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SD Department of Human Services Division of Long Term Services and Supports

HCBS@state.sd.us

3800 Highway 34 , c/o 500 East Capitol Ave., Pierre, SD, 57501, US

605-773-5990

LTSS HCBS Out-of-State Provider Enrollment Request

Thank you for your interest in becoming a Home and Community-Based Services Provider for consumers of the SD Division of Long-Term Services and Supports (LTSS).

Providers are encouraged to review the LTSS HCBS Provider Enrollment Manual and the service-specific Provider Provisions they intend to serve prior to completing the LTSS HCBS Enrollment Request.

In order to initiate the process to be a provider and have the capacity to accept all LTSS referrals, complete the LTSS HCBS Enrollment Request and submit required policies as outlined in the service-specific Provider Provisions.

Visit DHS/LTSS Provider Resources page for LTSS Provider Provisions and LTSS HCBS Enrollment Manual.

In order for LTSS to proceed with LTSS HCBS services enrollment, there must be an identified need for service in South Dakota and the provider must be providing services to a HOPE Waiver participant prior to LTSS Enrollment review.

Out-of-state providers can submit a claim to SD Medicaid Provider Enrollment for services that meets prior authorization and timely filing requirements with enrollment documentation to be deemed eligible or review and complete the LTSS Out-of-State enrollment requirements for HOPE Waiver Providers outlined within this request. 

 

Business Address (Required Field)

Full Name (Required)

As outlined in [LTSS HCBS Enrollment Procedure], In order for LTSS to proceed with HOPE Waiver services enrollment, there must be an identified need for service in South Dakota and the provider must be providing services to a HOPE Waiver participant prior to LTSS Enrollment review. 

Out-of-State Providers will be required to identify an individual that currently resides in South Dakota in need of their business’ services that align with applicable SD DHS/LTSS Provider Provisions.

DHS/LTSS will confirm if the individual is eligible for HOPE Waiver services and outreach to Provider [within 10 business days of submission.]

If the individual idenified is determined to not be eligible for HOPE Waiver services, the Provider will be notified and required to resubmit LTSS HCBS Enrollment Request for Out-of-State Providers.

Once identified individual is determined eligible for HOPE Waiver services, DHS/LTSS will pursue with reviewing submitted enrollment documents, policy verification and onsite review and correspondence.

LTSS will notify SD Medicaid Provider Enrollment and confirm the Provider has a pending SD Medicaid Provider application with applicable taxonomy code applied.

Identified Individual (Required Field)

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