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

Last reviewed: 2026-09-10

South Dakota’s HOPE Waiver funds durable medical equipment and disposable supplies through the Division of Long Term Services and Supports (LTSS), requiring providers to first secure an LTSS purchase-of-services agreement before applying to the Medicaid Provider Enrollment (PE) Portal.

Approval hinges on submitting the LTSS HCBS Provider Enrollment Request and adopting the Therap system for service documentation and billing. Out-of-state suppliers face a strict intake requirement, as they must identify a specific, eligible South Dakota resident currently needing their services before an enrollment request is even processed.

1. Service Definition and Scope

Under the South Dakota HOPE Waiver, this service encompasses durable medical equipment, prosthetics, orthotics, and disposable supplies (DMEPOS) furnished, fitted, and serviced for waiver participants. These items are designed to increase a participant's ability to perform activities of daily living or perceive, control, or communicate with the environment in which they live.

The service is strictly limited to items specified in the participant's approved plan of care. It excludes items that are not of direct medical or remedial benefit to the participant or those that are covered under the Medicaid State Plan.

• Service Name: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).
• Taxonomy Code: 332B00000X (durable medical equip & supplies).
• Target Population: South Dakotans 60 years of age and older, and 18 years of age and older with disabilities enrolled in the HOPE Waiver.
• Covered Items: Devices, controls, appliances, and disposable medical supplies authorized by the participant's care plan.
• Exclusions: Items covered by standard Medicaid State Plan benefits or Medicare must be exhausted before waiver funds are utilized.

2. Regulatory and Oversight Agencies

The Department of Human Services (DHS) Division of Long Term Services and Supports (LTSS) manages the HOPE waiver, processes initial HCBS enrollment requests, and executes the required purchase-of-services agreements.

The Department of Social Services (DSS) oversees the actual Medicaid enrollment process and maintains the Medicaid Provider Enrollment (PE) Portal.

• Department of Human Services (DHS) Division of Long Term Services and Supports (LTSS): Manages waiver operations and provider contracts (https://dhs.sd.gov/ltss).
• Department of Social Services (DSS): Administers the Medicaid Provider Enrollment (PE) Portal (https://dss.sd.gov/medicaid/providers/enrollment/enrollment.aspx).
• Dakota at Home: Maintains the Resource Directory where approved LTSS providers are listed (https://dakotaathome.org).
• Centers for Medicare & Medicaid Services (CMS): Establishes the baseline federal standards for DMEPOS suppliers (https://www.cms.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

South Dakota enforces a strict sequencing gate for HCBS waiver providers: an applicant cannot simply enroll in Medicaid as a waiver provider. They must first apply to and be approved by DHS LTSS for a purchase-of-services agreement.

For out-of-state medical supply companies, the state imposes a specific client-identification gate. The agency will not process speculative out-of-state enrollments; the supplier must already have a South Dakota resident seeking their specific services.

• LTSS Contract Precondition: Providers must receive approval of the LTSS Initial Enrollment process and ensure a purchase of services agreement is in place with DHS LTSS before submitting an application through the SD Medicaid Provider Enrollment portal.
• Out-of-State Resident Requirement: Out-of-state providers must submit the first and last name of a South Dakota resident currently needing their services on the LTSS HCBS Out-of-State Provider Enrollment Request.
• Business Registration: The entity must be a registered business with the South Dakota Secretary of State’s office.
• NPI Requirement: The applicant must possess an Organizational (Type 2) National Provider Identifier (NPI) tied to a FEIN as the IRS tax identifier.

4. Licensure and Certification Requirements

The South Dakota Department of Health (DOH) does not issue a specific state facility license for Medical Supply or DMEPOS providers, unlike the licenses required for Assisted Living Centers or Community Living Homes.

Instead of a state-specific DMEPOS license, South Dakota relies on federal Medicare DMEPOS supplier standards, active business registration, and the LTSS contracting process to vet medical supply providers.

• State Licensure Exemption: No specific South Dakota DOH facility license is required to operate as a medical supply/DMEPOS provider.
• Medicare Certification: Providers typically must meet federal Medicare DMEPOS supplier standards and maintain active Medicare enrollment.
• Secretary of State Registration: Providers must maintain active, good-standing business registration in South Dakota.
• Insurance Coverages: Providers must submit certificates of insurance, including auto liability if the company utilizes vehicles for local delivery of supplies.

5. Medicaid Provider Enrollment

Once the LTSS contract is secured, the provider must complete their enrollment through the South Dakota Medicaid Provider Enrollment (PE) Portal. The portal serves as the system of record for all enrolled billing entities.

Providers must enroll using an Organizational (Type 2) NPI and submit specific financial and disclosure documentation to facilitate electronic payments.

• System of Record: Applications must be submitted through the South Dakota Medicaid Provider Enrollment (PE) Portal.
• Entity NPI Enrollment: Requires an Organizational (Type 2) NPI and a FEIN tied to the legal business name.
• Required Forms: Applicants must upload the signed SD Medicaid Provider Agreement and the Ownership/Controlling Interest Disclosure form.
• Financial Setup: A letter from a financial institution is required to support online payment details, as all payments are made via Electronic Funds Transfer (EFT).
• Portal Access: Initial registration grants Provider Admin rights to the registered Billing NPI, which must be completed by a provider staff member, not an external credentialing entity.

6. Staffing, Training and Background Checks

Because medical supply services primarily involve the provision of goods rather than direct, hands-on personal care, staffing requirements focus on delivery logistics, proper fitting of equipment, and system access.

Providers are responsible for ensuring that any staff member interacting with the state's case management system or delivering goods to a participant's home meets basic competency and background standards.

• Therap System Access: Providers must maintain accurate agency and staff account information within the Therap system and ensure appropriate staff access.
• Delivery Personnel: Staff operating company or personal vehicles for work-related travel and delivery must hold valid driver's licenses and auto liability insurance.
• Fitting Qualifications: Staff responsible for fitting custom orthotics or prosthetics must hold appropriate national certifications (e.g., ABC or BOC) as dictated by Medicare standards.
• Background Screening: Standard agency background checks apply to any staff member entering a waiver participant's home to deliver or set up equipment.

7. Documentation, Policies and Records

South Dakota mandates the use of Therap, a web-based case management and billing platform, for all LTSS HCBS providers. Providers must use this system to manage authorizations and document service delivery.

Agencies must also maintain strict administrative records with the state, particularly regarding tax status and any changes in business ownership.

• Therap Utilization: Providers must use Therap to document service delivery, manage Service Authorizations, and maintain required participant documentation.
• Change of Ownership (CHOW): The sale or transfer of ownership requires at least 30 days' advance written notice to LTSS before the effective date.
• W-9 Maintenance: A compliant W-9 must be maintained with LTSS to ensure the purchase of services agreement remains valid.
• Resource Directory Inclusion: Providers must submit a Provider Inclusion Form to the Dakota at Home Resource Directory to be visible to case managers and participants.

8. Billing, Rates and Claims

Billing for HOPE Waiver medical supplies is conducted through the Therap platform, which interfaces with the state's MMIS. Providers must ensure they bill using the exact taxonomy code approved during enrollment.

Reimbursement rates for waiver services are published by LTSS, though DMEPOS items often require manual pricing or prior authorization based on the specific invoice cost of the item.

• Billing Platform: Therap is the mandatory platform used to complete billing-related activities for LTSS HCBS services.
• Taxonomy Requirement: Claims must be submitted using the 332B00000X taxonomy code for durable medical equipment and supplies.
• Rate Publication: All rates for LTSS services are located on the LTSS Provider Portal; they serve as informational resources and do not guarantee payment at specific rates.
• Payment Method: All Medicaid payments are disbursed via Electronic Funds Transfer (EFT) directly to the Billing NPI's associated bank account.
• Prior Authorization: Many DMEPOS items, especially custom equipment or out-of-state services, require prior authorization before delivery and billing.

9. Approval Sequence and Timeline

The approval process is strictly sequential. Providers must clear the DHS LTSS contracting phase before the DSS Medicaid enrollment phase can begin.

Attempting to bypass the LTSS contract and apply directly to Medicaid will result in immediate denial of the PE Portal application.

• Step 1: Submit the LTSS HCBS Provider Enrollment Request online (including the specific resident name if out-of-state).
• Step 2: LTSS Contracts team contacts the provider to obtain certificates of insurance and a W-9.
• Step 3: Execute the LTSS purchase-of-services agreement.
• Step 4: Submit the formal application through the SD Medicaid Provider Enrollment (PE) Portal.
• Step 5: Register for Therap accounts and configure staff access to receive participant referrals and service authorizations.

10. Common Denials and Survey Findings

Enrollment delays for medical supply providers in South Dakota frequently stem from procedural sequencing errors or incomplete out-of-state intake forms.

Because the state relies heavily on the PE Portal for accurate entity data, minor discrepancies in tax identification or taxonomy codes will trigger application rejections.

• Premature PE Portal Submission: Medicaid applications are routinely denied if submitted before the LTSS purchase of services agreement is fully executed.
• Ineligible Out-of-State Referral: Out-of-state applications are denied if the identified South Dakota resident is determined ineligible for HOPE Waiver services.
• Missing Taxonomy: Applications are rejected for failing to select the required 332B00000X taxonomy code for DMEPOS.
• Incomplete Ownership Disclosure: Delays occur when providers fail to list all individuals with ownership or controlling interest on the required Disclosure form.
• Therap Non-Compliance: Failure to maintain accurate agency and staff account information within Therap prevents the receipt of service authorizations.

11. Key Contacts and Resources

Providers should utilize the official state portals for both DHS LTSS and DSS Medicaid to access current manuals, forms, and system login pages.

Technical assistance for the Medicaid enrollment portal is handled by the DSS online portal help desk.

• SD Medicaid Provider Enrollment Portal: https://dss.sd.gov/medicaid/providers/enrollment/enrollment.aspx
• DHS Division of Long Term Services and Supports (LTSS): https://dhs.sd.gov/ltss
• Therap Services (SD Portal): https://www.therapservices.net
• Dakota at Home Resource Directory: https://dakotaathome.org
• Medicaid Portal Help Desk: [email protected]

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