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South Dakota - Skilled Respite Service — 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) authorizes respite care under the HOPE Waiver using procedure code T1005, with skilled nursing tasks delegated to or performed by licensed nurses under a Home Health Agency or Nursing Facility license. South Dakota does not license a standalone "Skilled Respite" service category; instead, agencies utilize standard Respite or Residential Respite codes while deploying licensed clinical staff to meet complex medical needs.

Approval requires a strict sequential process where providers must first secure appropriate facility or agency licensure from the South Dakota Department of Health (SDDOH), followed by an approved LTSS Initial Enrollment and a purchase of services contract. Only after the LTSS contract is fully executed can an agency submit an application through the Department of Social Services (DSS) Medicaid Provider Enrollment portal.

1. Service Definition and Scope

In South Dakota, respite is a service furnished on a short-term basis for the relief of primary caregivers. Because the state does not have a distinct "Skilled Respite" waiver service, providers serving individuals with complex medical needs utilize standard HCBS Respite authorizations but staff the service with RNs or LPNs operating under a clinical agency license.

This service can be delivered in the member's private residence or in a licensed residential setting. In-home respite is subject to federal Electronic Visit Verification (EVV) mandates.

2. Regulatory and Oversight Agencies

Three distinct state departments govern the approval and oversight of this service. The South Dakota Department of Health (SDDOH) handles the clinical licensure of the agency or facility.

The Department of Human Services (DHS) Division of Long Term Services and Supports (LTSS) manages waiver contracting and case management systems, while the Department of Social Services (DSS) operates the Medicaid Management Information System (MMIS) and provider enrollment.

3. Gatekeeping Prerequisites: Who Can Even Apply

South Dakota enforces a strict sequential gatekeeping mechanism for HCBS waiver providers. A provider cannot apply for Medicaid enrollment without an active LTSS contract, and cannot obtain an LTSS contract without first holding the appropriate SDDOH license.

Failure to complete SDDOH licensure prior to submission of the LTSS HCBS Provider Enrollment Request results in immediate discontinuation and denial of the LTSS enrollment process.

4. Licensure and Certification Requirements

Because skilled nursing tasks are involved, the provider entity must be licensed by the SDDOH Office of Health Facilities Licensure and Certification. This typically takes the form of a Home Health Agency license for in-home delivery or an Assisted Living Center/Nursing Facility license for residential delivery.

Providers must also complete an LTSS HCBS Provider Self-Assessment and undergo a policy review by DHS LTSS.

5. Medicaid Provider Enrollment

Once the LTSS contract is secured, the agency must enroll through the DSS Medicaid Provider Enrollment (PE) Portal. The PE Portal is the system of record for all new enrollments and updates.

Enrollment records are generally reviewed in the order received. The initial registration grants Provider Admin rights to the registered Billing NPI and must be completed by a provider staff member, not an external credentialing entity.

6. Staffing, Training and Background Checks

Direct care staff performing skilled tasks must hold active nursing licenses (RN or LPN) verified through the South Dakota Board of Nursing. All staff must pass rigorous background checks.

Agencies are federally required to monitor the Office of the Inspector General (OIG) exclusion list to ensure no staff are barred from participating in Medicaid programs.

7. Documentation, Policies and Records

South Dakota utilizes Therap as its web-based case management, service documentation, and billing platform for LTSS providers. Providers must maintain accurate agency and staff account information within Therap.

Agencies must also submit a Provider Inclusion Form to be listed in the Dakota at Home Resource Directory, ensuring public access to their service information.

8. Billing, Rates and Claims

Providers bill for HOPE Waiver respite services through the Therap system, which interfaces with the DSS MMIS for payment. All Medicaid payments are made via Electronic Funds Transfer (EFT).

In-home respite (T1005) requires Electronic Visit Verification (EVV) data to support claims submission.

9. Approval Sequence and Timeline

The approval timeline is dictated by the sequential nature of the requirements. SDDOH licensure must be fully complete before DHS LTSS will review the enrollment request.

After LTSS approves the request and executes a contract, the DSS Medicaid PE Portal application is submitted. Finally, LTSS initiates Therap account setup and provides system training.

10. Common Denials and Survey Findings

The most frequent cause for application denial is attempting to bypass the sequential gatekeeping process. DSS will deny Medicaid enrollment applications if the provider does not have an executed LTSS contract.

Similarly, LTSS will discontinue enrollment if the provider applies without the prerequisite SDDOH license. Post-enrollment, failing to check the OIG LEIE database every six months is a critical survey deficiency.

11. Key Contacts and Resources

Providers must navigate multiple state portals to complete enrollment. The DSS Provider Enrollment Portal is used for Medicaid billing credentials, while the DHS LTSS site houses waiver manuals and contract information.

The OIG LEIE database must be used for mandatory ongoing staff background checks.

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