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South Dakota - Personal Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

South Dakota’s Department of Human Services (DHS) Division of Long Term Services and Supports (LTSS) approves agencies to deliver In-Home Personal Care Services under the HOPE Waiver and the Medicaid State Plan. Providers must first secure a Purchase of Services Agreement (contract) directly with DHS LTSS before the Department of Social Services (DSS) will accept a Medicaid Provider Enrollment application.

Agencies delivering strictly in-home personal care do not require a facility license from the South Dakota Department of Health, unlike Assisted Living or Community Living Home providers. Approval hinges on passing the LTSS policy and procedure review, registering with the Secretary of State, and adopting the state's Therap system for electronic visit verification and billing.

1. Service Definition and Scope

In South Dakota, Personal Care Services (PCS) provide hands-on assistance with activities of daily living (ADLs) such as bathing, dressing, toileting, transferring, and eating. These services are delivered in the participant's own home to maintain their independence and prevent institutionalization.

The service is funded both as an entitlement under the South Dakota Medicaid State Plan and as a Home and Community-Based Service (HCBS) under the HOPE Waiver. Providers must be capable of evaluating and considering all service referrals within their attested coverage area.

2. Regulatory and Oversight Agencies

The Department of Human Services (DHS) Division of Long Term Services and Supports (LTSS) is the primary operating agency for HCBS waivers and manages provider contracting. The Department of Social Services (DSS) serves as the single state Medicaid agency and handles the final Medicaid provider enrollment.

While the South Dakota Department of Health (SDDOH) licenses residential facilities, they do not license standalone in-home personal care agencies. Providers interact primarily with DHS LTSS for quality assurance and DSS for claims.

3. Gatekeeping Prerequisites: Who Can Even Apply

South Dakota requires a sequential approval process where a provider must obtain a Purchase of Services Agreement (contract) with DHS LTSS before applying for Medicaid enrollment. DSS will deny any Medicaid Provider Enrollment application submitted without this prior LTSS contract approval.

Out-of-state providers face an additional prerequisite: they must submit the first and last name of an individual currently residing in South Dakota who is eligible for and needs their services. If the identified individual is not eligible for HOPE Waiver services, the LTSS HCBS Out-of-State Provider Enrollment Request is denied.

4. Licensure and Certification Requirements

South Dakota does not require a specific state license from the Department of Health for agencies providing only In-Home Personal Care Services. Instead, certification is achieved through the DHS LTSS HCBS Provider Enrollment Request process.

During this process, LTSS conducts a comprehensive Policy and Procedure Review. Providers must submit their operational policies, proof of insurance, and business documentation to demonstrate compliance with state standards.

5. Medicaid Provider Enrollment

After securing the LTSS contract, agencies must enroll through the DSS Medicaid Provider Enrollment (PE) Portal. The agency enrolls using an Organizational (Type 2) NPI and a Federal Employer Identification Number (FEIN).

The PE Portal is the system of record for all enrollment updates. Providers must maintain their online enrollment records and complete any revalidation actions at least 45 days prior to deadlines.

6. Staffing, Training and Background Checks

Agencies must ensure that all personal care staff meet state qualifications and pass required background screenings before providing hands-on care. Staff must be trained in the specific ADL tasks required by the participant's person-centered service plan.

Providers are responsible for maintaining accurate staff account information within the Therap system, ensuring that only authorized personnel have access to participant records and EVV tools.

7. Documentation, Policies and Records

South Dakota mandates the use of Therap for all HCBS service documentation. Providers must use this web-based platform to document service delivery, manage Service Authorizations, and maintain participant records.

Agencies must also maintain comprehensive internal policies covering incident reporting, participant rights, and emergency procedures, which are subject to an annual LTSS HCBS QA Review Cycle.

8. Billing, Rates and Claims

Billing for Personal Care Services is conducted through the Therap system, which interfaces with the state's MMIS. Claims must be supported by compliant EVV data demonstrating the date, time, and location of service delivery.

Rates are established by DHS LTSS and are published on the LTSS Provider Portal. All Medicaid payments are issued via Electronic Funds Transfer (EFT) by DSS.

9. Approval Sequence and Timeline

The approval process begins with the submission of the LTSS HCBS Provider Enrollment Request and supporting documents. LTSS reviews the policies and issues a Purchase of Services Agreement.

Once the LTSS contract is signed, the provider registers in the DSS PE Portal and submits the Medicaid enrollment application. The entire process can take up to 3 months depending on application completeness.

10. Common Denials and Survey Findings

A frequent cause for denial is submitting the DSS Medicaid Provider Enrollment application before securing the DHS LTSS contract. DSS will automatically reject these premature applications.

During annual QA reviews, common findings include failure to maintain accurate staff rosters in Therap, missing EVV data for billed claims, and lapsed insurance certificates.

11. Key Contacts and Resources

Providers should direct contracting and policy questions to DHS LTSS, and billing or portal access questions to DSS Provider Enrollment. The Dakota at Home resource center is available for general HCBS inquiries.

Familiarity with the LTSS Provider Portal and the DSS Medicaid Provider Enrollment page is essential for maintaining active status.

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