Enrollment process and secure a Purchase of Services Agreement before submitting a DSS Medicaid application will result in immediate denial.

4. Licensure and Certification Requirements

South Dakota does not require a distinct facility or home care license from the South Dakota Department of Health (SDDOH) for Adult Companion services. If a provider only offers Adult Companion services, they bypass SDDOH entirely.

Instead, certification is achieved through the DHS LTSS Initial Enrollment process. Providers must submit their operational policies and proof of insurance directly to the LTSS Contracts team to become certified to operate.

5. Medicaid Provider Enrollment

Once the LTSS contract is secured, providers must enroll through the South Dakota Medicaid Provider Enrollment Portal (PE Portal) managed by DSS. South Dakota operates a Fee-for-Service (FFS) model for this waiver.

Because the state uses a traditional FFS delivery system for the HOPE Waiver, no separate Managed Care Organization (MCO) credentialing or contracting is required for Adult Companion services.

6. Staffing, Training and Background Checks

While SDDOH does not license the agency, DHS LTSS requires agencies to ensure all direct care workers meet baseline safety and competency standards before they interact with vulnerable adults.

Agencies are responsible for maintaining personnel files that prove all background checks and training requirements were completed prior to the first date of service.

7. Documentation, Policies and Records

Providers must pass an LTSS Policy and Procedure Review during initial enrollment and maintain strict records for ongoing compliance. Recordkeeping must align with the approved policies.

DHS LTSS conducts routine audits to ensure that the services billed match the non-medical supervision and socialization documented in the client's daily logs.

8. Billing, Rates and Claims

South Dakota Medicaid utilizes a traditional Fee-for-Service (FFS) system for the HOPE Waiver. Claims are submitted directly to the DSS Medicaid Management Information System (MMIS).

Providers cannot bill for services unless they have been explicitly authorized by a Dakota at Home case manager and included in the participant's approved care plan.

9. Approval Sequence and Timeline

The dual-agency process means providers must sequence their applications perfectly. Applying to DSS before DHS LTSS finishes contracting is the most common critical error.

The entire process from initial business registration to active Medicaid billing status requires sequential approvals, with the final DSS portal stage taking over a month on its own.

10. Common Denials and Survey Findings

Most initial application failures stem from sequencing errors between DHS and DSS. Ongoing compliance issues usually relate to the annual QA review conducted by LTSS.

Providers frequently face corrective action if they fail to maintain the specific insurance coverages required by their LTSS contract or if staff files lack completed background checks.

11. Key Contacts and Resources

Use these official state resources to initiate the enrollment process, submit required documentation, and contact program administrators for technical assistance.

For questions regarding the initial contract, contact DHS LTSS. For questions regarding the final portal application or claims, contact DSS Provider Enrollment.

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