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South Dakota - Assisted Living Facility — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The South Dakota Department of Health (DOH) licenses this service as an Assisted Living Center (ALC), while the Department of Human Services (DHS) Division of Long Term Services and Supports (LTSS) administers the Medicaid funding under the HOPE Waiver. Approval requires an applicant to secure a physical facility, pass rigorous Life Safety Code and health surveys conducted by the DOH, and obtain the state license before submitting an enrollment application to South Dakota Medicaid.

South Dakota does not restrict market entry through a Certificate of Need or closed network procurement for assisted living providers. The structural gate rests entirely on capital readiness: an applicant must fully build or renovate a commercial residential facility to meet ARSD 44:70 standards and pass the DOH initial inspections before any Medicaid provider agreement can be executed.

1. Service Definition and Scope

In South Dakota, an Assisted Living Center is a licensed congregate residential facility that provides housing, personal care, and supervision to individuals who do not require 24-hour skilled nursing care. The service promotes the health, treatment, comfort, safety, and well-being of participants, integrating social and recreational programming with medication assistance.

Under the DHS LTSS Assisted Living Provider Provisions, nursing and skilled therapy services are considered incidental rather than integral to the provision of assisted living services. Facilities may also obtain special optional licensure endorsements to serve residents with specific needs, such as those requiring oxygen or dementia care.

2. Regulatory and Oversight Agencies

The South Dakota Department of Health (DOH) serves as the primary regulatory body, responsible for licensing the physical facility and conducting health and safety surveys. The DOH Office of Health Facilities Licensure & Certification manages the initial and renewal licensing processes.

Medicaid enrollment and billing are managed by the Department of Social Services (DSS), while the Department of Human Services (DHS) Division of Long Term Services and Supports (LTSS) oversees the waiver program rules, participant authorizations, and provider provisions.

3. Gatekeeping Prerequisites: Who Can Even Apply

South Dakota does not require a Certificate of Need (CON) for Assisted Living Centers, nor does it utilize a Facility Need Review, closed network, or moratorium for this service. There are no required affiliations with designated network entities or managed care plans to submit an initial application.

The primary structural precondition is physical and operational readiness. An applicant cannot apply for Medicaid enrollment until the facility is fully constructed or renovated, has passed the DOH Life Safety Code and health surveys, and has been issued an active Assisted Living Center license.

4. Licensure and Certification Requirements

To obtain an Assisted Living Center license, providers must submit an application to the DOH Office of Health Facilities Licensure & Certification. The process involves a comprehensive review of the facility's architectural plans, policies, and procedures to ensure compliance with ARSD 44:70.

Facilities must pass a Life Safety Code survey conducted by the State Fire Marshal or DOH designees, followed by a health survey. Facilities intending to serve specialized populations must apply for and meet the standards for optional licensure endorsements during this phase.

5. Medicaid Provider Enrollment

Once licensed, the facility must enroll as a Medicaid provider through the DSS Provider Enrollment (PE) Portal. The facility must enroll using an Organizational (Type 2) NPI and a Federal Employer Identification Number (FEIN) tied to the legal business name.

South Dakota Medicaid does not charge an application fee for enrollment. Providers must complete their enrollment records and submit all supporting documentation via email within 30 days of starting data capture in the portal, or the application will be rejected.

6. Staffing, Training and Background Checks

Assisted Living Centers must employ a qualified administrator responsible for the daily operation of the facility. Staffing levels must be sufficient to meet the 24-hour scheduled and unscheduled needs of all residents, though 24-hour skilled nursing is not required or covered.

Direct care staff, often Unlicensed Assistive Personnel (UAP), must complete state-approved training and competency evaluations, particularly for medication administration. Background checks are required for all staff with direct resident access.

7. Documentation, Policies and Records

Providers must maintain comprehensive policies and procedures that comply with ARSD 44:70 and the DHS LTSS Provider Provisions. Medicaid rules and regulations supersede all internal Assisted Living policies.

Each resident must have a signed admission agreement and a person-centered care plan developed in coordination with the LTSS Case Management Specialist. Facilities must maintain detailed records of medication administration, incident reports, and daily care provided.

8. Billing, Rates and Claims

Assisted Living Centers bill South Dakota Medicaid for the waiver service component of care, which covers personal care and supervision. Claims are submitted electronically through the Medicaid MMIS using the facility's Type 2 NPI.

Medicaid does not pay for room and board in an Assisted Living Center. Residents are responsible for room and board costs, though some may qualify for subsidies approved by the DSS Division of Economic Assistance.

9. Approval Sequence and Timeline

The approval process begins with entity formation and securing a physical location. The provider then submits the DOH licensure application and architectural plans for review.

Once the facility is ready, DOH conducts the Life Safety and health surveys. Upon passing and receiving the ALC license, the provider registers in the DSS PE Portal, submits the Medicaid enrollment application, and emails supporting documents within the 30-day window.

10. Common Denials and Survey Findings

Licensure delays frequently occur due to Life Safety Code violations found during the initial physical plant inspection, such as improper fire door ratings or inadequate egress pathways. Health survey denials often stem from insufficient medication administration policies or lack of required optional endorsements for the intended population.

On the Medicaid enrollment side, applications are routinely rejected if the provider fails to email the required supporting documentation (Provider Agreement, Disclosure, License) to [email protected] within 30 days of starting the PE Portal data capture.

11. Key Contacts and Resources

Providers should rely on the official South Dakota state websites for the most current regulations, provider manuals, and portal access. The DOH handles all physical licensure questions, while DSS handles billing and enrollment.

The DHS Division of LTSS provides the specific waiver provisions and coordinates participant care. Providers must monitor these sites for updates to ARSD rules and Medicaid bulletins.

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