1. Program Definition and Services

Skilled Nursing Services in South Dakota provide direct medical care to individuals with chronic conditions, complex needs, or disabilities. The program aims to deliver medically necessary care through licensed nursing professionals in home and community settings, allowing individuals to receive clinical oversight while avoiding institutionalization. Services include:

• In-Home Support: Medication administration, wound care, tube feedings, and tracheostomy care delivered by an RN or LPN directly within the individual’s private or family home
• Residential & Facility Support: Health status reporting, care plan implementation, chronic disease monitoring, and clinical coordination within authorized community-based or waiver-supported settings

2. Regulations

The program is governed by the following regulations:

• Administrative Rules of South Dakota (ARSD) Chapter 67:16:05 (Medicaid Home Health Services and Skilled Nursing Limits)
• Administrative Rules of South Dakota (ARSD) Chapter 46:11 (Community Services Providers Regulations)
• South Dakota Codified Laws (SDCL) Chapter 36-9 (South Dakota Nursing Practice Act)
• Title 42, Code of Federal Regulations, Section 484 (Federal Conditions of Participation for Home Health Agencies)

3. Licensing or Certification

Providers must be enrolled as active Medicaid Home Health agencies or approved waiver-based nursing entities recognized by the South Dakota Department of Social Services (DSS) or Department of Human Services (DHS). All clinical operations must strictly employ or contract professionals possessing valid credentials issued by the South Dakota Board of Nursing.

4. Responsible State Agency

The South Dakota Department of Social Services (DSS) , Division of Long-Term Services and Supports (LTSS) and the South Dakota Department of Human Services (DHS), Division of Developmental Disabilities (DDD) are responsible for evaluating applications, verifying nursing infrastructure, and certifying skilled nursing providers.

5. Application Process

The application process is conducted through the electronic South Dakota Medicaid Provider Enrollment (PE) Portal. Providers must complete data capture, link required clinical taxonomy codes, and upload formal entity documents online to initiate the official state enrollment process.

6. Required Documentation

While specific documentation requirements vary based on the target waiver, providers typically need to submit:

• Proof of compliance with state safety and South Dakota Board of Nursing practice rules
• Agency-specific Skilled Nursing Policy & Procedure Manual
• Verified copies of active clinical licenses (RN/LPN) and staff competency logs
• Proof of professional malpractice, general liability, and workers' compensation insurance

7. Timeline for Approval

The exact timeline for approval fluctuates based on agency capacity. Providers should contact the DSS Division of Long-Term Services and Supports or the DHS Division of Developmental Disabilities for detailed information on current processing timeframes.

8. Pre-Application Process

Prospective providers must complete specific foundation tasks before applying. They must establish their business entity with the South Dakota Secretary of State, secure a Federal Employer Identification Number (EIN), and obtain a corporate Type 2 National Provider Identifier (NPI).

9. Pre-Application Training

The state hosts mandatory administrative, electronic billing, and program compliance onboarding sessions online. Access details are sent to qualified clinical applicants once preliminary portal paperwork and credentials are reviewed.

10. Additional Notes

• Providers must ensure all nursing care plans are reviewed, signed, and recertified by the attending physician or authorized practitioner every 60 days
• In-home skilled nursing services must be billed utilizing the correct 15-minute unit codes and appropriate billing modifiers as outlined in the state fee schedule
• All direct care RNs, LPNs, and clinical supervisors must clear mandatory fingerprint-based criminal background checks prior to service delivery
• Providers must maintain detailed records of daily nursing notes, medication administration logs, and physician orders for Medicaid compliance audits

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

To get started, click the link to request portal access.