South Dakota - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

South Dakota funds intellectual and developmental disability services primarily through the CHOICES (Community, Hope, Opportunity, Independence, Careers, Empowerment, Success) Waiver, administered jointly by the Department of Human Services Division of Developmental Disabilities and the Department of Social Services. Prospective providers must secure a purchase of services agreement with DHS before the state will accept a Medicaid enrollment application.

For residential services such as Community Living Homes or Assisted Living, providers must first obtain a license from the South Dakota Department of Health. Only after securing this licensure and the DHS contract can an agency submit an application through the South Dakota Medicaid Provider Enrollment Portal.

1. Service Definition and Scope

The CHOICES Waiver provides a comprehensive array of home and community-based services to South Dakotans with intellectual and developmental disabilities. Services range from intermittent habilitation to 24-hour supported living.

Providers may be approved for specific service lines within the waiver, and the scope of approval dictates the required facility licenses and staff qualifications.

• Target Population: Children and adults with intellectual and developmental disabilities meeting ICF/IID level of care.
• Service Array: Includes residential habilitation, day habilitation, prevocational services, supported employment, and service coordination.
• Residential Options: Encompasses Community Living Homes and Assisted Living settings.
• System of Record: Therap is the mandated web-based platform for case management, service documentation, and billing.
• Virtual Delivery: Certain habilitative services permit limited virtual delivery, capped at specific weekly hours as defined in the participant's Person-Centered Plan.

2. Regulatory and Oversight Agencies

Oversight of I/DD services in South Dakota is split between the agency that manages the waiver and the agency that manages Medicaid enrollment. Facility-based services require additional oversight from the health department.

Providers must interact with multiple state portals to maintain compliance, billing, and enrollment status.

• Waiver Administrator: South Dakota Department of Human Services (DHS) Division of Developmental Disabilities (https://dhs.sd.gov/division-developmental-disabilities).
• Medicaid Authority: South Dakota Department of Social Services (DSS) (https://dss.sd.gov).
• Licensing Authority: South Dakota Department of Health (SDDOH) (https://doh.sd.gov).
• Enrollment Portal: South Dakota Medicaid Provider Enrollment Portal (https://app-dss-sw85pc05dmsproviderenroll.azurewebsites.net/).
• System of Record: Therap Services (https://www.therapservices.net).

3. Gatekeeping Prerequisites: Who Can Even Apply

South Dakota enforces strict sequencing for provider enrollment. A provider cannot simply apply to Medicaid to offer CHOICES waiver services.

The state requires a formalized relationship with the operating agency and, where applicable, facility licensure before the Medicaid application is even considered.

• DHS Contract Requirement: Providers must receive approval of the LTSS Initial Enrollment process and ensure a purchase of services agreement is in place with DHS before submitting a Medicaid application.
• SDDOH Licensure Prerequisite: For services requiring a facility license, such as Assisted Living Centers or Community Living Homes, the provider must obtain the SDDOH license before submitting the LTSS HCBS Provider Enrollment Request.
• Out-of-State Provider Intake: Out-of-state providers must submit an LTSS HCBS Out-of-State Provider Enrollment Request form and identify a specific South Dakota resident who needs their services.
• Business Registration: Providers must be a registered business with the South Dakota Secretary of State.
• Resource Directory Inclusion: Providers must submit a Provider Inclusion Form to the Dakota at Home Resource Directory.

4. Licensure and Certification Requirements

Not all CHOICES waiver services require a facility license. In-home and community-based supports rely on DHS certification and contracting.

Residential settings must meet specific South Dakota Department of Health administrative rules for operation, life safety, and health standards.

• Community Living Homes: Must be licensed by SDDOH prior to DHS contracting.
• Assisted Living Centers: Must be licensed by SDDOH prior to DHS contracting.
• HCBS Settings Final Rule: Residential and non-residential settings must pass an HCBS Settings Final Rule review by DHS to ensure community integration.
• Heightened Scrutiny: Settings subject to CMS Heightened Scrutiny review face extended approval timelines pending state and federal review.
• Insurance Requirements: Providers must submit certificates of insurance, including auto liability if transporting participants.

5. Medicaid Provider Enrollment

Medicaid enrollment is administered by the Department of Social Services through the PE Portal. This step occurs only after DHS contracting is complete.

The enrollment process links the provider's National Provider Identifier (NPI) to the specific waiver service codes authorized by DHS.

• Portal Submission: Applications must be submitted online via the South Dakota Medicaid Provider Enrollment Portal.
• NPI Requirement: Providers must obtain and register an appropriate Type 1 or Type 2 NPI.
• Tax Documentation: A compliant W-9 must be submitted during the DHS contracting phase and verified during Medicaid enrollment.
• Application Denial Risk: Submitting a Medicaid application without a prior DHS purchase of services agreement will result in immediate denial.
• Change of Ownership: A CHOW requires 30 days advance written notice and a new LTSS HCBS Enrollment Request.

6. Staffing, Training and Background Checks

Direct support professionals and professional staff must meet qualifications outlined in the CHOICES waiver appendix.

Agencies are responsible for verifying credentials, conducting background checks, and ensuring ongoing training compliance.

• Direct Service Worker: Must meet minimum age and education requirements as specified in the waiver.
• Professional Staff: Roles such as Speech-Language Pathologists must hold appropriate state licensure and provide age-appropriate services.
• Background Checks: Agencies must conduct criminal background checks and registry screenings for all patient-facing staff.
• Training Plans: Providers must agree to make staff training plans available to DHS upon request.
• Therap Access: Providers must maintain accurate staff account information within Therap and ensure appropriate system use.

7. Documentation, Policies and Records

South Dakota mandates the use of Therap for all service documentation and case management interactions.

Providers must maintain comprehensive policy manuals that align with DHS LTSS requirements and state administrative rules.

• Electronic Visit Verification: Providers must use Therap to support compliance with EVV requirements for applicable personal care services.
• Service Authorizations: Providers must manage and acknowledge Service Authorizations directly within Therap.
• Policy Review: DHS conducts a policy and procedure review during the initial LTSS enrollment process.
• Person-Centered Plans: All delivered services must be clearly documented and justified in the participant's Person-Centered Plan (PCP).
• Data Recording: Habilitation programs require data to be recorded each time the service is provided.

8. Billing, Rates and Claims

Reimbursement rates for CHOICES waiver services are established by DHS and published on the LTSS Provider Portal.

Claims are processed through the state's MMIS, but billing activities are initiated and supported through Therap.

• Rate Publication: All rates for LTSS services are located on the LTSS Provider Portal; published rates serve as informational resources.
• Billing Platform: Providers use Therap to complete billing-related activities and generate claim data.
• Transportation Costs: For certain services like prevocational training, transportation during the service is included in the rate, but transit to/from the site is not.
• Group Rates: Rates for day services are tiered based on staffing ratios, such as individual, small group, or large group.
• Annual Budgets: Services must be purchased within a participant's annual individual budget amount.

9. Approval Sequence and Timeline

Becoming a CHOICES waiver provider is a multi-step process that spans several state agencies.

Providers must sequence their applications correctly to avoid automatic denials at the Medicaid enrollment stage.

• Step 1 Business Setup: Register with the Secretary of State and obtain an NPI.
• Step 2 Facility Licensure: Obtain SDDOH licensure for Assisted Living or Community Living Homes, if applicable.
• Step 3 DHS Intake: Submit the LTSS HCBS Provider Enrollment Request to DHS.
• Step 4 DHS Contracting: Complete policy review, HCBS settings review, and sign the purchase of services agreement.
• Step 5 Medicaid Enrollment: Submit the application through the DSS PE Portal.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied when providers fail to follow the strict sequencing rules.

Ongoing compliance is monitored through annual or triennial QA review cycles by DHS.

• Premature Medicaid Application: Applying to DSS before securing a DHS contract results in application denial.
• Missing Licensure: Failing to complete SDDOH licensure prior to submitting the LTSS request halts the enrollment process.
• Out-of-State Ineligibility: Out-of-state applications are denied if the identified South Dakota resident is deemed ineligible for waiver services.
• Settings Rule Violations: Facilities failing the HCBS Settings Final Rule review cannot be enrolled.
• QA Cycle: In-home services face annual QA reviews, while residential services undergo a 3-year review cycle.

11. Key Contacts and Resources

Providers should rely on official state portals and published manuals for the most current enrollment requirements.

The Dakota at Home directory serves as the primary public-facing resource for waiver services.

• DHS Developmental Disabilities: https://dhs.sd.gov/division-developmental-disabilities
• DSS Medicaid Provider Enrollment: https://dss.sd.gov/medicaid/providers/enrollment/enrollment.aspx
• Medicaid PE Portal: https://app-dss-sw85pc05dmsproviderenroll.azurewebsites.net/
• Dakota at Home: 833-663-9673 (Option 2 for Case Management)
• Therap Services: https://www.therapservices.net

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