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

Last reviewed: 2026-08-16

In South Dakota, Medical Supply Services for Medicaid Home and Community-Based Services (HCBS) waiver participants encompass the furnishing, fitting, and servicing of durable medical equipment (DME) and disposable supplies. These services are critical for individuals enrolled in programs like the HOPE Waiver and CHOICES Waiver, providing them with the necessary physical supports to remain safely in their homes and communities rather than institutional settings.

The single biggest structural barrier to entry for this service in South Dakota is a strict, mandatory sequencing of state approvals. Prospective providers cannot simply apply to Medicaid; they must first successfully complete the Department of Human Services (DHS) Long-Term Services and Supports (LTSS) Initial Enrollment process and secure a Purchase of Services Agreement (contract). Any application submitted to the Department of Social Services (DSS) Medicaid Provider Enrollment portal before this LTSS contract is fully executed will be automatically denied.

1. Service Definition and Scope

Medical Supply Services under South Dakota's HCBS waivers provide durable medical equipment and disposable medical supplies that are not otherwise covered by the standard Medicaid State Plan. These items must be directly related to the participant's physical health, safety, or ability to perform activities of daily living.

The scope of this service includes the initial evaluation for the equipment, delivery, fitting, training the participant or caregivers on its use, and ongoing maintenance or servicing. Items requested solely for general utility or convenience are strictly excluded.

• Service Scope: Furnishing, fitting, and servicing durable medical equipment and disposable medical supplies for waiver participants.
• Target Population: Individuals enrolled in South Dakota HCBS waivers, including the HOPE Waiver, CHOICES Waiver, Family Support 360, and Assistive Daily Living Services (ADLS).
• Regulatory Definition: South Dakota Administrative Rule 64:06:03:58 defines durable medical equipment as equipment that can withstand repeated use, serves a medical purpose, and is appropriate for home use.
• Exclusions: Items intended for general utility (e.g., standard air conditioners without specific medical justification) and repair parts for single-patient use only are not covered.
• Service Justification: All equipment and supplies must be tied to an assessed need documented in the participant's service plan by their waiver case manager.

2. Regulatory and Oversight Agencies

Oversight of HCBS Medical Supply Services in South Dakota is bifurcated. The Department of Human Services (DHS) manages the waiver programs, assesses provider readiness, and holds the provider contracts. The Department of Social Services (DSS) manages the financial side, including the Medicaid Management Information System (MMIS) and provider enrollment.

Providers must interact with both departments' systems to become fully approved and to submit claims for reimbursement.

• Agency: South Dakota Department of Human Services (DHS) Division of Long-Term Services and Supports (LTSS) (https://dhs.sd.gov/en/ltss)
• Agency: South Dakota Department of Social Services (DSS) Division of Medical Services (https://dss.sd.gov/medicaid/)
• Portal: South Dakota Medicaid Provider Enrollment (PE) Portal (https://app-dss-sw85pc05dmsproviderenroll.azurewebsites.net/)
• Portal: South Dakota Medicaid Provider Portal for Claims and Billing (https://dssapps.appssd.sd.gov/)

3. Gatekeeping Prerequisites: Who Can Even Apply

South Dakota does not require a Certificate of Need (CON) for DME providers, nor does it utilize closed networks or Request for Proposal (RFP) procurements for basic medical supplies. However, the state enforces strict structural prerequisites that block an application from being accepted if not met.

The primary gatekeeper is the mandatory DHS LTSS contracting phase. A provider cannot access the Medicaid enrollment system without first being vetted and contracted by the waiver operating agency.

• Mandatory Sequencing: Providers must obtain DHS LTSS approval and an executed Purchase of Services Agreement before submitting a DSS Medicaid application.
• Medicare Enrollment Prerequisite: Providers typically must be enrolled as a Medicare DMEPOS supplier with active accreditation before Medicaid will enroll them for DME services.
• Business Registration: The agency must be a registered business in good standing with the South Dakota Secretary of State.
• NPI Requirement: The provider must possess an active Type 2 National Provider Identifier (NPI) and an Employer Identification Number (EIN).
• Physical Location: The provider must maintain a physical business location that is accessible to the public and state inspectors.

4. Licensure and Certification Requirements

South Dakota does not issue a state-specific Durable Medical Equipment (DME) license. Because there is no distinct state licensure board for DME, approval to operate relies entirely on federal Medicare DMEPOS accreditation and state Medicaid waiver contracting.

Providers must maintain their federal accreditation and adhere to the standards set forth in the LTSS HCBS Provider Enrollment Manual to remain certified to provide services in the state.

• State DME License: None required; South Dakota explicitly does not have a dedicated state-level DME licensure requirement.
• Federal Accreditation: Providers must hold active Medicare DMEPOS accreditation from a CMS-approved accrediting organization (e.g., ACHC, BOC, HQAA).
• Insurance Requirements: Providers must maintain general liability insurance and provide a Certificate of Insurance to LTSS during the contracting phase.
• Tax Documentation: A compliant W-9 must be submitted to LTSS to ensure appropriate tax reporting.
• Vehicle Insurance: If the provider utilizes company vehicles for delivery and fitting, auto liability insurance must be maintained and documented.

5. Medicaid Provider Enrollment

Enrolling as a Medical Supply Service provider in South Dakota is a two-part process. It begins with the Department of Human Services (DHS) and concludes with the Department of Social Services (DSS).

Providers must navigate both the LTSS HCBS Enrollment Request process and the DSS Provider Enrollment (PE) Portal, ensuring all business information matches exactly across both systems.

• Step 1: Initiate the LTSS HCBS Enrollment Request online form through the DHS provider portal.
• Step 2: Complete and return the LTSS HCBS Provider Self-Assessment survey within 30 days of receipt.
• Step 3: Execute the LTSS Purchase of Services Agreement (contract) and submit required insurance and W-9 documentation.
• Step 4: Submit the formal Medicaid application via the DSS Provider Enrollment (PE) Portal.
• Timeline: State portal approval typically takes 30 to 45 business days after the LTSS contract is fully executed.
• Fee: South Dakota Medicaid may require an application fee for institutional providers, which aligns with the federally mandated CMS application fee for the current calendar year.

6. Staffing, Training and Background Checks

While Medical Supply Services are primarily product-focused, staff members who deliver, fit, or service equipment in a waiver participant's home must meet state HCBS safety and competency standards.

Agencies are responsible for ensuring their personnel are properly vetted and trained to interact with vulnerable adults and individuals with disabilities.

• Background Checks: All staff interacting directly with waiver participants must pass state and federal criminal background checks.
• OIG Exclusion Screening: Staff and owners must be screened monthly against the federal List of Excluded Individuals/Entities (LEIE).
• Professional Competency: Technicians fitting complex equipment must hold relevant manufacturer certifications or professional credentials (e.g., Assistive Technology Professional for complex rehab).
• Mandatory Training: Staff must complete required HCBS waiver training, including protocols for incident reporting and abuse, neglect, and exploitation prevention.
• Personnel Records: The provider must maintain a personnel file for each employee documenting background checks, training completion, and credential verification.

7. Documentation, Policies and Records

South Dakota requires HCBS providers to maintain comprehensive operational policies and participant records. These documents are reviewed during the initial LTSS Self-Assessment and are subject to ongoing state audits.

Failure to maintain accurate delivery logs and valid prescriptions is a primary cause for Medicaid recoupment.

• Policy Manual: Providers must submit a comprehensive Policy and Procedure manual during the LTSS Self-Assessment phase for state review.
• Ownership Disclosure: Full ownership disclosure is required, detailing any individuals or entities with a 5% or more controlling interest.
• Prescription Records: Providers must maintain valid, signed physician orders or prescriptions for all dispensed DME and medical supplies.
• Proof of Delivery: Providers must keep signed delivery tickets or electronic proof of delivery for all items billed to Medicaid.
• Record Retention: All participant, billing, and personnel records must be retained for a minimum of 6 years per South Dakota Medicaid policy.
• Change of Ownership: The sale or transfer of an LTSS contracted provider agency requires at least 30 days advance written notice to the state.

8. Billing, Rates and Claims

South Dakota Medicaid operates primarily on a fee-for-service basis. Medical Supply Service providers bill the state directly rather than routing claims through Managed Care Organizations (MCOs).

Claims are processed through the state's MMIS, and providers must adhere strictly to the coding and prior authorization rules outlined in the SD Medicaid DME Billing Manual.

• Billing System: Claims are submitted electronically via the South Dakota Medicaid Portal (https://dssapps.appssd.sd.gov/).
• Prior Authorization: Many DME items and high-cost supplies require prior authorization from the waiver case manager before the item can be dispensed.
• Coding Standards: Providers must use standard HCPCS codes and applicable modifiers as defined in the SD Medicaid billing guidelines.
• Reimbursement Rates: Services are paid according to the published SD Medicaid Fee Schedule; providers must accept this payment as payment in full.
• Service Plans: Items billed must match the authorized units and descriptions explicitly listed in the participant's approved HCBS service plan.

9. Approval Sequence and Timeline

The approval process for becoming a Medical Supply Service provider in South Dakota is strictly linear. Attempting to bypass the DHS LTSS contracting phase will halt the entire enrollment process.

Providers should expect the end-to-end process to take several months, particularly if they are also securing their initial Medicare DMEPOS accreditation.

• Phase 1: Establish the business entity, register with the SD Secretary of State, and obtain Medicare DMEPOS accreditation (timeline varies, typically 3-6 months).
• Phase 2: Submit the LTSS HCBS Enrollment Request and complete the LTSS Provider Self-Assessment (must be completed within 30 days of receipt).
• Phase 3: Execute the LTSS Purchase of Services Agreement and submit required insurance and tax documents (typically 1-2 weeks).
• Phase 4: Submit the formal application through the DSS Provider Enrollment (PE) Portal (review takes 30-45 business days).
• Phase 5: Receive final approval, issuance of the SD Medicaid Provider ID, and authorization to begin accepting waiver referrals.

10. Common Denials and Survey Findings

Applications and claims are frequently denied in South Dakota due to procedural missteps, missed deadlines, or insufficient documentation.

Understanding these common pitfalls can help providers avoid costly delays during enrollment and prevent fund recoupment during post-payment audits.

• Premature Application: Applying in the DSS PE Portal before securing the LTSS contract results in an automatic denial of the Medicaid application.
• Self-Assessment Failure: Failing to return the LTSS HCBS Provider Self-Assessment within the strict 30-day window causes LTSS to discontinue the enrollment process.
• Missing Prior Authorization: Dispensing and billing for waiver supplies without an approved service plan and prior authorization from the case manager leads to claim denials.
• Inadequate Delivery Proof: Audits frequently result in recoupment of funds when providers cannot produce signed and dated delivery tickets for billed equipment.
• Lapsed Accreditation: Failing to maintain active Medicare DMEPOS accreditation can result in immediate suspension of Medicaid billing privileges.

11. Key Contacts and Resources

Prospective Medical Supply Service providers should utilize the official state portals and division websites to access current manuals, fee schedules, and enrollment forms.

Maintaining contact with both DHS and DSS is essential for navigating the dual-agency oversight structure in South Dakota.

• SD DHS Division of Long-Term Services and Supports (LTSS): https://dhs.sd.gov/en/ltss
• SD DSS Medicaid Provider Enrollment Information: https://dss.sd.gov/medicaid/providers/enrollment/enrollment.aspx
• SD Medicaid Provider Enrollment (PE) Portal: https://app-dss-sw85pc05dmsproviderenroll.azurewebsites.net/
• SD Medicaid Claims and Billing Portal: https://dssapps.appssd.sd.gov/
• SD Secretary of State Business Services: https://sdsos.gov/business-services/

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