Adult Day Care Regulations in South Dakota

Who regulates adult day care in South Dakota

The Department of Human Services (DHS), Division of Long Term Services and Supports (LTSS) operates the HOPE waiver and approves and contracts with the adult day providers that serve its participants. South Dakota Medicaid, part of the Department of Social Services (DSS), enrolls those providers and pays their claims.

The Department of Health's list of licensed facility types does not include adult day centers, and the health care facility definitions in SDCL 34-12-1.1 do not include adult day care. If you plan to operate inside a licensed facility or serve only private-pay participants, confirm any requirements with the Department of Health and DHS.

Types of adult day programs in South Dakota

South Dakota's rules use the term adult day services. ARSD 67:44:03:01 defines it as regular care, supervision and structured activities in a non-institutional, community-based setting, including the health and social services needed to ensure a participant's optimal functioning, for less than 24 hours per day.

The HOPE waiver billing manual adds that adult day services are for participants who live at home and that nursing is not required. When a center provides nursing based on assessed need, it includes health screenings, blood pressure checks, medication management and a general assessment of the participant's condition.

Opening an adult day center in South Dakota

To serve HOPE waiver participants, a center goes through DHS LTSS and SD Medicaid. The SD Medicaid Billing and Policy Manual for the HOPE Waiver lists these steps:

1. Submit the LTSS HCBS Provider Enrollment Request.
2. Complete an LTSS onsite review of your location, then a self-assessment and policy verification. Requirements are set out in the service-specific LTSS Provider Provisions.
3. Pass the HCBS Settings Final Rule review, which is required for adult day providers.
4. Sign a contract with DHS/LTSS. A current contract is required before SD Medicaid will approve your enrollment.
5. Enroll your billing and servicing NPIs in the SD Medicaid Provider Enrollment Portal. The portal has no application fee, and records must be completed within 30 days of starting.
6. Set up your Therap account and complete Therap training. Services cannot begin until the contract, Medicaid enrollment and DHS/LTSS authorization are all in place.

Key requirements

• Care planning: services must follow an Individual Support Plan finalized before services begin and reviewed at least annually. Services must be authorized and acknowledged in Therap before delivery, or claims will be denied.
• Meals and bathing: both are billed as separate services. Bathing must be authorized, and the provider must have taxonomy 253Z00000Z on its SD Medicaid record when it provides bathing.
• Assisted living residents: adult day for residents of an assisted living center or community living home must come from a HOPE Waiver-approved adult day provider, not the residence. The residence must arrange or provide non-medical transportation, and adult day cannot be used only for bathing.
• Settings rule: DHS assesses adult day centers for compliance with the federal HCBS Settings Final Rule, as described in its HCBS Settings Guide to Expectations and Compliance (revised September 30, 2022).
• Records: keep records that fully justify each service for at least 6 years after the last date a claim was paid or denied.

Medicaid funding for adult day in South Dakota

Adult day services are a covered service of the HOPE waiver (Home-and-Community-Based Options and Person-Centered Excellence), one of South Dakota's four Medicaid 1915(c) waivers. ARSD 67:44:03:06, amended effective September 30, 2024, lists adult day services among the covered services.

The waiver serves people age 65 and older and adults 18 and older with a qualifying disability who meet nursing facility level of care and the program's financial rules. Participants may have a cost share. SD Medicaid deducts the cost share from the provider's payment, and the provider collects that amount from the participant.

Billing basics

The HOPE manual lists procedure code S5100 for adult day, with taxonomy 261QA0600X. The manual does not state the billing unit, so check the HOPE Waiver fee schedule posted on the SD Medicaid fee schedules page.

HOPE claims must be billed in Therap, on a CMS 1500 claim form or as an 837P electronic transaction. Claims can also go through the SD Medicaid Portal or a compliant third-party solution, and they must be received within 6 months after the month of service. Under ARSD 67:44:03:11, payment is limited to the lesser of your usual and customary fee or the fee on the department's website.

Adult day (S5100) is not an EVV service in the HOPE manual. The exception is bathing: when you provide authorized bathing, you must collect EVV data.

Other ways centers are paid

Enrolled veterans who meet VA eligibility and clinical criteria can get Adult Day Health Care through the VA, which may be provided at VA medical centers, State Veterans Homes or community organizations.

Official resources

• DHS Division of Long Term Services and Supports
• DHS HOPE Waiver
• SD Medicaid Billing and Policy Manual: HOPE Waiver
• SD Medicaid Billing and Policy Manual: Electronic Visit Verification
• ARSD Chapter 67:44:03: HOPE Waiver
• SD Medicaid Provider Enrollment
• SD Medicaid Fee Schedules
• SD Medicaid Home and Community Based Services
• Department of Health Health Facility Licensure
• VA Adult Day Health Care
• National Adult Day Services Association

Frequently asked questions

Do I need a license to open an adult day center in South Dakota?

The Department of Health's licensed facility types do not include adult day centers. To serve HOPE waiver participants, you need an LTSS enrollment review, a DHS/LTSS contract, an HCBS Settings review and SD Medicaid enrollment. Confirm any other requirements with the Department of Health and DHS.

Does South Dakota Medicaid pay for adult day care?

Yes. Adult day services are covered under the HOPE waiver for eligible older adults and adults with qualifying disabilities. Providers bill SD Medicaid through Therap, the SD Medicaid Portal, a CMS 1500 form or an 837P transaction.

Who reviews adult day centers in South Dakota?

DHS LTSS conducts an onsite location review and an HCBS Settings Final Rule review before approval, and it shares oversight of HOPE waiver providers with SD Medicaid.

Does EVV apply to adult day in South Dakota?

Not for the adult day service itself. The HOPE manual lists adult day (S5100) as not EVV-required, but EVV data must be collected when a center provides authorized bathing.