South Dakota - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

South Dakota does not issue a distinct state license for Home Health Agencies; instead, the Department of Social Services (DSS) requires agencies to obtain federal Medicare certification through the Department of Health (DOH) Office of Health Facilities Licensure and Certification before enrolling as a Medicaid provider. Home health services deliver intermittent skilled nursing, physical therapy, occupational therapy, speech-language pathology, and home health aide support under a physician-ordered plan of care to Medicaid recipients in their places of residence.

Because state licensure is absent, the structural gate to entry is achieving Medicare certification via a successful initial survey by the state DOH or a CMS-approved accrediting organization. Once certified and issued a CMS Certification Number (CCN), agencies submit an organizational (Type 2) NPI enrollment through the SD Medicaid Provider Enrollment (PE) Portal to bill for services.

1. Service Definition and Scope

South Dakota Medicaid covers home health services for eligible recipients when ordered by a physician and provided on a part-time or intermittent basis. Services must be medically necessary and documented in a written plan of care that is reviewed and updated at least every 60 days.

The scope of services is designed to treat the patient's medical condition in their home, preventing institutionalization when possible.

• Skilled Nursing: Intermittent nursing care provided by a registered nurse (RN) or a licensed practical nurse (LPN) under RN supervision.
• Therapy Services: Physical therapy, occupational therapy, and speech-language pathology services provided by licensed professionals.
• Home Health Aide: Personal care and basic health-related tasks supervised by an RN or appropriate therapist.
• Medical Supplies: Routine medical supplies are generally included in the visit rate; specialized items are billed separately under Durable Medical Equipment (DME).
• Place of Service: Services must be delivered in the recipient's primary residence, excluding hospitals or nursing facilities.

2. Regulatory and Oversight Agencies

Oversight of home health agencies in South Dakota is split between the agency managing Medicare certification surveys and the agency administering the Medicaid program.

Providers must interact with both departments to achieve full operational and billing status.

• South Dakota Department of Health (DOH): Conducts Medicare certification surveys and oversees public health. https://doh.sd.gov/
• DOH Office of Health Facilities Licensure and Certification: Manages the federal survey process for unaccredited agencies. https://doh.sd.gov/providers/health-facility-licensure/
• South Dakota Department of Social Services (DSS): Administers the state Medicaid program. https://dss.sd.gov/
• DSS Division of Medical Services: Oversees Medicaid provider enrollment, policy, and claims processing. https://dss.sd.gov/medicaid/

3. Gatekeeping Prerequisites: Who Can Even Apply

South Dakota does not have a Certificate of Need (CON) program or a state-level facility need review for home health agencies. The absolute prerequisite to Medicaid enrollment is obtaining federal Medicare certification.

Because the state does not issue a home health license, an agency cannot legally operate and bill Medicaid without first clearing the federal certification pathway.

• State Licensure Exemption: South Dakota explicitly does not require or issue a state license for home health agencies.
• Medicare Certification: Agencies must hold a valid CMS Certification Number (CCN) under Title XVIII to enroll in SD Medicaid.
• Initial Survey: Must pass a federal initial certification survey conducted by SD DOH or a deemed accrediting organization (such as CHAP, ACHC, or TJC).
• Organizational NPI: Must possess a Type 2 NPI and a Federal Employer Identification Number (FEIN) tied to the legal business name.
• No CON Requirement: South Dakota does not require a Certificate of Need to establish a new home health agency.

4. Licensure and Certification Requirements

Since there is no state license, providers must strictly follow the federal Conditions of Participation (CoPs) for Home Health Agencies outlined in 42 CFR Part 484.

Agencies must demonstrate compliance with these federal standards during their initial survey and maintain compliance for ongoing certification.

• CMS Form 855A: Must be submitted to the designated Medicare Administrative Contractor (MAC) to initiate the certification process and undergo screening.
• OASIS Transmission: Agencies must demonstrate the technical ability to transmit Outcome and Assessment Information Set (OASIS) data to the state system.
• Administrator Qualifications: Must employ a qualified administrator who is a licensed physician, RN, or holds an undergraduate degree with experience in health service administration.
• Clinical Manager: Must designate a qualified clinical manager (RN) to oversee all patient care services and personnel.
• Emergency Preparedness: Must develop and maintain a comprehensive emergency preparedness program that complies with federal CoPs.

5. Medicaid Provider Enrollment

Enrollment is processed entirely online through the SD Medicaid Provider Enrollment (PE) Portal. No application fee is charged by SD Medicaid for this process.

Providers must complete the online data entry and email supporting documentation within a strict 30-day window to avoid rejection.

• PE Portal: The mandatory online system for all new enrollments and updates. https://app-dss-sw85pc05dmsproviderenroll.azurewebsites.net/Account/Login
• Taxonomy Code: Agencies must enroll using the appropriate Home Health Agency taxonomy code (251E00000X).
• Required Documentation: Must email the Provider Agreement, Disclosure form, and proof of Medicare certification to [email protected].
• Electronic Funds Transfer: Requires a letter from a financial institution to support online payment details, as all payments are made via EFT.
• Timely Completion: Enrollment records and emailed documentation must be completed and received within 30 days of starting data capture in the portal.

6. Staffing, Training and Background Checks

Staffing standards default to federal Medicare CoPs and South Dakota professional licensing board requirements.

Agencies must ensure all clinical staff hold active, unencumbered licenses in South Dakota or a valid multi-state compact license.

• Registered Nurses (RNs): Must hold an active license from the South Dakota Board of Nursing or a multi-state compact license.
• Home Health Aides: Must complete a minimum of 75 hours of training and 16 hours of supervised practical training, plus pass a competency evaluation.
• Therapists: Physical therapists, occupational therapists, and speech-language pathologists must be licensed by their respective South Dakota professional boards.
• Background Checks: Agencies must conduct criminal background checks on all staff providing direct patient care prior to employment.
• In-Service Training: Home health aides must receive at least 12 hours of in-service training during each 12-month period.

7. Documentation, Policies and Records

Clinical records must comply with federal CoPs and SD Medicaid provider agreement stipulations. Accurate and timely documentation is critical for both care coordination and claim justification.

Records must be retained for a minimum of six years from the date of service or longer if required by specific federal regulations.

• Plan of Care: Must be established, signed, and periodically reviewed by a physician every 60 days.
• Clinical Notes: Must be written on the day service is rendered and incorporated into the clinical record within 14 days.
• OASIS Assessments: Comprehensive assessments must be completed within 5 days of the start of care and updated at specific time points (e.g., recertification, discharge).
• Patient Rights: Agencies must provide written notice of patient rights and document the patient's receipt of this notice in advance of furnishing care.
• Record Retention: Clinical and financial records must be maintained for at least six years and made available to DSS upon request.

8. Billing, Rates and Claims

SD Medicaid reimburses home health services based on a published fee schedule. Claims are submitted electronically via the SD Medicaid Provider Online Portal.

Providers must ensure that all billed services are supported by the physician-ordered plan of care and documented clinical notes.

• Provider Online Portal: Used for claim submission, remittance advice, and eligibility inquiry. https://dss.sd.gov/medicaid/portal.aspx
• Billing Codes: Services are billed using standard HCPCS codes (e.g., G0156 for Home Health Aide, G0299 for RN services) and appropriate revenue codes.
• Prior Authorization: Out-of-state providers or specific extended services may require prior authorization from DSS before services are rendered.
• Timely Filing: Claims must be submitted within the timely filing deadlines specified in SD Administrative Rule (generally 6 months from the date of service).
• Payment Method: All Medicaid payments are made via Electronic Funds Transfer (EFT) to the billing NPI.

9. Approval Sequence and Timeline

The pathway to Medicaid enrollment requires completing the federal certification process first, which dictates the overall timeline.

Because agencies must operate and serve patients prior to their initial survey, sufficient operating capital is required to sustain the business during the pre-certification phase.

• Step 1: Submit CMS-855A to the MAC and await approval (typically 60-90 days).
• Step 2: Operate and provide care to a minimum number of patients to prepare for the initial certification survey.
• Step 3: Undergo the initial survey by SD DOH or an approved accrediting organization.
• Step 4: Receive CMS Certification Number (CCN) and effective date from the CMS Regional Office.
• Step 5: Register in the SD Medicaid PE Portal, submit the enrollment record, and email supporting documents (processed in the order received).

10. Common Denials and Survey Findings

Delays in Medicaid enrollment usually stem from incomplete portal submissions or missing emailed documentation. Survey deficiencies relate directly to federal CoPs.

Agencies must closely monitor their 30-day portal window and ensure all ownership disclosures are accurate.

• Portal Timeout: SD Medicaid denies or rejects enrollment records if supporting documentation is not emailed within 30 days of data capture.
• Missing Disclosures: Failure to submit the required SD Medicaid Disclosure form detailing ownership and control interest.
• Care Plan Deficiencies: Surveyors frequently cite agencies for failing to ensure staff follow the physician-ordered plan of care exactly.
• Incomplete Assessments: Missing or late OASIS assessments or failure to integrate assessment findings into the care plan.
• Supervision Lapses: Failure to document required RN supervisory visits for home health aides every 14 days.

11. Key Contacts and Resources

Providers should utilize the official state portals and contact emails for the most direct assistance with enrollment and certification.

The DSS Provider Enrollment team handles all Medicaid application inquiries, while the DOH manages survey-related questions.

• SD Medicaid Provider Enrollment Email: [email protected] (used for submitting enrollment documentation).
• SD Medicaid Provider Enrollment Portal: https://app-dss-sw85pc05dmsproviderenroll.azurewebsites.net/Account/Login
• SD Medicaid Provider Online Portal (Claims): https://dss.sd.gov/medicaid/portal.aspx
• SD Department of Health: https://doh.sd.gov/
• SD DSS Division of Medical Services: https://dss.sd.gov/medicaid/

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