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South Dakota - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The South Dakota Department of Human Services (DHS) Division of Long Term Services and Supports (LTSS) and the Department of Social Services (DSS) jointly approve Respite Care providers to deliver short-term caregiver relief through the HOPE, CHOICES, Family Support 360, and Assistive Daily Living Services (ADLS) waivers.

Approval requires securing a purchase of services agreement with DHS LTSS before applying for Medicaid billing privileges through DSS. Agencies seeking to provide Residential Respite Care must first obtain a facility license from the South Dakota Department of Health (SDDOH) as an Assisted Living Center or Community Living Home before DHS LTSS will accept their enrollment request.

1. Service Definition and Scope

In South Dakota, Respite Care provides short-term relief to an unpaid primary caregiver, ensuring the waiver participant continues to receive necessary supervision and support. The service is authorized intermittently based on the individual's Person-Centered Plan of Care.

The state distinguishes between In-Home Respite, delivered in the participant's private residence, and Residential Respite Care, delivered in a licensed facility setting.

2. Regulatory and Oversight Agencies

The Department of Human Services (DHS) Division of Long Term Services and Supports (LTSS) manages provider contracting, policy review, and quality assurance for HCBS waivers. The Department of Social Services (DSS) administers the Medicaid program, handling final provider enrollment and claims processing.

For facility-based respite, the South Dakota Department of Health (SDDOH) serves as the primary licensing authority.

3. Gatekeeping Prerequisites: Who Can Even Apply

South Dakota utilizes a strict sequential gatekeeping process for HCBS enrollment. Providers cannot apply directly to Medicaid; they must first pass LTSS review and secure a contract.

Additionally, out-of-state providers face a specific client-identification prerequisite before their application will be reviewed.

4. Licensure and Certification Requirements

South Dakota does not issue a distinct "Respite Care License." Instead, In-Home Respite providers are certified through the DHS LTSS enrollment and policy review process.

Residential Respite providers rely on their underlying SDDOH facility license and must comply with federal community integration standards.

5. Medicaid Provider Enrollment

Once the DHS LTSS contract is executed, providers must enroll through the DSS Provider Enrollment (PE) Portal to obtain billing privileges.

The PE Portal is the system of record for all South Dakota Medicaid enrollments and requires specific organizational and financial documentation.

6. Staffing, Training and Background Checks

Respite staff must be qualified to safely substitute for the primary caregiver. Facility-based staff follow the regulations of their specific SDDOH facility license.

Agencies must also ensure proper insurance coverage if transportation is part of the service delivery.

7. Documentation, Policies and Records

Providers must maintain records demonstrating that service delivery aligns with the participant's Person-Centered Plan of Care.

DHS LTSS conducts periodic Quality Assurance (QA) reviews based on the type of respite service provided.

8. Billing, Rates and Claims

Claims are submitted to the DSS MMIS system. Rates are standardized by DHS and published for provider reference.

Providers must adhere to timely filing deadlines to ensure claims are not denied.

9. Approval Sequence and Timeline

The approval process in South Dakota is strictly sequential. Providers must complete facility licensure (if applicable) and LTSS contracting before accessing the Medicaid portal.

The LTSS HCBS Provider Enrollment Manual outlines these steps, with recent updates effective May 1, 2026.

10. Common Denials and Survey Findings

Applications are frequently rejected if providers attempt to bypass the LTSS contracting phase or fail to secure underlying facility licenses.

Administrative errors during the contracting phase also cause significant delays.

11. Key Contacts and Resources

Providers must interact with multiple state agencies to complete the enrollment process.

Once approved, providers are also required to list their services in the state's public resource directory.

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