The short answer South Dakota nearly adopted non-medical home care licensure in 2026, but the governor vetoed HB 1138 in March 2026 — so non-medical home care remains unlicensed, and skilled home health operates primarily under Medicare certification surveyed by the DOH.
What South Dakota requires
South Dakota
2026 veto. HB 1138 (2026) would have required licensure of non-medical home care agencies — eight hours of worker training, background checks, and a $100 annual agency license fee — but Governor Rhoden vetoed it on March 25, 2026, so South Dakota still has no non-medical home care license.
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Current status. Non-medical personal care, companion, and homemaker agencies operate without state licensure; Medicaid personal care providers follow DSS administrative rules (e.g., ARSD 67:16:05) instead.
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Skilled home health. Skilled home health agencies serving Medicare must be federally certified under 42 CFR Part 484, with the South Dakota Department of Health's licensure and certification office acting as the CMS survey agency under the state health facility statutes (SDCL Title 34).
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Watch this space. Given the near-miss in 2026, licensure legislation is likely to return; agencies entering South Dakota should track the next legislative session.
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The federal baseline (applies in every state)
Federal
No federal home care license. There is no federal license for home care or home health agencies. Licensure is a state function: each state (and DC) decides whether and how to license home health agencies and non-medical personal care/companion agencies, so requirements vary dramatically by jurisdiction.
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Medicare certification (42 CFR Part 484). Agencies that bill Medicare for skilled home health must be certified as meeting the Medicare Conditions of Participation at 42 CFR Part 484 (patient rights, comprehensive assessment, QAPI, skilled professional services, home health aide standards, and more), on top of any state license.
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Accreditation with deemed status. Most new Medicare home health agencies obtain certification through a CMS-approved accrediting organization with deeming authority — ACHC, CHAP, or The Joint Commission — whose surveys substitute for the state agency's Medicare certification survey.
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State survey agencies enforce both. State survey agencies (usually the state health department) operate under agreements with CMS to survey Medicare-certified agencies, and most also run the state licensure survey program — initial surveys, renewal/recertification surveys, complaint investigations, and plan-of-correction enforcement per the CMS State Operations Manual.
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Primary sources for this page
- https://southdakotasearchlight.com/2026/03/25/governor-vetoes-home-care-regulation-bill/
- https://doh.sd.gov/
- https://doh.sd.gov/healthcare-professionals/health-facility-licensure/facility-types/home-health-agencies-hha/
- https://southdakotasearchlight.com/2026/03/25/governor-vetoes-home-care-regulation-bill/
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