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

Last reviewed: 2026-08-16

In South Dakota, Homemaker services provide essential general household support—such as meal preparation, laundry, shopping, and light housekeeping—for individuals who cannot perform these tasks independently. These services are primarily funded through Home and Community-Based Services (HCBS) waivers, such as the HOPE Waiver, allowing elderly adults and individuals with disabilities to remain safely in their own homes.

The single biggest structural barrier to entry for this service in South Dakota is the mandatory Department of Human Services (DHS) Division of Long Term Services and Supports (LTSS) contract and policy review process. Because the South Dakota Department of Health does not license non-medical home care agencies, providers cannot simply apply for a license and enroll in Medicaid; they must first submit a comprehensive Policy and Procedure Manual to DHS LTSS, pass a readiness review, and secure an active LTSS contract before the Department of Social Services (DSS) will approve their Medicaid enrollment.

1. Service Definition and Scope

Homemaker services in South Dakota are designed to maintain a safe, clean, and healthy environment for waiver participants. The service focuses strictly on environmental and household tasks rather than hands-on medical or personal care.

Providers must ensure that the tasks performed align directly with the needs identified in the participant's authorized care plan, as developed by their waiver case manager.

• Target Population: Elderly adults and individuals with physical disabilities enrolled in HCBS programs like the HOPE Waiver.
• Covered Tasks: Routine light housekeeping, laundry, meal planning and preparation, and essential shopping for groceries or supplies.
• Exclusions: Hands-on personal care (bathing, dressing), skilled nursing, or heavy chore services (which fall under distinct service codes and requirements).
• Service Setting: The participant's private residence; services cannot be billed if the participant resides in an assisted living or residential facility.
• Documentation: Daily care logs and time records verifying the specific household tasks completed during the shift.

2. Regulatory and Oversight Agencies

Because South Dakota does not license non-medical home care agencies, oversight is split between the Department of Human Services (DHS) and the Department of Social Services (DSS). DHS manages the waiver programs, policy reviews, and provider contracts.

DSS serves as the state Medicaid agency, handling the formal provider enrollment process, the Medicaid Management Information System (MMIS), and claims processing.

• South Dakota Department of Human Services (DHS): Manages HCBS waivers and overall provider contracting (https://dhs.sd.gov/).
• DHS Division of Long Term Services and Supports (LTSS): Conducts mandatory policy reviews and issues provider contracts (https://dhs.sd.gov/about-dhs/long-term-services-and-supports).
• South Dakota Department of Social Services (DSS): Oversees the state Medicaid program, MMIS, and final provider enrollment (https://dss.sd.gov/).
• DSS Provider Enrollment (PE) Portal: The online system used to process actual Medicaid provider applications (https://app-dss-sw85pc05dmsproviderenroll.azurewebsites.net/Account/Login).
• South Dakota Department of Health (DOH): Explicitly does not regulate or license non-medical homemaker or personal care agencies (https://doh.sd.gov/).

3. Gatekeeping Prerequisites: Who Can Even Apply

South Dakota presents a relatively open market for non-medical homemaker services. There is no Certificate of Need (CON) program, nor is there a closed network, Request for Proposals (RFP) procurement lock-out, or moratorium for HCBS waiver providers. Furthermore, the South Dakota Department of Health does not require a license for agencies providing strictly non-medical homemaker services.

However, the primary structural precondition is the DHS LTSS Contract requirement. A provider cannot simply enroll via the DSS Medicaid portal; they must first register their business, obtain an NPI, and pass the LTSS Policy and Procedure Review to secure an active LTSS contract. Without this contract, the DSS Medicaid enrollment application will be rejected.

• Licensure Exemption: No DOH home health or home care license is required to provide non-medical homemaker services in South Dakota.
• Certificate of Need: None exists in South Dakota for home care or HCBS agencies.
• Business Registration: The agency must be registered and in good standing with the South Dakota Secretary of State prior to applying.
• NPI Requirement: The agency must obtain a Type 2 National Provider Identifier (NPI) before initiating the enrollment process.
• LTSS Contract Precondition: Applicants must pass the DHS LTSS Policy and Procedure Review and execute a contract before Medicaid enrollment is finalized.

4. Licensure and Certification Requirements

As established, South Dakota does not issue a specific Homemaker License or Non-Medical Home Care License. Instead of a DOH license, the state uses the DHS LTSS Provider Enrollment and Contracting process as its certification equivalent.

To achieve this, providers must submit a comprehensive Policy and Procedure Manual to LTSS for review. This manual must demonstrate compliance with state waiver standards, including client rights, emergency procedures, and staff competency protocols.

• DOH Licensure: Not required for In-Home services, which include Homemaker, Personal Care, and Chore services.
• LTSS Policy Review: Mandatory submission of the agency's Policy and Procedure Manual to DHS LTSS for approval.
• Insurance Requirements: Providers must submit certificates of general liability, professional liability, and workers' compensation insurance to the LTSS Contracts team.
• Transportation Insurance: Auto liability insurance is required if staff transport clients or run errands, such as grocery shopping.
• Tax Documentation: Agencies must submit a compliant W-9 form to the LTSS Contracts team prior to contract initiation.

5. Medicaid Provider Enrollment

Once the LTSS contract requirements are met, providers must formally enroll with South Dakota Medicaid through the Department of Social Services (DSS). South Dakota operates primarily as a fee-for-service Medicaid program, meaning providers complete a single enrollment with SD DSS rather than navigating multiple Managed Care Organization (MCO) credentialing processes.

Enrollment is conducted entirely online via the Provider Enrollment (PE) Portal. Providers have a strict 30-day window to complete their application and submit supporting documentation once data capture begins.

• Enrollment System: SD Medicaid Provider Enrollment (PE) Portal.
• Application Fee: No application fee is charged by SD Medicaid for this specific provider type.
• Submission Timeline: Enrollment records and documentation must be completed and received within 30 days of starting data capture, or the application will be denied.
• Supporting Documentation: Must be emailed to SDMedicaidPE@state.sd.us with the agency's NPI and provider name in the email body.
• Managed Care: Not applicable; SD Medicaid is primarily fee-for-service, requiring only DSS enrollment for HCBS waiver services.

6. Staffing, Training and Background Checks

South Dakota does not have a state-mandated certification program (like a CNA requirement) for homemakers. However, the provider agency is contractually responsible for ensuring all staff are competent to perform the tasks outlined in the participant's care plan.

Agencies must conduct thorough background checks before allowing staff to enter a participant's home and must maintain personnel files documenting training, competency evaluations, and background clearances.

• Minimum Qualifications: Staff must be 18 years of age or older and possess basic literacy and communication skills.
• State Certification: No defined state certification standards exist for homemakers or personal care aides in South Dakota.
• Competency Evaluation: Agencies must assess and document each staff member's ability to perform light housekeeping, meal prep, and shopping safely.
• Background Checks: Mandatory state and federal criminal background checks and registry screenings must be completed prior to client contact.
• Family Members: Services must be provided by a qualified individual who is not a legally responsible family member, unless specific waiver exceptions apply.

7. Documentation, Policies and Records

DHS LTSS requires strict adherence to documentation standards to justify Medicaid billing. Providers must maintain a comprehensive Policy and Procedure Manual that is reviewed annually during the LTSS HCBS Quality Assurance (QA) Review Cycle.

Client records must clearly link the homemaker tasks performed to the goals outlined in the waiver case manager's authorized care plan.

• Policy Manual: Must cover client rights, grievance procedures, incident reporting, and infection control.
• Care Logs: Daily documentation of specific tasks completed (e.g., laundry, meal prep), signed or verified by the client or staff.
• Time Records: Electronic Visit Verification (EVV) or detailed timesheets capturing exact start and stop times for each shift.
• QA Review Cycle: In-Home services, including Homemaker, are subject to an Annual LTSS HCBS Quality Assurance review.
• Record Retention: Medicaid records must typically be retained for a minimum of six years from the date of service.

8. Billing, Rates and Claims

Homemaker services are billed to South Dakota Medicaid on a fee-for-service basis using the SD Medicaid Provider Online Portal. Providers must only bill for services that have been prior-authorized by the participant's waiver case manager.

Because South Dakota does not utilize managed care for these HCBS waivers, all claims are submitted directly to the state's MMIS.

• Billing Portal: SD Medicaid Provider Online Portal (MMIS).
• Authorization: Services must be explicitly authorized in the participant's LTSS care plan before delivery and billing.
• Billing Increments: Typically billed in 15-minute units using specific HCPCS codes designated for homemaker services.
• EVV Compliance: Agencies must comply with 21st Century Cures Act Electronic Visit Verification requirements for in-home services.
• Remittance: Remittance advices and payment statuses are viewed and downloaded directly from the Provider Online Portal.

9. Approval Sequence and Timeline

The path to becoming a billing provider involves sequential steps between the Secretary of State, DHS LTSS, and DSS. Because there is no DOH licensure phase, the timeline is generally faster than in states that heavily regulate non-medical care.

The entire process from business registration to active Medicaid billing status typically takes 60 to 90 days, depending on the speed of the LTSS policy review and contract execution.

• Step 1: Register the business with the SD Secretary of State and obtain an EIN and Type 2 NPI (1-2 weeks).
• Step 2: Submit the LTSS HCBS Provider Enrollment Request and Policy Manual to DHS LTSS (30-45 days for review).
• Step 3: Execute the LTSS Provider Contract and submit W-9 and Insurance certificates (1-2 weeks).
• Step 4: Submit the Medicaid enrollment application via the DSS PE Portal (30-45 business days for state portal approval).
• Step 5: Receive an active Medicaid provider ID and begin accepting authorizations from waiver case managers.

10. Common Denials and Survey Findings

Applications and annual QA reviews frequently face delays or denials due to incomplete documentation or failure to meet LTSS contract standards. The most common initial barrier is an inadequate Policy and Procedure Manual that fails to address SD-specific waiver requirements.

During the annual LTSS HCBS QA Review, auditors frequently cite agencies for poor daily documentation and failure to maintain updated background checks.

• Application Timeout: DSS PE Portal applications are automatically denied if supporting documentation is not received within 30 days of starting the application.
• Inadequate Policies: LTSS rejecting the Policy and Procedure Manual for lacking required grievance or incident reporting protocols.
• Missing Insurance: Failure to provide or maintain required auto liability or workers' compensation insurance certificates.
• Documentation Gaps: Annual QA citations for daily care logs that lack specific task details or client verification.
• Unapproved Tasks: Billing for hands-on personal care or skilled nursing tasks under the homemaker service code.

11. Key Contacts and Resources

Navigating the dual requirements of DHS (for contracting) and DSS (for Medicaid enrollment) requires utilizing the correct state resources. Providers should bookmark the portals and contact the respective departments for guidance.

Below are the essential contacts and links for prospective Homemaker service providers in South Dakota.

• SD Department of Human Services (DHS) LTSS: https://dhs.sd.gov/about-dhs/long-term-services-and-supports
• SD Department of Social Services (DSS) Medicaid Provider Enrollment: https://dss.sd.gov/medicaid/providers/enrollment/enrollment.aspx
• DSS Provider Enrollment (PE) Portal: https://app-dss-sw85pc05dmsproviderenroll.azurewebsites.net/Account/Login
• SD Medicaid Provider Online Portal (Billing): https://dss.sd.gov/medicaid/portal.aspx
• SD Secretary of State (Business Registration): https://sdsos.gov/
• DSS Provider Enrollment Email: SDMedicaidPE@state.sd.us

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