By Category
State Snapshot
Vocational Rehabilitation (VR)
South Dakota VR Rates and Services
State Resources for Disability Employment and Workforce Supports
South Dakota Department of Rehabilitation Services
South Dakota Department of Labor
South Dakota Department of Mental Health
South Dakota Division of Developmental Disabilities
South Dakota State Department of Education
South Dakota Department of Public Health
South Dakota State Medicaid Agency
South Dakota Workforce Development Board
Medicaid Buy-In
Learn more about Medicaid Buy-In programs on our Medicaid Buy-In Programs page.
| Program | Income Eligibility Individual |
Income Eligibility Couple |
Asset Limit Individual |
Asset Limit Couple |
Age Limit | Premium Structure | Grace Period / Continuous Coverage |
|---|---|---|---|---|---|---|---|
| Medicaid for Workers with Disabilities (MAWD) program | Total countable income must be below 250% FPL
Monthly countable unearned income must be less than the SSI Federal Benefit Rate (plus $20) |
N/A | $8,000 | N/A | No age limit | No premium | If individual loses their job, they have a grace period of up to 3 months to find employment to stay in the program and maintain coverage |
Download the complete Medicaid Buy-In resource (PDF). It includes information for all states.
State-by-State Medicaid-Funded Employment Services Inventory
Learn more about this inventory on our State-by-State Inventory page.
SD CHOICES Waiver (0044.R09.00)1915(c)
Effective: 06/01/2023 – Expires: 05/31/2028
Effective: 06/01/2023 – Expires: 05/31/2028
Target Population:Individuals with intellectual disabilities or developmental disabilities ages 0 or older who meet an ICF/IID level of care
Type of Medicaid Authority:1915(c)
Managed Care:No
Service Types
- Individual Supported Employment
- Group Supported Employment
- Small Group Vocational Support
- Career Exploration
Service Definitions and Limitations
Individual Supported Employment
Services are based on the belief that all individuals with developmental disabilities can work in integrated, competitive employment and that individuals of working age should be provided the supports necessary not only to gain and maintain employment but to advance in their chosen fields and explore new employment options as their skills, interests, and needs change.
Supported Employment services are supports to a participant to obtain and maintain a job in integrated competitive employment, customized employment, or self-employment. Services include job coaching, job support, retention, and follow along. Participants may access Supported Employment regardless of whether Pre-Employment services have been previously accessed. Supported Employment is defined as:
• Integrated work setting in the general workforce.
• Compensation at or above the minimum wage for individual supported employment.
• Must be provided in a manner that promotes integration into the workplace and interaction between participants and people without disabilities in those workplaces.
• Goals and/or supports related to employment are outlined within the person-centered ISP.
Participants receiving Supported Employment services must have an outcome to sustain competitive, integrated, paid employment at or above minimum wage in an integrated setting in the general workforce in a job that meets personal and career goals included in their person-centered ISP. The service must be reviewed at least annually or more frequently as needed to assess the need for the service and progress on the employment outcome.
Discovery: Development of an employment profile as the desired outcome
Job Development: Coordination between the job seeker and employer to identify and negotiate job responsibilities
Stabilization: Provision of necessary supports that result in the person learning job responsibilities, building relationships with supervisor(s) and coworkers, and achieving professional growth as identified by the person
Long-Term Support: Provision of on-going supports as identified by the team or person to sustain long-term employment, which may include re-engagement of additional supports if needed. The delivery of Supported Employment services may include personal care type services as long as those supports do not encompass the entirety of the service.
Supported Employment should not be billed for transportation purposes only, including for pick up and/or drop off assistance when a participant cannot secure transportation to an employment or service site. Transportation between the participant’s place of residence and the employment or service site is allowable only when the provider remains onsite to provide Supported Employment services.
Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.).
Limits on the amount, duration, or frequency of this service:
Not Applicable
Group Supported Employment
Services are based on the belief that all individuals with developmental disabilities can work in integrated, competitive employment and that individuals of working age should be provided the supports necessary not only to gain and maintain employment but to advance in their chosen fields and explore new employment options as their skills, interests, and needs change.
Similar to Individual Supported Employment, the outcome of Group Supported Employment is sustained paid employment at or above minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals. Participants receiving group supported employment services must have an outcome to sustain competitive, integrated, paid employment at or above minimum wage in an integrated setting in the general workforce in a job that meets personal and career goals included in their person-centered ISP. The service must be reviewed at least annually or more frequently as needed to assess the need for the service and progress on the employment outcome.
Group Supported Employment services are supports to a group of participants to obtain and maintain a job in integrated competitive employment, customized employment, or self-employment. Services include job coaching, job support, retention, and follow along. Participants may access Supported Employment regardless of whether Pre-Employment services have been previously accessed. Group Supported Employment is defined as:
• Integrated work setting in the general workforce.
• Compensation at or above the minimum wage for individual supported employment.
• Group Supported Employment can be provided to a group of (2) to (4) individuals.
• Must be provided in a manner that promotes integration into the workplace and interaction between participants and people without disabilities in those workplaces.
• Goals and/or supports related to employment are outlined within the person-centered ISP.
Participants receiving Supported Employment services must have an outcome for competitive, integrated employment included in their person-centered ISP. The service must be reviewed at least annually or more frequently as needed to assess the need for the service and progress on the employment outcome.
Transportation between the participant’s place of residence and the employment site is allowable and the cost of this transportation is included in the rate paid to providers of supported employment services. Participants may choose not to use the transportation provided as part of this service. In that event, however, the participant’s choice to use public transportation must be documented in the participant’s care plan. Charges associated with the alternative transportation method are the responsibility of the participant.
Limits on the amount, duration, or frequency of this service:
Between 2-4 participants supported in a group at a time.
Small Group Vocational Support
Services are based on the belief that all individuals with developmental disabilities can work in integrated, competitive employment and that individuals of working age should be provided the supports necessary not only to gain and maintain employment but to advance in their chosen fields and explore new employment options as their skills, interests, and needs change.
Unlike Individual and Group Supported Employment, which seeks to provide participants with the supports and training necessary to maintain a job in an integrated competitive employment environment, Small Group Vocational Support services are designed to create a pathway towards integrated community-based employment for those who are not yet ready to receive Group or Individual Supported Employment services. Participants receiving these services must have an outcome to sustain competitive, integrated, paid employment at or above minimum wage in an integrated setting in the general workforce in a job that meets personal and career goals included in their person-centered ISP. The service must be reviewed at least annually or more frequently as needed to assess the need for the service and progress on the employment outcome.
Small Group Vocational Support services are expected to specifically involve strategies that enhance a participant’s employability in integrated, community settings, in a separate and distinct area of the business, while affording participants the opportunity for interaction between non-disabled peers or customers. Specifically, these provide structured environments in which individuals can work in the community to develop appropriate work skills and habits that include initiating interaction with coworkers, taking direction from supervisors, making transportation arrangements, and managing time and money. Small Group Vocational Support services include work experience where the provider holds a contract with the business and the agency provider pays the participant or group of participants who complete the job. Enclave services can be provided in groups of 2-8 participants.
Successful outcomes for participants include demonstrated improvement of work skills and employment habits, and/or a Provider recommendation that the Participant advance to Group Supported or another higher tier of Career and Employment services.
Transportation between the participant’s place of residence and the employment site is allowable and the cost of this transportation is included in the rate paid to providers of supported employment services. Participants may choose not to use the transportation provided as part of this service. In that event, however, the participant’s choice to use public transportation must be documented in the participant’s care plan. Charges associated with the alternative transportation method are the responsibility of the participant.
Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.).
Limits on the amount, duration, or frequency of this service:
Between 2-8 individuals supported at a time. Crew work is not limited or excluded from this service.
Career Exploration
Services are based on the belief that all individuals with developmental disabilities can work in integrated, competitive employment and that individuals of working age should be provided the supports necessary not only to gain and maintain employment but to advance in their chosen fields and explore new employment options as their skills, interests, and needs change. The outcome of the service is sustained paid employment at or above minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals.
Career Exploration services are designed to assist participants in identifying and developing skills to prepare them for integrated competitive jobs and compensation at or above minimum wage, but not less than customary wage and level of benefits paid by the employer for similar work performed by employees without disabilities.
Primarily focusing on the development of competitive worker traits through a trial-work training model, Career Exploration services can be furnished in a variety of community settings and is not limited to fixed-site facilities. Participant training will include learning the expectations of a competitive work environment, problem solving skills and strategies, and general workplace safety and mobility training.
Career Exploration includes occupational training to teach participants skills for the competitive labor market, and personal training designed to develop appropriate worker traits. Occupational training through this service will include teaching concepts such as following directions, attendance, task completion, problem solving, and workplace safety.
Further Career Exploration components will include training participants on benefits management, the financial information needed by participants when they enter employment in the general workforce, and the use of work-related evaluations which involve the use of planned activities, systematic observation, job shadowing, internships, and work trials to accomplish a formal assessment of the participant skills and interests, including identification of service needs and identification of employment objectives.
Career Exploration services are limited to an 18-month delivery window, with a maximum of two three-month extensions available with DHS approval. Upon culmination of Career Exploration, a participant has identified and is prepared to pursue additional career goals through other Employment-related Services. The DHS/DDD will preauthorize participant access to Career Exploration as well as requests for extension. Access and requests for extension must include ISP team determination of the person’s interest in employment, existing work readiness skills and the length of time likely needed to transition successfully to competitive, integrated employment. The DHS/DDD will determine through the preauthorization process if the supports identified by the ISP team are prevocational rather than vocational in nature.
Participants receiving career exploration services must have an outcome to sustain competitive, integrated, paid employment at or above minimum wage in an integrated setting in the general workforce in a job that meets personal and career goals included in their person-centered ISP. The service must be reviewed at least annually or more frequently as needed to assess the need for the service and progress on the employment outcome.
Transportation between the participant’s place of residence and the Career Exploration site is provided as a component of Career Exploration and the cost of this transportation is included in this rate. Participants may choose not to use the transportation provided by the Career Exploration location. In that event, however, the participant’s choice to use public transportation must be documented in the participant’s care plan. Charges associated with the alternative transportation method are the responsibility of the participant.
Providers of Career Exploration will maintain thorough and timely documentation of services demonstrating full compliance with all programmatic and contractual requirements, the Administrative Rules of South Dakota, and all Department of Human Services and Department of Social Services policies.
Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.).
Limits on the amount, duration, or frequency of this service:
Career exploration services are limited to 18 months, with a maximum of two three-month extensions with approval by DHS/DDD. Career exploration services cannot occur in a residential setting.
Unit of Service
Year 1
| Waiver Service | Component/ Type | Unit | # Users | Avg. Units Per User | Avg. Cost /Unit | Component Cost | Total Cost |
|---|---|---|---|---|---|---|---|
| Individual Supported Employment | Individual Supported Employment | Hour | 309 | 195.00 | 54.99 | 3,313,422.45 | 4,857,336.25 |
| Individual Supported Employment | Individual Supported Employment- Long-Term Support | 15 minute | 185 | 572.00 | 14.59 | 1,543,913.80 | 4,857,336.25 |
| Group Supported Employment | Group Supported Employment | Hour | 126 | 832.00 | 15.47 | 1,621,751.04 | 1,621,751.04 |
| Small Group Vocational Support | Small Group Vocational Support | Hour | 231 | 832.00 | 7.73 | 1,485,644.16 | 1,485,644.16 |
| Career Exploration | Career Exploration- Facility | Hour | 58 | 676.00 | 12.59 | 493,628.72 | 709,423.52 |
| Career Exploration | Career Exploration- Community | Hour | 29 | 520.00 | 14.31 | 215,794.80 | 709,423.52 |
Year 5
| Waiver Service | Component/ Type | Unit | # Users | Avg. Units Per User | Avg. Cost /Unit | Component Cost | Total Cost |
|---|---|---|---|---|---|---|---|
| Individual Supported Employment | Individual Supported Employment | Hour | 334 | 195.00 | 59.52 | 3,876,537.60 | 5,682,913.60 |
| Individual Supported Employment | Individual Supported Employment- Long-Term Support | 15 minute | 200 | 572.00 | 15.79 | 1,806,376.00 | 5,682,913.60 |
| Group Supported Employment | Group Supported Employment | Hour | 136 | 832.00 | 16.75 | 1,895,296.00 | 1,895,296.00 |
| Small Group Vocational Support | Small Group Vocational Support | Hour | 250 | 832.00 | 8.37 | 1,740,960.00 | 1,740,960.00 |
| Career Exploration | Career Exploration- Facility | Hour | 63 | 676.00 | 13.63 | 580,474.44 | 830,173.24 |
| Career Exploration | Career Exploration- Community | Hour | 31 | 520.00 | 15.49 | 249,698.80 | 830,173.24 |
Rate Determination Methods
An independent rate build-up approach was used to develop payment rates for covered services. The foundation of the independent rate build-up is direct care worker wages and benefits, which comprise the largest percentage of costs for these services. This approach:
• Uses a variety of data sources to establish rates for services that are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that care and services are available to the general population in the geographic area.
• Relies primarily on credible data sources and reported cost data (i.e., costs are not audited, nor are rates compared to costs after a reporting period and adjusted to reflect those costs).
• Makes additional adjustments to rates to reflect state-specific policy goals – for example, incenting specific kinds of services
This approach yields a more transparent rate methodology compared to the current SBR A3 model, by allowing DHS to clearly delineate the components that contribute to rates and make adjustments as needed.
The values for each component of the rate models were calculated, and rates were built from the bottom up for each of the waiver services included in the rate study. Costs were determined for each component associated with the direct care provided for a service (for example, direct service professional wages and benefits), identified the corresponding payment amount(s), and added on payment amounts reflecting administration and program support costs required to deliver the service.
The independent rate model build-up approach incorporates assumptions about types of employees, wage rates, benefit costs, program support and administration costs, supervisor span of control, staffing patterns, and direct care worker productivity factors. Some of these components vary among services (e.g., staffing patterns) while others are the same across the services (e.g., administrative factor).
In March 2017, SD Senate Bill 147 was passed. This bill requires The Department of Social Services and the Department of Human Services to jointly establish a rate-setting methodology for services delivered by home and community-based service providers. This requirement set forth was specific to the rate methodology for direct service providers. This rate study did not include a review of case management rates. The 2021 rate study of developmental disability services delivered under the CHOICES waiver, conducted a comprehensive rate modeling analysis of home and community-based services (HCBS) offered by the CHOICES waiver. To conduct a comprehensive rate modeling analysis of home and community-based services (HCBS) offered by the CHOICES waiver, DHS contracted with Guidehouse in May 2021. Guidehouse’s work involved administering a provider cost survey, reviewing cost reports, developing rate models, and assessing fiscal impact based on proposed rates. Guidehouse collected wage data, service delivery details, and organizational information from all Community Service Providers through a cost survey. The two-pronged stakeholder engagement approach involved the formation of a Rate Methodology Workgroup and Steering Committee. DHS communicated the operating norms and scope of the engagement at the start of the rate study process and clarified that the Rate Methodology Workgroup and Steering Committee would work to accurately capture the costs of service delivery in South Dakota and to determine the common principles and parameters that will apply to the future rate setting methodology. The Rate Methodology Workgroup, composed of the CSP Association Executive Director, CSP representatives, Department of Social Services (DSS) and DHS staff, provided subject matter expertise on provider survey and rate methodology development and reviewed and validated rate model factors and assumptions, including wages, benefits, administration, program support and staffing. The Steering Committee, composed of a legislative representative, the CSP Association Executive Director and DSS and DHS staff, validated decision-making processes and reviewed the rate methodology approach. The state has outlined additional information on the public input process for this renewal in Main Section 6-I.
To achieve a thoughtful and informed payment system redesign, envision a rate transition strategy and shape rate-related recommendations, DHS took a two-pronged approach of engaging with stakeholder workgroups that included representatives from the CSPs and the State’s agencies and legislature. DHS communicated the operating norms and scope of the engagement at the start of the rate study process and clarified that the Rate Methodology Workgroup and Steering Committee would work to accurately capture the costs of service delivery in South Dakota and to determine the common principles and parameters that will apply to the future rate setting methodology. The Rate Methodology Workgroup provided subject matter expertise on provider survey and rate methodology development and reviewed and validated rate model factors and assumptions, including wages, benefits, administration, program support and staffing.
The Steering Committee validated decision-making processes and reviewed the rate methodology approach. The DSS provided oversight to the DHS/DDD during the rate determination process. Additionally, a report of the rate determination process was shared with the South Dakota legislature. The state is changing its rate methodology for multiple services with this renewal. This includes the following services: career exploration, small group vocational support, group supported employment, individual supported employment, day services, residential habilitation, shared living residential habilitation, specialized medical equipment and drugs. The state has added assistive technology to the waiver. The state has removed nursing and other medically related services as distinct services within the waiver, as the costs associated with performing these tasks have been incorporated into the indirect costs of both residential and day service delivery.
For each service, multiple data sources and calculations were used to define key cost assumptions such as wages for Direct Service Professionals (DSPs) as well as other essential staff types delivering waiver services. Cost assumptions for base wages, benefits, and staffing patterns were obtained from the Provider Survey and indirect costs including administrative and program support cost factors were based on CSP Cost Reports. Additional data points such as inflationary metrics and supplemental pay estimates were obtained from the industry data collected by the federal Bureau of Labor Statistics (BLS).
Service rates do not vary geographically. During the rate study review, the state surveyed all Community Support Providers regarding the costs associated with providing services. The data produced through the survey did not indicate a different cost of providing services based on the geographical location of providers. Rates do not vary by provider.
If a person experiences a temporary additional but significant need, the qualified provider may request Extraordinary Needs Funding (ENF). These requests require supporting documentation and are reviewed by DHS/DDD staff for approval/denial and are paid using state general fund dollars.
The conflict-free case management rate was derived in October 2015 from the Community Support Provider cost report data from salaries, benefits, taxes, and overhead for existing case managers. South Dakota Department of Labor wage statistics were used to validate the cost report data. Rate adjustments will be calculated using the inflationary rate approved for qualified providers by the South Dakota State Legislature. The state has previously conducted rate study reviews in 2008 and 2013 before beginning the rate study review in 2019, which was completed in 2021. Additionally, the South Dakota State Legislature appropriated an additional $14 million dollars in 2021 to update reimbursement rates until the rate study review was finalized. DHS/DDD has committed to a review of the case management rate in FY24. The case management rate has continued to increase as a result of legislative appropriations, including a 5% increase that will be applied to FY24.
The fee schedule is available at: https://dhs.sd.gov/en/provider-portal/budget-and-finance?search=provider%20fee%20schedule.
SD Family Support 360 Waiver (0338.R05.00)1915(c)
Effective: 06/01/2022 – Expires: 05/31/2027
Effective: 06/01/2022 – Expires: 05/31/2027
Target Population:Individuals with intellectual disabilities or developmental disabilities ages 0 or older who meet an ICF/IID level of care
Type of Medicaid Authority:1915(c)
Managed Care:No
Service Types
- Supported Employment
- Personal Care 1
- Personal Care 2
Service Definitions and Limitations
Supported Employment
Supported Employment services consist of intensive, ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need supports to perform in a regular work setting. Supported Employment may include assisting the participant to locate a job or develop a job on behalf of the participant. Supported Employment is conducted in a variety of settings, particularly work sites where persons without disabilities are employed. Supported Employment includes activities needed to sustain paid work by participants, including supervision and training. When Supported Employment services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptations, supervision and training required by participants receiving waiver services as a result of their disabilities but does not include payment for the supervisory activities rendered as a normal part of the business setting.
Supported Employment services are directed towards assisting participants to obtain and retain paid employment in community settings for which an individual is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. These services are job finding and job placement activities, situational evaluations and trial placements, instruction for participants, co-workers and employers to assist participants to transition to work in an integrated setting; and long-term support to help participants maintain a desired, integrated employment status.
Supported Employment services do not include production of goods or services, nor compensation of participants served.
Documentation is maintained in the file of each participant receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.).
Limits on the amount, duration, or frequency of this service:
None listed.
Personal Care 1
The Family Support 360 waiver’s Personal Care 1 service provides a range of assistance to enable waiver participants to accomplish tasks that they would normally do for themselves if they did not have a disability, including assistance with eating, bathing, personal hygiene, and activities of daily living. This service may include assistance with preparation of meals, but does not include the cost of meals themselves. When specified in the plan of care this service may also include such housekeeping chores as bedmaking, dusting and vacuuming, which are incidental to the care furnished, or which are essential to the health and welfare of the participant, rather than the participants family. This assistance may take the form of hands-on assistance (actually performing a task for the person) or cuing/prompting the participant to perform a task.
Personal care services may be provided on an episodic or on a continuing basis. Frequency or intensity of personal care is provided as indicated in the service plan.
Because Personal Care 1 services in the waiver differ in supervision arrangements (including training), provider type, Family Support 360 waiver participants are not required to access State Plan services prior to accessing services through the waiver. Additionally, waiver participants are not required to have a physician order to access Personal Care 1 services available through the waiver. The State Plan requires a physician order.
Limits on the amount, duration, or frequency of this service:
Personal Care 1 services do not duplicate the State Plan personal care plan service as the Personal Care 1 services provided through the Family Support 360 waiver differ in supervision arrangements and provider type. The waiver services offer participant direction through an Agency With Choice Model and a Common Law model as described in Appendix E. Additionally, waiver participants are not required to have a physician order to access Personal Care 1 services available through the waiver. The State Plan requires a physician order. Qualified providers of waiver services are Community Support Providers and other qualified providers designated by the Department of Human Services as described in Appendix C. The State Plan services do not offer participant direction opportunities in the provision of personal care. Qualified providers of personal care under the State Plan are limited as prescribed in ARSD 67:67:05.01 to “Home health agency,” an organization which is primarily engaged in providing skilled nursing, medical social services, or home health aide services and which meets the requirements of a home health agency under 42 C.F.R. § 405.1201 (October 1, 1988). To avoid duplication of services, including companion care, the support coordinator reviews the individual service plan to ensure the services reflect the goals described in the plan. Additionally, if the waiver participant’s service plan list personal care services that appear to be another waiver service, for example companion care, the personal care waiver service will be reviewed closely. If the services being delivered are not personal care services the state will contact the support coordinator to explain the need to change the waiver service. The support coordinator will be responsible to contact the family to discuss and upon agreement the waiver participant’s service plan will be updated to reflect the correct waiver service.
These services are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.
Personal Care 2
A range of assistance is provided to enable waiver participants to accomplish tasks that they would normally do for themselves if they did not have a disability, including assistance with eating, bathing, personal hygiene, and activities of daily living. This assistance may take the form of hands-on assistance (actually performing a task for the person) or cuing/prompting the participant to perform a task. Personal Care 2 services may be provided on an episodic or on a continuing basis. Frequency or intensity of Personal Care 2 is provided as indicated in the approved service plan.
Personal Care 2 services provided through the Family Support waiver can enhance the amount, duration or frequency of the State Plan service. Qualified providers of personal care under the State Plan are limited as prescribed in ARSD 67:16:05:01 to “Home health agency,” an organization which is primarily engaged in providing skilled nursing, medical social services, or home health aide services and which meets the requirements of a home health agency under 42 C.F.R. § 405.1201 (October 1, 2005). The amount of Personal Care 2 services chargeable as waiver services is the amount incurred after any limits in State Plan services through the Home Health agency are exhausted. Frequency or intensity of Personal Care 2 is provided as indicated in the approved service plan.
This service is not available to individuals who are eligible to receive such service through the Medicaid State Plan (including EPSDT benefits). This waiver service is only provided to individuals age 21 and over. All medically necessary personal care services for children under age 21 are covered in the state plan pursuant to the EPSDT benefit.
Limits on the amount, duration, or frequency of this service:
Not applicable.
Unit of Service
Year 1
| Waiver Service/ Component | Unit | # Users | Avg. Units Per User | Avg. Cost /Unit | Component Cost |
|---|---|---|---|---|---|
| Supported Employment | 15 minutes | 16 | 171.40 | 9.65 | 26,464.16 |
| Personal Care 1 | 15 minutes | 96 | 607.16 | 9.65 | 562,473.02 |
| Personal Care 2 | 15 minutes | 8 | 85.00 | 8.01 | 5,446.80 |
Year 5
| Waiver Service/ Component | Unit | # Users | Avg. Units Per User | Avg. Cost /Unit | Component Cost |
|---|---|---|---|---|---|
| Supported Employment | 15 minutes | 18 | 171.40 | 10.45 | 32,240.34 |
| Personal Care 1 | 15 minutes | 103 | 607.16 | 10.45 | 653,516.67 |
| Personal Care 2 | 15 minutes | 12 | 85.00 | 8.67 | 8,843.40 |
Rate Determination Methods
Rates are established by DHS for the waiver service – support coordination. Current support coordination rates are established based on cost information and time study data. Cost information includes the support coordinator salary, benefits, travel and phone expenses, supplies, dues, equipment, and fees. The SSMA supervises the rate determination process conducted by DHS/DDD and approves policies related to the determination.
Time study data indicates how many billable units of service can be produced annually. Annually one full time equivalent (FTE) is paid for 2080 hours. Time study data was used to identify the number of billable units that a support coordinator could produce, by identifying time spent on non-billable activities, such as vacation, annual and sick leave, travel time (which can be extensive in frontier areas of the state), meeting and training time, etc. From the time study, 41% of time was spent on support coordination for waiver recipients and 14% of time was spent on support coordination for non-waiver recipients. Of the total hours, 55% of total time was billable time spent on support coordination. 41% of the total hours produced 853 hours of billable waiver time; 14% of the total hours produced 291 hours of billable general funded time. Adding the billable waiver time and billable general funded time, 1, 144 hour is billable support coordination time. Of the 2,080 total hours, 55% of the time is billable support coordination time. At the time of the completion of the time study there were 12 FTE which showed 1,144 total billable support coordination hours per FTE. The 1,144 total billable support coordination hours was multiplied by 12 FTE to amount to 13,728 total billable support coordination hours. The total administrative costs for the 12 FTE were determined and divided by the billable support coordination hours of 13,728 to produce a billable per hour rate of $54.27. The rate was then inflated by 5% for FY06 to $56.98 (rounded to $57.00). The per unit rate of $57.00 was then divided by four to produce the FY06 support coordination rate of $14.25. This rate is indexed for inflation when funding is appropriated by the State Legislature. When the rate for service coordination is indexed for inflation as described the Family Support Council is apprised of the proposed rate change. The opportunity for public comment and input are provided through posting of information on the State’s website and conducting public forums. Sharing of the information with stakeholders, the administrative agency, and the legislature allows the opportunity to determine if a rate rebase is necessary. Additionally, the budget is presented to the public annually through the legislative process. This process is open for public attendance and comment. The current support coordination rate is comparable or exceeds other rates within South Dakota for case management services. Support coordination rates are reviewed annually during the DHS/DDD budgeting process. Support coordination received a 2.4% inflationary increase during WY5. Support coordination rates will receive a 6% increase in WY1 of the approved waiver. Service rates do not vary by provider. Information related to the support coordination rate is posted at https://dhs.sd.gov/en/provider-portal/budget-and-finance?search=provider%20fee%20schedule. The Department of Social Services identifies claim limits in the MMIS to prevent fraud, waste, and abuse and overbilling of services. The DHS/DDD can provide authorization to exceed these limits when reviewing and approving service authorizations.
Rates for Personal Care 1, Respite (both individual and group) and Companion Care and Supported Employment are negotiated by the participant with the support of the Agency with Choice provider within a designated range, or with support from the Common Law provider for rates that are usual and customary (See Appendix E). The rates include the actual costs of employee related expenses (including but not specifically limited to Federal Unemployment Insurance (FUTA), State Unemployment Insurance (SUTA), and health insurance). The wage range may be increased each year by the South Dakota Cost of Living Adjustment, as determined by the South Dakota Department of Labor and Regulation. DDD will offer an exceptions process by which a person can seek a wage above the range based upon assessed need and exceptional circumstances. . The waiver utilizes an Agency with Choice and Common Law models thereby allowing the waiver participant /family to be co-employer or common-law employer of providers. The Agency with Choice and Common Law provider are responsible to ensure appropriate background checks are completed and the provider is clear for employment. Participants must follow the standard DOL Fair Labor Standards Act including state and federal minimum wage requirements. If a participant chooses not to self-direct, an agency will charge rates based on unit costs as determined by annual cost report. The state does not set these rates.
Rates for Personal Care 2, which is an extended state plan service, are paid at the rate established within the state plan. The SSMA is responsible for the rate establishment of state plan personal care services. Supplies/Vendor services (Environmental Accessibility Adaptations, Specialized Medical Adaptive Equipment and Supplies, Nutritional Supplements, Vehicle Modifications, and Specialized Therapies) are provided at market/retail rates; there are no rate methodologies for these services. There is not a maximum allowable rate determined by the state for these services nor a frequency limit. As these services are purchased at market rate the state does not perform bids or review past claims. Additionally, given these services are purchased at market rate the state does not set rates.
Provider rates are based upon a historical review of the methodology. The rate methodology for provider services has not been updated in the past five years. As noted above, participants primarily are using self-directed services and have sufficient access to providers, with the recent exception of Family Support Coordinators, where additional capacity is needed. DHS/DDD had planned to review this rate methodology, but this has been delayed during COVID and is proposed for FY2025, contingent on funds availability.
The DHS/DDD outlines the public input process for this renewal in Main Section 6-I.