Waiver Consulting Group — Start any program. In any state.

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

Last reviewed: 2026-09-10

In South Dakota, Home Modification Services are funded through Medicaid 1915(c) waivers, including the CHOICES Waiver, Family Support 360, Assistive Daily Living Services (ADLS), and the HOPE Waiver, which are operated jointly by the Department of Social Services (DSS) and the Department of Human Services (DHS). Providers must enroll directly through the South Dakota Medicaid Provider Enrollment (PE) Portal.

South Dakota does not issue a distinct state license for home modification providers. Instead, providers must meet the qualifications outlined in the specific waiver applications, which generally require appropriate local building permits, contractor licenses, and adherence to state and local building codes before Medicaid enrollment is approved.

1. Service Definition and Scope

Home Modification Services in South Dakota encompass assessed, permitted, and inspected structural changes to an individual's residence that are necessary to ensure their health, welfare, and safety, or to enable them to function with greater independence in the home.

These services are designed to prevent institutionalization and are tailored to the specific needs of the waiver participant as identified in their individualized care plan.

2. Regulatory and Oversight Agencies

The South Dakota Department of Social Services (DSS) is the single state Medicaid agency responsible for overall administration, while the Department of Human Services (DHS) operates the specific HCBS waivers.

Providers interact with both agencies for enrollment, compliance, and billing purposes.

3. Gatekeeping Prerequisites: Who Can Even Apply

South Dakota does not impose a Certificate of Need, closed network moratorium, or mandatory managed care affiliation for Home Modification Services under its HCBS waivers.

The primary prerequisite is that the provider must hold any necessary local contractor licenses and be capable of obtaining required building permits for the specific modifications being performed.

4. Licensure and Certification Requirements

Because South Dakota does not have a specific state-level license for HCBS home modification providers, approval is based on meeting the provider qualifications specified in the waiver.

Providers must comply with all local and state building codes and ensure that all work is inspected and approved by local authorities where applicable.

5. Medicaid Provider Enrollment

Providers must enroll through the South Dakota Medicaid Provider Enrollment (PE) Portal. The process involves submitting an application, agreeing to Medicaid provider terms, and providing proof of necessary local licenses.

There is no application fee charged for enrolling as a Medicaid provider in South Dakota.

6. Staffing, Training and Background Checks

While home modification providers do not provide direct personal care, any staff entering a participant's home must comply with general Medicaid provider requirements.

This typically includes basic background checks to ensure the safety of vulnerable waiver participants.

7. Documentation, Policies and Records

Providers must maintain detailed records of all modifications, including initial assessments, itemized bids, permits obtained, and final inspection reports.

These records must be retained according to South Dakota Medicaid's general record retention policies and made available for audit by DSS or DHS.

8. Billing, Rates and Claims

Home Modification Services are typically billed based on the approved bid amount rather than a fixed fee schedule, subject to waiver-specific lifetime or annual caps.

Claims are submitted through the South Dakota Medicaid portal after the work is completed, inspected, and approved by the waiver case manager.

9. Approval Sequence and Timeline

The process begins with obtaining any necessary local contractor licenses, followed by submitting an application through the Medicaid PE Portal.

Once enrolled, providers must submit bids for specific participant projects, receive authorization from the case manager, complete the work, and pass inspections before billing.

10. Common Denials and Survey Findings

Enrollment applications may be delayed or denied if the provider fails to submit proof of required local licenses or business registration.

Claims for completed work are often denied if the provider did not obtain prior authorization from the case manager or failed to provide documentation of final building inspections.

11. Key Contacts and Resources

Providers should utilize the official state portals and contact the respective departments for guidance on enrollment and waiver-specific requirements.

The DSS and DHS websites provide access to provider manuals, waiver applications, and the enrollment portal.

See all South Dakota services · South Dakota Medicaid consulting · book a consultation.