South Dakota - Adult Health Transportation — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

South Dakota Medicaid covers Non-Emergency Medical Travel (NEMT) and Secure Medical Transportation for recipients attending covered medical appointments and HOPE Waiver services. Secure Medical Transportation is a distinct service category requiring specifically designed and equipped vehicles for recipients who are confined to a wheelchair or require transportation on a stretcher.

Approval to bill for waiver-funded transportation requires completing the Department of Human Services (DHS) Division of Long Term Services and Supports (LTSS) Initial Enrollment process and securing a purchase of services agreement before applying through the Department of Social Services (DSS) Provider Enrollment (PE) Portal.

1. Service Definition and Scope

South Dakota Medicaid distinguishes between general non-emergency transportation and Secure Medical Transportation. The latter is strictly defined by the physical needs of the recipient and the specialized equipment of the vehicle.

Transportation is covered when moving a recipient from their home to a medical provider, between medical providers, or from a medical provider back to the home for Medicaid-covered services.

• Service Categories: Non-Emergency Medical Travel (NEMT) and Secure Medical Transportation.
• Target Population: Medicaid recipients, including HOPE Waiver participants (age 60 and older, or 18 and older with disabilities).
• Wheelchair Confinement Definition: Being unable to walk without the continuous aid of another person or unable to walk in any circumstance.
• Vehicle Requirement: Secure Medical Transportation requires specifically designed and equipped vehicles for wheelchairs or stretchers.
• Non-Covered Services: Cancelled transportation, no-shows, and trips to non-allowable locations are not reimbursable.

2. Regulatory and Oversight Agencies

Oversight for medical transportation in South Dakota is divided between the agency managing the Medicaid state plan and the division managing home and community-based waivers.

The Department of Social Services handles general Medicaid provider enrollment and claims, while the Department of Human Services oversees waiver service contracts and the Therap system.

• South Dakota Department of Social Services (DSS): https://dss.sd.gov
• DSS Medicaid Provider Enrollment: https://dss.sd.gov/medicaid/providers/enrollment/enrollment.aspx
• South Dakota Department of Human Services (DHS): https://dhs.sd.gov
• Division of Long Term Services and Supports (LTSS): Oversees HOPE Waiver provider contracts and enrollment.

3. Gatekeeping Prerequisites: Who Can Even Apply

South Dakota imposes a strict sequencing gate for HCBS waiver transportation providers. Applicants cannot simply submit a Medicaid enrollment application; they must first secure a contract with the state's LTSS division.

Out-of-state providers face an additional prerequisite requiring them to identify a specific, eligible South Dakota resident who needs their services before an application is reviewed.

• LTSS Contract Prerequisite: Providers must receive approval of the LTSS Initial Enrollment process and have a purchase of services agreement in place with DHS LTSS before submitting a Medicaid application.
• Medicaid Application Denial: Submitting an application through the SD Medicaid Provider Enrollment portal without a prior LTSS contract results in automatic denial.
• Out-of-State Provider Gate: Out-of-state providers must submit the first and last name of a current South Dakota resident who is eligible for HOPE Waiver services and needs their services.
• Business Registration: The agency must be a registered business with the South Dakota Secretary of State's office.

4. Licensure and Certification Requirements

South Dakota does not issue a distinct, standalone "NEMT license" through the Department of Health for transportation providers. Instead, approval is based on meeting vehicle standards, maintaining specific insurance coverages, and fulfilling LTSS and Medicaid enrollment criteria.

Providers must submit proof of these operational standards directly to the LTSS Contracts team during the initial enrollment phase.

• Vehicle Standards: Must use specifically designed and equipped vehicles for Secure Medical Transportation (wheelchair/stretcher capabilities).
• Insurance Mandate: Providers must maintain auto liability insurance for personal or company-owned vehicles used for work-related travel.
• Certificate of Insurance: Must be submitted to the LTSS Contracts team prior to contract initiation.
• Tax Documentation: A compliant W-9 must be provided to LTSS to verify tax information before a contract is issued.

5. Medicaid Provider Enrollment

Medicaid enrollment is processed through the DSS Provider Enrollment (PE) Portal, which serves as the system of record for new enrollments and updates.

Access to the portal requires a Billing National Provider Identifier (NPI) and must be managed by internal provider staff rather than external credentialing entities.

• System of Record: The Provider Enrollment (PE) Portal is used to complete new enrollments and check submission status.
• NPI Requirement: Access requires registration and is authorized for Billing NPIs only.
• Required Form: Provider Agreement.
• Required Form: Disclosure form.
• Required Form: Transportation Addendum.
• Financial Documentation: A letter from a financial institution is required to support online payment details for Electronic Funds Transfer (EFT).

6. Staffing, Training and Background Checks

Transportation providers must maintain qualified staff capable of operating specialized vehicles and managing the state's required electronic systems.

Staff must be trained to use the Therap platform for service documentation, billing, and Electronic Visit Verification (EVV) compliance.

• System Access: Staff must be authorized and trained to use Therap for service documentation and EVV.
• Staff Account Management: Providers are responsible for maintaining accurate agency and staff account information within the Therap system.
• Driver Qualifications: Staff must be capable of safely operating specifically designed vehicles for wheelchair and stretcher transports.
• Provider Admin Rights: Initial PE Portal registration grants Provider Admin rights, which must be completed by a provider staff member, not an external credentialing entity.

7. Documentation, Policies and Records

Providers must maintain comprehensive medical and financial records that fully justify the extent of services billed to South Dakota Medicaid.

Specific documentation is required to prove that a recipient attended a medical appointment and met the physical requirements for secure transportation.

• Record Retention: Records must be retained for at least 6 years after the last date a claim was paid or denied.
• Trip Documentation: Providers must keep documentation on file supporting that the recipient was transported to a medical appointment.
• Confinement Documentation: Providers must document that the recipient was confined to a wheelchair or required transportation on a stretcher.
• Recommended Form: South Dakota Medicaid recommends using the department's Transportation Documentation Form to satisfy trip requirements.
• Exceptions Form: Providers requesting coverage for a non-covered service must complete sections one and two of the Transportation Exceptions Form.

8. Billing, Rates and Claims

Billing for LTSS HCBS services is managed through the Therap platform, while general Medicaid claims follow DSS guidelines.

South Dakota Medicaid is the payer of last resort, requiring providers to pursue other liable third-party payers before submitting claims.

• Base Rate Code: A0130 is used for the base rate for non-emergency secure medical transportation.
• Modifier QM: Used only with A0130 for a hospital discharge pick-up when the hospital contacted the provider to arrange the trip.
• Modifier 59: Used to indicate a distinct or separate service, such as multiple trips on the same day.
• Mileage Billing: Allowable loaded mileage must be billed in whole numbers, rounding up or down using standard conventions (no decimals).
• Billing Platform: Therap is the web-based platform used for LTSS billing activities and EVV compliance.
• Third-Party Liability: Providers must use Medicare Crossover or Third-Party Liability billing instructions when applicable.

9. Approval Sequence and Timeline

The approval process for HCBS transportation providers follows a strict sequence, governed by the LTSS HCBS Provider Enrollment Manual effective May 1, 2026.

Providers must complete state business registration and LTSS contracting before interacting with the Medicaid enrollment portal.

• Step 1: Register the business with the South Dakota Secretary of State.
• Step 2: Submit the LTSS HCBS Provider Enrollment Request to DHS LTSS.
• Step 3: Provide certificates of insurance and a W-9 to the LTSS Contracts team.
• Step 4: Execute a purchase of services agreement (contract) with DHS LTSS.
• Step 5: Register for the DSS Provider Enrollment (PE) Portal using a Billing NPI.
• Step 6: Submit the Medicaid provider enrollment application along with the Transportation Addendum.

10. Common Denials and Survey Findings

Applications and claims are frequently denied when providers fail to follow the required sequencing or lack necessary documentation.

Strict adherence to modifier rules and mileage formatting is required to prevent claim rejections.

• Premature Medicaid Application: Applying through the PE Portal before securing an LTSS contract results in automatic application denial.
• Invalid Out-of-State Requests: Out-of-state applications are denied if the identified South Dakota resident is not eligible for HOPE Waiver services.
• Improper Modifier Use: Claims using the QM modifier for outpatient or clinical pick-ups (instead of hospital discharges) will be denied.
• Decimal Mileage: Billing loaded mileage with decimals instead of whole numbers causes claim rejection.
• Missing Confinement Proof: Failure to document that a recipient required a wheelchair or stretcher invalidates Secure Medical Transportation claims.

11. Key Contacts and Resources

Providers must utilize official state portals and directories for enrollment, billing, and receiving participant referrals.

The Dakota at Home Resource Directory serves as the primary public-facing database for approved HCBS providers.

• South Dakota Medicaid Provider Enrollment Portal: https://dss.sd.gov/medicaid/providers/enrollment/enrollment.aspx
• South Dakota Department of Human Services (DHS): https://dhs.sd.gov
• Dakota at Home Resource Directory: Online resource where approved LTSS providers submit a Provider Inclusion Form to receive referrals.
• Therap Services: The required web-based platform for LTSS case management, EVV, and billing.

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