Adult Day Care in South Dakota

All states: adult day services map

South Dakota adult day services at a glance

Last verified against state sources: 2026-10-21.

How is adult day care regulated in South Dakota?

South Dakota does not license adult day centers. Instead, centers that want to be paid through the Medicaid HOPE Waiver or the Older Americans Act must sign a contract with the South Dakota Department of Human Services (DHS), Division of Long Term Services and Supports (LTSS), and follow its Adult Day Services Provider Provisions. South Dakota has one service, called adult day services, and does not set up adult day health care as a separate category.

Three layers can apply to a South Dakota center, and each comes from a different place:

• Licensing (none). The state law that lists the health care facilities the state licenses, SDCL 34-12-1.1, includes hospitals, nursing facilities, assisted living centers, adult foster care homes, community living homes and others, but not adult day centers. The old adult day care rules, ARSD 67:40:15, were repealed effective January 7, 2014.
• Medicaid (DHS LTSS with South Dakota Medicaid). The HOPE Waiver (Home and Community-Based Options and Person-Centered Excellence) is South Dakota's Medicaid waiver for older adults and adults with disabilities. Its rules are in ARSD 67:44:03, the South Dakota Medicaid HOPE Waiver billing and policy manual (updated April 2025), the HOPE fee schedule, and the DHS LTSS Adult Day Services Provider Provisions (effective June 1, 2024), which are part of the DHS contract.
• Other funding (DHS LTSS). DHS LTSS also pays for adult day with Older Americans Act Title III and state funds under ARSD 67:40:19. The same Provider Provisions cover these contracts.

The HOPE Waiver rules define adult day services as regular care, supervision and structured activities in a non-institutional community setting, including health and social services, for less than 24 hours a day. The LTSS rules define it as regular care and supervision of adults away from their home for part of a 24-hour day. Nursing, such as health screenings, blood pressure checks and medication management, is provided when a participant's assessment calls for it but is not required for every center.

Because the Medicaid and funding layers share one standard, the Provider Provisions, there is no stricter layer to choose between for day-to-day operations. The HOPE Waiver adds its own eligibility rules, a state-written plan and prior authorization.

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

No. South Dakota has no state license for adult day centers, so you can open one without a state adult day license. To serve HOPE Waiver or Older Americans Act Title III participants, though, you need a contract with DHS LTSS, an onsite review and a federal HCBS settings review. Every center must meet state and local building, zoning, fire and health codes.

Becoming a HOPE Waiver provider. The HOPE Waiver manual lists these steps:

• Complete a DHS LTSS enrollment review, starting with an LTSS HCBS Provider Enrollment Request.
• Pass an LTSS onsite review that verifies your location.
• Pass the HCBS Settings Final Rule review. South Dakota told CMS that each new adult day center must pass its Evidence and Onsite Review Assessment before it is approved as a waiver setting (state submission to CMS).
• Sign a DHS LTSS contract (Purchase of Services Agreement).
• Enroll with South Dakota Medicaid. The manual lists taxonomy 261QA0600X for adult day.

Building and safety. Under the Provider Provisions (H 7.1 and D 4.5), a contracted center must comply with all state and local building, zoning, fire and health codes and keep its annual fire and health inspections on file. Ask your city or county which permits apply to your building.

Fees. We did not find an application fee for the DHS contract. Ask DHS LTSS.

Certificate of need. We did not find a certificate of need requirement or a moratorium for adult day, which is not a licensed facility type in South Dakota. Confirm with DHS before you sign a lease.

More than one site. There is no per-site license. If one administrator oversees more than one site, the Provider Provisions (F 6.1) require a program director for each additional site.

Buying a center. We did not find rules on what happens to a DHS contract when a center changes owners. Contact DHS LTSS early in any purchase.

Reviews. The state told CMS it conducts onsite reviews of adult day centers every three years, or more often if needed. We did not find a set contract renewal period.

What are the staffing rules for adult day centers in South Dakota?

Centers under a DHS contract must keep at least 1 staff member for every 6 participants. DHS says centers serving a high percentage of severely impaired participants should staff at 1 to 4, but that is worded as a recommendation, not a requirement. There is no state ratio for private-pay centers with no DHS contract.

The ratio is in section F 6.1 of the Adult Day Services Provider Provisions.

• Licensing: no ratio specified, because there is no licensing layer.
• Medicaid (HOPE Waiver contract): at least 1:6, with 1:4 recommended for programs with many severely impaired participants.
• Other funding (Title III and state-funded contracts): the same 1:6 minimum, since the same Provider Provisions apply.

Who counts toward the ratio. Only staff who have met the training requirements, work on site, are actively involved with participants and are immediately available. Volunteers count only if they meet the same standards and job qualifications as paid staff and have designated duties. A staff member must be named to supervise when the director is absent, and qualified substitute staff must be provided.

Minimum staff on site. We did not find a minimum number of staff required on site regardless of census, or nurse hours that grow with census.

Required positions. Under F 6.4, a center needs a qualified administrator or program director; an RN or LPN with valid South Dakota credentials if its participants need nursing; a food service director if food is prepared on site; and drivers with a valid license, a safe driving record and first aid and CPR training. We did not find specific education or experience requirements for the director in the June 2024 version.

Training. Every staff member completes a new employee orientation and at least 6 hours of training a year. Topics include participant needs, fire and disaster plans, choking prevention, transfers and help with activities of daily living, nutrition and food safety, CPR and first aid, and infection control. The center keeps a training record.

Background checks. Staff who help with personal care or can see participant health information must pass a state-approved fingerprint background check, or a state-approved alternative. Centers check references and job histories and check the federal OIG and SAM exclusion lists every month (F 6.2 and D 4.13).

Health screening. Staff must show medical evidence that they are free of communicable disease before they start. We did not find other required vaccinations.

What does an adult day center in South Dakota have to provide?

A center under a DHS contract must provide social services, meals and snacks, health-related services based on assessment, help with daily living activities, planned activities and family education. It also needs enough space for its activities, a private rest area and at least two exits. Transportation is optional. These requirements come from the DHS contract, not a license.

Required services. Under sections E 5.1 to E 5.8 of the Provider Provisions:

• Social services for participants and families.
• Nutrition: at least one meal a day if the center is open through lunch, plus snacks and fluids.
• Health-related services based on the assessment and physician orders.
• Help with activities of daily living (moderate assistance with 1 to 3 of them).
• Planned activities, with a monthly calendar posted.
• Education for families and participants at admission and each year.

Medications. Medications must be managed according to ARSD 20:48:04.01 and stored labeled and secured away from activity areas.

Hours. Each center sets its own days and hours and must have a written policy for closing in bad weather and on holidays. We did not find a minimum number of days or hours.

Transportation. A center does not have to offer transportation. If it does, it must follow local, state and federal rules, keep its transportation policy in each vehicle, and use qualified drivers. The center may charge families extra for transportation if the cost is published in its enrollment handbook.

Space and safety. Under H 7.1 and H 7.3:

• Enough space for the full range of activities, a separate private space for discussions, storage, a rest area that allows privacy, and safe, accessible outdoor space.
• A center that shares a building with other services needs its own activity space during its hours and a separate entrance.
• Centers with participants who need scheduled or assisted toileting should have at least one accessible toilet for every 6 participants.
• At least two clearly marked exits, and an alarm or warning system if participants have cognitive impairments that call for one.
• Quarterly fire drills, documented; an evacuation plan posted in each room; emergency numbers posted; and a written emergency plan in the building and in every vehicle.

We did not find a square footage requirement per participant or a separate space rule for dementia care.

Written policies. The Provider Provisions (C 3.1 to C 3.16) require written policies on abuse, neglect and exploitation reporting; the governing body and plan of operation; who is appropriate for services; confidentiality; days of operation; discharge; gifting; grievances; intake and admission; records retention; staff qualifications; staff training; transportation; unaccounted absence; and emergency care, along with a policy and procedure manual available on request. A governing body with full legal authority must approve the written plan of operation. We did not find how often policies must be reviewed.

What rules protect participants in South Dakota adult day centers?

Centers under a DHS contract need a medical report at enrollment, updated each year, and a written enrollment agreement that lists services and admission and discharge criteria. Each participant's needs and service plan are reviewed at least once a year. Records are kept at least 6 years after a claim is paid or denied.

Who can enroll. Under the Provider Provisions (C 3.3), adult day is generally not right for people who are bedfast, in an infectious stage of a communicable disease without physician clearance, destructive or disruptive beyond what the center can manage, or too independent to benefit.

Enrollment. Under D 4.3:

• A medical report on current health status at enrollment, updated each year.
• Each participant names a health care provider for emergencies and ongoing care.
• An enrollment agreement that lists the services agreed to, discloses the program's range of care and services, and states admission, discharge and transfer criteria.
• Needs and service plans are reassessed when needed and at least once a year.

State-paid participants. HOPE Waiver participants must have an Individual Support Plan finalized before services start, and the plan is renewed at least once a year. For Title III participants the center keeps a written plan of care with measurable goals and a discharge plan, and DHS reassesses state-funded participants at least every 12 months.

Records. Required records include a permanent registry of participants with admission and discharge dates, attendance and service records, progress notes, care plans and reviews, incident reports, personnel and fiscal records, and annual fire and health inspections (D 4.5). Records are kept at least 6 years after a claim is paid or denied.

Incidents and abuse. Centers must keep incident reports, have a written abuse, neglect and exploitation reporting policy, and train staff each year on South Dakota's abuse reporting law, SDCL 22-46. We did not find an adult day deadline or recipient for incident reports, so ask DHS LTSS what it expects.

What we did not find. We did not find a discharge notice period (a discharge policy is required), TB screening at enrollment, or a deadline in days for the first care plan. Families should ask the center for its enrollment agreement and its discharge and grievance policies.

How does Medicaid pay for adult day in South Dakota?

South Dakota Medicaid pays for adult day through the HOPE Waiver, a 1915(c) waiver run by DHS LTSS under South Dakota Medicaid oversight. Centers bill code S5100 in 15-minute units, at $15.08 an hour ($3.77 per unit) under the fee schedule effective July 1, 2026. Meals and bathing can be billed separately when authorized.

Who qualifies. HOPE Waiver participants are 65 or older, or 18 or older with a qualifying disability, and meet nursing facility level of care (ARSD 67:44:03). HOPE participants who live in assisted living or a community living home may also attend adult day.

• Billing code and unit: S5100, per 15 minutes. A unit can be billed only after 8 minutes, so 8 to 22 minutes is one unit.
• Rate: $15.08 an hour, or $3.77 per 15-minute unit, effective July 1, 2026 (HOPE Waiver fee schedule).
• Private pay cap: the HOPE rate may not be more than the center's private pay rate, and providers attest to their private pay rate at the start of each state fiscal year.
• Other services: meals at adult day are billed separately (S5170), and bathing may be billed separately if authorized.
• Authorization: services must be authorized and acknowledged in Therap before they are delivered. The Provider Provisions require the authorization to be acknowledged within 7 business days. Units above the authorization are recouped.
• Payment in full: HOPE participants are not asked for donations, and Medicaid is payment in full.

Transportation. The HOPE fee schedule has no adult day transportation code. For residents of assisted living and community living homes, the residence must arrange non-medical transportation to adult day.

Attendance documentation. Adult day payment is based on 15-minute units of attendance, so the center's attendance and service records must support each unit billed and match the Therap authorization. Documentation must exist for each date of service. The HOPE manual lists adult day as not requiring electronic visit verification. If a center bills bathing as a separate service, it needs the personal care taxonomy and must collect electronic visit data for the bathing. We did not find a required sign-in and sign-out format for adult day attendance.

Can a private-pay adult day center operate in South Dakota without Medicaid?

Yes. Because South Dakota does not license adult day, a center that takes only private pay and has no DHS contract needs no state adult day license and is not bound by the DHS Provider Provisions. It still must meet local building, zoning, fire and health codes.

What we did not find. We did not find state limits on what a center without a DHS contract may do, such as hands-on care, nursing or giving medications, beyond professional licensing laws. We also did not find state consumer protection rules written for private-pay adult day contracts. Families choosing a private-pay center should ask for its written enrollment agreement, fees, staffing and discharge policy, since no state adult day standard requires them.

Older Americans Act and state funds. DHS LTSS pays for adult day with Older Americans Act Title III and state funds for people 60 and older, or 18 and older with a disability, who live at home, need long-term supports by assessment and are not eligible for another program offering the same service (ARSD 67:40:19). Centers with these contracts follow the same Provider Provisions, provide a cash match, report monthly, and collect participant demographic data at enrollment and update it each year in Therap. Title III programs may set a confidential suggested donation schedule but cannot deny service to anyone who cannot donate. The HOPE fee schedule also lists state-funded LTSS adult day codes (08055 and 08094).

Dementia program grants. In 2023 the Legislature passed House Bill 1078, which appropriated $2,000,000 from the general fund to DHS for grants to develop and expand adult day programs for adults with dementia, with priority for counties without a program. We did not find how the grants were awarded.

Veterans. We did not find VA adult day health care purchased in South Dakota. Veterans should ask their VA medical center.

The market. We did not find a state count of adult day centers, since no license exists, or a South Dakota adult day association with its own website. DHS LTSS can tell you how many providers hold HOPE or Title III contracts.

What is changing next for adult day in South Dakota?

As of our last check on October 21, 2026, we did not find a confirmed upcoming change to adult day rules or payment in South Dakota. DHS is renewing the HOPE Waiver, but we could not confirm when the renewal takes effect or whether CMS has approved it.

• HOPE Waiver renewal (not final). DHS is renewing the HOPE Waiver, and the public comment period closed April 24, 2026 (tribal consultation minutes). We did not confirm an effective date, CMS approval, or whether adult day service definitions or provider qualifications change. Check with DHS LTSS.
• Current HOPE rate, July 1, 2026. The fee schedule effective July 1, 2026 sets adult day (S5100) at $15.08 an hour, or $3.77 per 15-minute unit.
• Provider Provisions version. The Adult Day Services Provider Provisions on this page took effect June 1, 2024. DHS updates its provider provisions from time to time, so check the LTSS Provider Portal for the current version before you rely on details here.

South Dakota adult day sources

• SDCL 34-12-1.1: health care facilities subject to licensure
• SD DHS LTSS: Adult Day Services Provider Provisions, effective June 1, 2024
• South Dakota Medicaid: HOPE Waiver billing and policy manual
• South Dakota Medicaid: HOPE Waiver fee schedule, effective July 1, 2026
• ARSD 67:44:03: HOPE Waiver rules
• ARSD Article 67:40: Long Term Services and Supports rules (including 67:40:19)
• South Dakota HCBS settings submission to CMS
• South Dakota Legislature: 2023 House Bill 1078 (enrolled)
• South Dakota Medicaid tribal consultation minutes, April 21, 2026 (HOPE Waiver renewal)
• SD DHS Long Term Services and Supports: HOPE Waiver

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• Simplifying Payments with Electronic Billing for Adult Day Care
• How to Differentiate Your Adult Day Care Center: A Guide for Operators
• Podcast: How Adult Day Services Let You Serve 50 Clients with Just 8 Staff
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states with no state adult day license

Alabama, Alaska, Colorado, Connecticut, District of Columbia, Idaho, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Mississippi, New Jersey, New York, North Dakota, Ohio, Oregon, Vermont, Washington, West Virginia, Wisconsin. See every state on the adult day services map.

Page history

• October 21, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for adult day centers, covering attendance, care plans, transportation and billing. If you would like to talk about running your center, contact Ankota or read more about Ankota's adult day care software.