1. Program Definition and Services

Case Management Services in South Dakota provide personalized care coordination, goal planning, and community support access for individuals with disabilities and complex medical needs. The program helps participants navigate complex service systems, maximize choice, and maintain community stability. Services include:

• In-Home Support: Conducting person-centered intake assessments, drafting the initial Individualized Service Plan (ISP), coordinating crisis intervention strategies, and offering direct support navigation inside the participant’s private home
• Residential & Facility Support: Facilitating multidisciplinary team reviews, coordinating medical/behavioral specialist referrals, evaluating service quality, and monitoring care compliance within authorized residential or community habilitation settings

2. Regulations

The program is governed by the following regulations:

• Administrative Rules of South Dakota (ARSD) Chapter 46:11:05 (Developmental Disabilities Service Standards and Case Manager Rules)
• Administrative Rules of South Dakota (ARSD) Chapter 67:44 (Long-Term Services and Supports Standardized Administration)
• South Dakota Codified Laws (SDCL) Chapter 27B-2 (State Administration of Developmental Disabilities Systems)
• Federal Conflict-Free Case Management Mandates (Title 42, Code of Federal Regulations, Section 441.301(c)(1))

3. Licensing or Certification

Organizations providing case management under the CHOICES or Family Support 360 frameworks must be certified as a Community Services Provider (SP) or Community Support Provider (CSP) by the South Dakota Department of Human Services (DHS). 

4. Responsible State Agency

The South Dakota Department of Human Services (DHS) Division of Developmental Disabilities (DDD) and the South Dakota Department of Social Services (DSS)  Division of Long-Term Services and Supports (LTSS) are responsible for evaluating agency credentials, granting provider certifications, and monitoring person-centered compliance.

5. Application Process

The application process is initiated through the electronic South Dakota Medicaid Provider Enrollment Portal. Organizations must concurrently submit structural layout descriptions, conflict-of-interest mitigation policies, and proof of state-designated quality assurance accreditation to the DHS-DDD or DSS-LTSS divisions.

6. Required Documentation

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

• Signed Medicaid Provider Agreement and Conflict-Free Attestation form
• Agency-specific Case Management Services Policy & Procedure Manual
• Formal resumes, verified human services degrees, and background checks for all coordinators
• Proof of minimum professional liability, errors and omissions, and general business insurance

7. Timeline for Approval

The exact timeline for approval fluctuates based on agency capacity. Providers should contact the DHS Division of Developmental Disabilities or the DSS Division of Long-Term Services and Supports for detailed information on current organizational 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 corporate Federal Employer Identification Number (EIN), and obtain an agency Type 2 National Provider Identifier (NPI).

9. Pre-Application Training

The state hosts mandatory administrative, Therapy platform navigation, and person-centered planning onboarding modules online. Access details are distributed to qualified organization administrators once baseline portal enrollment paperwork has been validated by state specialists.

10. Additional Notes

• In accordance with ARSD 46:11:05, case managers are legally required to establish the participant's ISP team within 15 calendar days of service initiation, finalize the plan within 30 days, and implement it within 45 days
• Case managers are required to complete a formal quarterly assessment of the ISP and hold a comprehensive re-evaluation meeting with the complete team at least once every 365 days
• All case management personnel are categorized as mandatory reporters under South Dakota law and must complete verified annual training on preventing abuse, neglect, and exploitation
• Detailed electronic contact logs tracking each face-to-face visit, telephonic intervention, and referral follow-up must be securely generated within Therapy to justify Medicaid billing claims

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.

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