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

Last reviewed: 2026-08-16

In South Dakota, services for individuals with intellectual and developmental disabilities (I/DD) are primarily delivered through the 1915(c) CHOICES Waiver and the Family Support 360 Waiver. These programs offer a comprehensive array of home and community-based services (HCBS), ranging from 24/7 residential habilitation and shared living to day habilitation, supported employment, and in-home respite care.

The single biggest structural barrier to entry for new I/DD providers in South Dakota is the requirement to become a certified Community Support Provider (CSP) under Administrative Rules of South Dakota (ARSD) Chapter 46:11. This certification mandates that agencies not only pass rigorous state site-readiness evaluations but also secure formal accreditation from a designated national quality organization, such as the Council on Quality and Leadership (CQL) or CARF, before they can execute active Medicaid provider agreements.

1. Service Definition and Scope

South Dakota's I/DD service array is designed to keep individuals in community settings rather than institutional care. The CHOICES Waiver provides comprehensive, intensive supports, while the Family Support 360 Waiver focuses on participant-directed services and family support.

Providers can enroll to offer specific services based on their agency's capacity, but all services must align with the participant's Individualized Service Plan (ISP) and promote maximum independence.

• Target Population: Individuals with intellectual or developmental disabilities ages 0 or older who meet an ICF/IID level of care.
• CHOICES Waiver: Covers residential habilitation, shared living, day habilitation, and supported employment.
• Family Support 360 Waiver: Covers in-home respite, personal care, environmental accessibility adaptations, and specialized medical equipment.
• Residential Habilitation: Provides 24/7 support, supervision, and skills training in a licensed or certified community setting.
• Shared Living: Habilitation services provided in a host home or shared living arrangement.
• Service Delivery Model: Primarily agency-based, requiring formal certification as a Community Support Provider (CSP) or Organized Health Care Delivery System (OHCDS).

2. Regulatory and Oversight Agencies

Oversight of I/DD waiver services in South Dakota is divided between two primary state departments. Programmatic rules, provider certification, and quality assurance are managed by the Department of Human Services (DHS).

The Department of Social Services (DSS) acts as the state Medicaid agency, handling the financial aspects, final provider enrollment, and claims processing through the state's Medicaid Management Information System (MMIS).

• Lead Operating Agency: South Dakota Department of Human Services (DHS) (https://dhs.sd.gov/)
• Programmatic Division: DHS Division of Developmental Disabilities (DDD) (https://dhs.sd.gov/en/developmental-disabilities)
• Medicaid Authority: South Dakota Department of Social Services (DSS) (https://dss.sd.gov/medicaid/)
• Enrollment Portal: SD DSS Provider Enrollment (PE) Portal (https://app-dss-sw85pc05dmsproviderenroll.azurewebsites.net/)

3. Gatekeeping Prerequisites: Who Can Even Apply

South Dakota does not utilize a traditional Certificate of Need (CON) process, closed managed care networks, or competitive Request for Proposals (RFP) to restrict I/DD provider enrollment. The network is generally open to any qualified entity.

However, there is a strict structural precondition: an applicant cannot enroll in Medicaid to bill for these services without first obtaining formal certification from the DHS Division of Developmental Disabilities. This certification acts as the primary gatekeeper.

• Certification Mandate: Applicants must secure explicit formal certification as a Community Support Provider (CSP) or Organized Health Care Delivery System (OHCDS) under ARSD Chapter 46:11 prior to Medicaid enrollment.
• National Accreditation: To maintain CSP certification, agencies must secure formal accreditation from a designated national quality organization (e.g., CQL or CARF).
• Business Registration: The agency must be legally incorporated and registered with the South Dakota Secretary of State.
• NPI Requirement: Providers must obtain an Organizational (Type 2) National Provider Identifier (NPI) and a Federal Employer Identification Number (FEIN).
• Network Status: Open enrollment; there are currently no state-imposed moratoria or closed network restrictions blocking new applicants who meet certification standards.

4. Licensure and Certification Requirements

Rather than a standard medical facility license, I/DD providers in South Dakota must meet the rigorous operational and environmental standards set forth in ARSD Chapter 46:11. This involves comprehensive policy reviews and physical site inspections by DHS.

Providers must also demonstrate full compliance with the federal HCBS Settings Final Rule, ensuring that all service locations integrate participants into the broader community and protect their privacy and autonomy.

• Regulatory Authority: Certification is governed by Administrative Rules of South Dakota (ARSD) Chapter 46:11.
• HCBS Settings Rule: Providers must pass DHS site-readiness evaluations to prove compliance with federal community integration and privacy standards.
• Insurance Requirements: Agencies must purchase and maintain general commercial liability, professional liability, and workers' compensation coverages.
• EHR Configuration: Providers must configure an electronic health record (EHR) database capable of logging 24/7 shift notes and service documentation.
• Facility Standards: If offering out-of-home respite or residential services, physical properties must pass environmental, fire, and safety inspections.

5. Medicaid Provider Enrollment

Once certified by DHS/DDD, providers must complete their enrollment through the South Dakota DSS Provider Enrollment (PE) Portal. South Dakota operates its waivers primarily on a fee-for-service basis.

The PE Portal is entirely online, and providers must ensure all supporting documentation is submitted promptly, as the system will automatically reject incomplete applications after a short window.

• System of Record: All enrollment activities are completed through the SD DSS Provider Enrollment (PE) Portal.
• Application Fee: South Dakota Medicaid does not charge an application fee for this enrollment type.
• Required Forms: Applicants must submit the SD Medicaid Provider Agreement and the Ownership/Controlling Interest Disclosure form.
• Financial Setup: Providers must submit a letter from a financial institution to support Electronic Funds Transfer (EFT) details for online payment.
• Taxonomy Codes: Providers must select a group/agency taxonomy code (e.g., 193200000X) that matches their specific CSP licensure type.
• Time Limit: Enrollment records and all supporting documentation must be completed and received within 30 days of starting data capture in the portal.

6. Staffing, Training and Background Checks

Direct Support Professionals (DSPs) and agency management must meet strict state-mandated competencies before working any shifts. South Dakota places a heavy emphasis on behavioral support and person-centered planning.

Agencies are responsible for verifying all credentials and maintaining proof of cleared background checks in staff personnel files prior to any direct participant contact.

• Background Checks: Mandatory criminal background checks and registry checks against state and federal disqualification lists for all direct care staff, managers, and owners.
• Basic Certifications: CPR and First Aid certification are required for all DSPs and respite workers.
• State-Mandated Competencies: Staff must demonstrate complete proficiency in person-centered planning and positive behavioral interventions.
• Medication Oversight: Staff responsible for administering or overseeing medication must complete state-approved medication aide training.
• HCBS Training: Mandatory training on individual rights, privacy, and compliance with the HCBS Settings Final Rule.

7. Documentation, Policies and Records

Certified providers must develop and maintain a comprehensive Policy & Procedure Manual that dictates daily operations. This manual is reviewed during the DHS certification process.

Documentation must clearly link the services provided to the goals outlined in the participant's ISP, and agencies must have robust systems for incident reporting and emergency management.

• Policy Manual: Must include participant intake procedures, care instructions, and emergency/contact protocols.
• Service Verification: Daily logs and shift notes must be maintained to verify service delivery and support Medicaid billing.
• Incident Reporting: Documented protocols for reporting critical incidents to DHS/DDD within state-mandated timeframes.
• Rights & Privacy: Written policies ensuring HIPAA compliance and the protection of participant rights under ARSD 46:11.
• Backup Plans: Documented backup caregiver plans to ensure continuous coverage, especially in residential and respite settings.

8. Billing, Rates and Claims

South Dakota Medicaid reimburses CHOICES and Family Support 360 waiver services on a fee-for-service basis. Rates are established by DHS/DDD and published on the state's fee schedules.

Providers submit claims electronically through the SD Health Enterprise MMIS. All services must be prior-authorized by the participant's case manager before billing can occur.

• Billing System: Claims are processed electronically through the SD Health Enterprise MMIS.
• Reimbursement Model: Fee-for-service based on published DHS/DDD rate schedules.
• Prior Authorization: All waiver services require active authorization from a case manager (e.g., via Dakota at Home) before service delivery.
• Timely Filing: Claims must be submitted within standard Medicaid timely filing limits; providers should complete enrollment updates at least 45 days prior to these deadlines.
• Payment Method: All Medicaid payments are made exclusively via Electronic Funds Transfer (EFT).

9. Approval Sequence and Timeline

Becoming a fully approved I/DD provider in South Dakota is a multi-step process that requires sequential approvals from the Secretary of State, DHS/DDD, a national accrediting body, and DSS Medicaid.

Because of the requirement to secure national accreditation and pass site-readiness checks, the entire process can take several months to over a year from initial business formation to billing the first claim.

• Step 1: Incorporate the business with the SD Secretary of State and obtain an EIN and Type 2 NPI (1-2 weeks).
• Step 2: Develop policies, secure physical sites, and apply for DHS/DDD CSP Certification (2-4 months).
• Step 3: Initiate and complete national accreditation with CQL or CARF (timeline varies, often 6-12 months).
• Step 4: Submit the Medicaid enrollment application via the DSS PE Portal (must be completed within 30 days of starting).
• Step 5: DSS review and approval of the Medicaid Provider Agreement (statutorily up to 45-90 days).

10. Common Denials and Survey Findings

Applications and site surveys frequently fail due to administrative omissions or a failure to fully implement the physical and operational requirements of the HCBS Settings Rule.

Strict adherence to portal timelines is also critical; the DSS PE Portal will automatically reject applications that sit incomplete.

• Portal Timeout: Medicaid enrollment applications are automatically denied/rejected if not completed with all documentation within 30 days of initiation.
• Settings Rule Violations: Facilities failing to demonstrate community integration, participant privacy, or autonomy during DHS site-readiness checks.
• Incomplete Policies: Missing mandatory components in the Policy & Procedure Manual, such as backup caregiver plans or incident reporting protocols.
• Credential Gaps: Failure to provide proof that all DSPs have completed background checks and CPR/First Aid before starting shifts.
• Accreditation Lapses: Inability to secure or maintain the required CQL or CARF national accreditation, leading to loss of CSP certification.

11. Key Contacts and Resources

Prospective providers should rely on the official state department websites and the administrative rules database for the most current regulations and fee schedules.

The DSS Provider Enrollment Portal and the DHS Provider Portal are the primary operational hubs for submitting applications and accessing compliance toolkits.

• SD Department of Human Services (DHS): https://dhs.sd.gov/
• DHS Division of Developmental Disabilities (DDD): https://dhs.sd.gov/en/developmental-disabilities
• SD DSS Medicaid Provider Enrollment: https://dss.sd.gov/medicaid/providers/enrollment/enrollment.aspx
• SD DSS PE Portal: https://app-dss-sw85pc05dmsproviderenroll.azurewebsites.net/
• Administrative Rules of South Dakota (ARSD) 46:11: https://sdlegislature.gov/Rules/Administrative/46:11
• Dakota at Home (Case Management Intake): 833-663-9673

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