How to start a hospice in South Dakota

Inpatient / residential hospice facility license — South Dakota Department of Health.

License

Health care facility license for an inpatient hospice or residential hospice (facility-based hospice)

Issuing agency

South Dakota Department of Health, Office of Health Care Facilities Licensure & Certification

Medicare certification

Medicare certification is separate from the state license (state survey or CMS-approved accreditor). CMS imposed a nationwide 6-month moratorium on new Medicare hospice enrollments (including new practice locations) effective 2026-05-13, extendable in 6-month increments; applications received by the Medicare contractor before that date are still processed, accreditation cannot be used for deemed-status entry during the moratorium, and a hospice undergoing a non-exempt ownership change within 36 months of enrollment must re-enroll as new and is therefore blocked. The federal notice leaves Medicaid/CHIP hospice moratoria to each state.

Regulation

SDCL 34-12-1.1 (definitions of inpatient hospice and residential hospice as health care facilities); ARSD 44:79, 44:80

1. Freestanding inpatient or residential hospice facilities (not part of a hospital or nursing home) are licensed as health care facilities under SDCL ch. 34-12
2. Meet ARSD 44:79 (inpatient hospice) or ARSD 44:80 (residential hospice) standards

Program

South Dakota Medicaid (Department of Social Services, Division of Medical Services)

Enrollment portal

South Dakota Medicaid Provider Enrollment (PE) Portal

Application fee

SD Medicaid's enrollment page says no application fee is charged. (Federal rule 42 CFR 455.460 allows the fee; CMS set it at $750 for 2026.)

Fingerprinting

Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. The SD DSS enrollment page we could reach does not describe a separate state fingerprint process (its maintenance/revalidation page returned an error).

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. The SD DSS enrollment page we could reach does not describe a separate state site visit process.

Revalidation

Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years. SD Medicaid ran a portal-wide revalidation when the PE Portal launched in 2021 (due June 7, 2021). Records that could not be revalidated were terminated, and existing providers did not have to re-sign provider agreements.

Full South Dakota Medicaid enrollment guide →

CON program

No

Agency

South Dakota Department of Health (nursing facility bed moratorium and redistribution)

Moratoria

A nursing facility bed moratorium dates to 1988 and was extended indefinitely in 2005 (SDCL 34-12-35.4). The Department of Health may let a facility add beds or approve a new nursing facility only by redistributing beds from closed facilities or voluntarily surrendered beds, so the statewide total cannot exceed the 2005 level. Redistribution runs through periodic requests for proposals (held most years from 2013 to 2025), and the department reports annually to the Legislature on the need for more beds (SB 6, 2017).

South Dakota certificate of need details →

State minimum wage

$11.85 an hour

Effective

2026-01-01

Scheduled increases

Adjusted each January 1 by CPI; the state publishes the new rate by October 15. The 2027 rate was not yet found.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Hospice agencies (community based) — active organization NPIs (NPPES)

31 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

16 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

138,321 (as of Jun 1, 2026)

All South Dakota Hospice Medicaid rates, ranked →