1. Program Definition and Services

Personal Care Services (PCS) in South Dakota provide non-skilled, non-medical assistance to individuals with disabilities, chronic conditions, or age-related limitations to help them complete essential activities of daily living (ADLs) in their home or residence. Services include:

• Bathing and grooming assistance
• Dressing and toileting help
• Meal preparation and feeding support
• Mobility and transfer assistance
• Medication reminders (not administration)
• Light housekeeping related to ADLs
• Documentation of care via daily care logs, time records, and case manager communication

2. Regulations

Personal Care Services are authorized and governed under federal and state rules, specifically the Medicaid State Plan benefits and various Home and Community-Based Services (HCBS) Waivers approved by the Centers for Medicare & Medicaid Services (CMS).

3. Licensing or Certification

Providers must complete specific state approval and enrollment prerequisites, which include:

• Registering the business entity with the South Dakota Secretary of State
• Obtaining an Employer Identification Number (EIN) and a Type 2 National Provider Identifier (NPI)
• Enrolling and obtaining confirmation as an approved Medicaid PCS provider with DSS or DHS-DDD
• Developing a comprehensive Personal Care Services Policy & Procedure Manual
• Securing professional liability and workers’ compensation insurance

4. Responsible State Agency

Multiple agencies oversee and govern Personal Care Services depending on the targeted waiver program:

• South Dakota Department of Social Services (DSS) – Division of Long-Term Services and Supports (LTSS): Administers services under the Medicaid State Plan and for older adults
• South Dakota Department of Human Services (DHS) – Division of Developmental Disabilities (DDD): Oversees delivery under developmental disability waivers
• Centers for Medicare & Medicaid Services (CMS): Ensures federal regulatory and compliance oversight

5. Application Process

The provider enrollment and deployment process moves through the following workflow:

• Register the business and obtain an EIN and Type 2 NPI
•  Apply to DSS-LTSS or DHS-DDD based on the target participant population
• Submit required staff credentials, policy manuals, and service documentation samples
• Complete the state-mandated readiness review and secure official approval
• Begin accepting service authorizations and participant referrals from waiver case managers

6. Required Documentation

Applicants and providers must maintain and submit:

• EIN, NPI, and formal business registration documents
• Medicaid provider approval confirmation
• Liability and workers’ compensation insurance certificates
• A Policy & Procedure Manual containing: participant intake/ADL assessment templates, daily service logs, participant rights/HIPAA policies, emergency backup/critical incident response plans, and billing verification forms
• Staff files including background checks, CPR/First Aid certifications, and training logs

7. Timeline for Approval

The estimated timeline to launch spans several distinct phases:

• Business Setup & Manual Development: 1–2 months
• Medicaid Enrollment & Staff Credentialing: 2–3 months
• Training & Documentation Readiness: 30–60 days
• Service Launch: Immediately upon receiving state approval and participant referral.

8. Pre-Application Process

Before initiating the provider application, businesses must establish their legal infrastructure, secure necessary identifiers (EIN/NPI), and ensure they have a fully developed, state-compliant Policy & Procedure Manual ready for evaluation.

9. Pre-Application Training

While formal pre-application training for agency owners is integrated into the readiness review, all hired Direct Support Staff/Personal Care Aides must complete mandatory onboarding training before delivering services. This training covers:

• Assistance with ADLs
• Abuse, neglect, and exploitation prevention
• Participant rights and confidentiality (HIPAA)
• Emergency response and critical incident procedures
• Annual in-service evaluations

10. Additional Notes

• Services are specifically designed to support daily independence, improve quality of life, and reduce the caregiving burden on families
• PCS can be authorized through multiple specialized programs, including the CHOICES Waiver (intellectual/developmental disabilities), Family Support 360 Waiver (children and adults in family homes), LTSS HCBS Waiver (seniors and adults with physical limitations), Medicaid State Plan PCS, and TEFRA/EPSDT (individuals under 21)

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.

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