Find & Ask › South Dakota › this rule

South Dakota Medicaid Billing and Policy Manual - Personal Care Agency Services (ARSD 67:16:24:03.03; SDCL Ch. 36-9)

South Dakotasub-regulatorySouth Dakota Department of Social Services, Division of Medical Services (in coordination with the Department of Human Services, Division of Long-Term Services and Supports)

What this rule requires your agency to do

  • 1The agency must keep legible medical and financial records that fully justify and disclose the extent of services and retain them for at least 6 years after the last date a claim was paid. (SD Medicaid Billing and Policy Manual - Personal Care Agency Services (Documentation))(South Dakota Medicaid Billing and Policy Manual - Personal Care Agency Services (ARSD 67:16:24:03.03; SDCL Ch. 36-9))
  • 2The agency must ensure personal care services are provided by an individual who is qualified to provide the services and is not a member of the recipient's family. (SD Medicaid Billing and Policy Manual - Personal Care Agency Services; ARSD 67:16:24:03.03)(SD Medicaid Billing and Policy Manual - Personal Care Agency Services; ARSD 67:16:24:03.03)
  • 3The agency must not allow personal care services to be provided by a recipient's legally responsible person (such as a parent of a minor or a spouse). (SD Medicaid Billing and Policy Manual - Personal Care Agency Services)(SD Medicaid Billing and Policy Manual - Personal Care Agency Services)
  • 4The agency must ensure personal care services comply with federal Electronic Visit Verification (EVV) requirements. (SD Medicaid Billing and Policy Manual - Personal Care Agency Services (EVV))(South Dakota Medicaid Billing and Policy Manual - Personal Care Agency Services (ARSD 67:16:24:03.03; SDCL Ch. 36-9))
  • 5The agency must enroll all eligible servicing and billing providers' National Provider Identifiers (NPIs) with South Dakota Medicaid before furnishing personal care services. (SD Medicaid Billing and Policy Manual - Personal Care Agency Services (Provider Enrollment))(South Dakota Medicaid Billing and Policy Manual - Personal Care Agency Services (ARSD 67:16:24:03.03; SDCL Ch. 36-9))
  • 6The agency must sign a Purchase of Services Agreement between LTSS and the provider and establish an account in the LTSS case management system, Therap. (SD Medicaid Billing and Policy Manual - Personal Care Agency Services (LTSS Requirements))(South Dakota Medicaid Billing and Policy Manual - Personal Care Agency Services (ARSD 67:16:24:03.03; SDCL Ch. 36-9))
  • 7The agency must undergo an onsite review by the Division of Long-Term Services and Supports and successfully complete any necessary corrective actions. (SD Medicaid Billing and Policy Manual - Personal Care Agency Services (LTSS Requirements))(South Dakota Medicaid Billing and Policy Manual - Personal Care Agency Services (ARSD 67:16:24:03.03; SDCL Ch. 36-9))

Applies to: personal care

South Dakota does not impose a standalone state license on personal/non-medical home care providers through the Department of Health; instead, personal care agencies are governed as South Dakota Medicaid providers. To furnish Medicaid personal care agency services, an agency must enroll with SD Medicaid, satisfy Division of Long-Term Services and Supports (LTSS) conditions (onsite review, Purchase of Services Agreement, Therap account), and comply with service, documentation, and EVV requirements. Personal care services are defined at ARSD 67:16:24:03.03, and SDCL Ch. 36-9 governs when services must be delivered by a licensed nurse.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.