1. Program Definition and Services

Specialized Therapy Services in South Dakota deliver licensed therapeutic interventions to support functional independence and an enhanced quality of life. The program focuses on helping individuals achieve developmental milestones, regain skills, and safely live in the community. Services include:

• In-Home Support: Direct clinical physical therapy (PT), occupational therapy (OT), or speech-language pathology (SLP) sessions, plan of care updates, and caregiver training provided within the participant's family home
• Residential & Facility Support: Specialized mobility training, fine motor exercise programs, communication system setup, and treatment coordination delivered in licensed residential or habilitation environments

2. Regulations

The program is governed by the following regulations:

• Administrative Rules of South Dakota (ARSD) Article 67:16 (South Dakota Medicaid Covered Medical Services Parameters)
• Administrative Rules of South Dakota (ARSD) Chapter 67:54:09 (Family Support 360 Waiver Operational Guidelines)
• South Dakota Codified Laws (SDCL) Title 36, Chapters 36-10 (Physical Therapists), 36-31 (Occupational Therapists), and 36-37 (Speech-Language Pathologists)
• Title 42, Code of Federal Regulations, Section 440.110 (Federal Definitions for Physical Therapy, Occupational Therapy, and Speech Pathology Services)

3. Licensing or Certification

Providers must ensure that all practicing clinicians possess active, unrestricted professional licenses issued by the South Dakota Board of Examiners for Physical Therapy, the South Dakota Board of Medical and Osteopathic Examiners (for OT), or the South Dakota State Board of Examiners for Speech-Language Pathology. The agency must be actively enrolled as a Medicaid or waiver-approved service vendor.

4. Responsible State Agency

The South Dakota Department of Social Services (DSS),  Medical Services Division, and the South Dakota Department of Human Services (DHS) , Division of Developmental Disabilities (DDD) are responsible for verifying professional licensure registries, reviewing corporate provider applications, and monitoring specialized therapy programmatic compliance.

5. Application Process

The application process is conducted through the electronic South Dakota Medicaid Provider Enrollment Portal. Organizations must complete individual credential linking for each employed or contracted therapist, attach national provider credentials, and submit formal agency configuration packets online to secure authorization.

6. Required Documentation

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

• Verified copies of valid South Dakota state professional licenses for all clinical personnel
• Agency-specific Specialized Therapy Services Policy & Procedure Manual
• National Provider Identifier (NPI) registry confirmations for each therapist and the parent clinic
• Proof of professional malpractice, general liability, and workers' compensation insurance coverage

7. Timeline for Approval

The exact timeline for approval fluctuates based on agency capacity. Providers should contact the DSS Medical Services Division or the DHS Division of Developmental Disabilities for detailed information on current clinical credentialing and enrollment 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 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, electronic claims submission, and billing compliance onboarding modules online. Access details are sent to qualified clinical organizations once baseline provider enrollment documentation has been received and logged by state reviewers.

10. Additional Notes

• Every specialized therapy intervention plan must be driven by a comprehensive assessment and backed by an authorized physician’s order or prescription renewed every 60 to 90 days
• Therapists must maintain distinct, daily clinical documentation containing measurable goal progress, explicit session durations, and official provider electronic signatures
• All clinicians, assistants, and therapy coordinators must pass mandatory state fingerprint-based criminal clearances and child/adult abuse registry checks prior to client contact
• Services must be authorized through the participant's person-centered Individualized Support Plan (ISP) or care plan and must respect any annual fiscal cap limits specified under the regional waiver rules

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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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