1. Program Definition and Services

Adult Day Services (ADS) in South Dakota provide structured, non-residential programming, care, and supervision during daytime hours for adults with physical, cognitive, or behavioral health conditions. The program promotes community-based independence, social interaction, and health monitoring while offering essential respite for primary caregivers. Services include:

• In-Home Support:  All standard care routines are delivered exclusively within a group setting outside of the participant’s home environment.
• Residential & Facility Support: Supervision, structured recreational/social activities, personal care assistance (toileting, grooming), nutritional support, and localized center-based health or medication monitoring.

2. Regulations

The program is governed by the following regulations:

• Administrative Rules of South Dakota (ARSD) Chapter 67:40:15 (Adult Day Services Guidelines and Contract Standards)
• Administrative Rules of South Dakota (ARSD) Chapter 67:44 (Long-Term Services and Supports Provider Requirements)
• South Dakota Codified Laws (SDCL) Chapter 22-46 (Abuse, Neglect, and Exploitation of Vulnerable Adults Mandatory Reporting Laws)
• Federal Home and Community-Based Services (HCBS) Settings Final Rule (Title 42, Code of Federal Regulations, Section 441.301)

3. Licensing or Certification

South Dakota does not enforce a generic standalone facility license for adult day care. Instead, operational approval is granted via a formalized state contracting agreement. Providers must satisfy all baseline health, sanitation, and safety standards verified by the Department of Social Services (DSS) and maintain an approved Purchase of Services contract under the HOPE Waiver.

4. Responsible State Agency

The South Dakota Department of Human Services (DHS),  Division of Long-Term Services and Supports (LTSS) and the South Dakota Department of Social Services (DSS) , Medical Services Division, are collectively responsible for reviewing contract applications, conducting pre-service facility surveys, and administering provider enrollment.

5. Application Process

The application process is initiated by contacting DHS/LTSS (often through the Dakota at Home network) to complete a preliminary contract review. Upon executing the state Purchase of Services agreement, the agency applies for formal enrollment through the South Dakota Medicaid Provider Portal.

6. Required Documentation

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

• Signed copy of the DHS/LTSS Purchase of Services contract
• Agency-specific Adult Day Services Policy & Procedure Manual
• Proof of facility compliance with sanitation guidelines and building fire safety regulations
• Staff qualification records, CPR/First Aid certifications, and professional liability insurance certificates

7. Timeline for Approval

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

8. Pre-Application Process

Prospective providers must complete specific foundation tasks before applying. They must register 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 Visit Verification (EVV), and electronic documentation onboarding training. Qualified center operators receive direct invitation credentials via Therap once preliminary enrollment documentation is acknowledged by the state.

10. Additional Notes

• Providers must maintain a baseline staff-to-participant ratio of 1:6 (this drops to 1:4 if serving a highly impaired or memory care-intensive population)
• Centers must provide a minimum of 10 cumulative hours of consulting or screening services from a licensed nurse (RN or LPN) per calendar month
• All adult day personnel are classified as mandatory abuse reporters under South Dakota law and must complete annual abuse registry clearances
• Services must be authorized through the participant's person-centered Individualized Support Plan (ISP) and verified within Therapy prior to billing

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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.

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