1 46:11:03:02. Critical incident reports -- Submission to division. The A provider shall
give verbal notice, of any of the following critical incident incidents involving a participant, to
the division no later than the end of the division’s next business day or the provider’s next
administrative business day, whichever occurs first, from the time the provider becomes aware of
the incident. The provider shall submit a written critical incident report utilizing the division’s
on-line reporting system within seven calendar days after the initial notice is made. A report
must be submitted for the following:
(1) Deaths;
(2) Life-threatening illnesses or injuries;
(3) Alleged instances of abuse, neglect, or exploitation against or by any participant;
(4) Changes in health or behavior that may jeopardize continued services;
(5) Serious medication errors;
(6) Illnesses or injuries that resulted from unsafe or unsanitary conditions;
(7) Any illegal activity involving a participant;
(8) Any use of physical, mechanical, or chemical intervention, not part of an approved
plan;
(9) Any bruise or injury resulting from the use of a physical, mechanical, or chemical
intervention;
(10) Any diagnosed case of a reportable communicable disease involving a participant; or
2 (11) Alleged instances of corporal punishment, seclusion, denial of food, or other practices
prohibited in SDCL 27B-8-42; or
(12) Any other critical incident as required by the division.
The verbal notice must be provided no later than the end of the division's next business day
or the provider's next administrative business day, whichever occurs first, from the time the
provider becomes aware of the incident.
The provider shall also submit a written critical incident report utilizing the division's
online reporting system within seven business days after the initial verbal notice is made. The
report must contain a description of the incident, specifying what happened, when it happened,
and where it happened. The report shall also must include a description of any action taken by
the provider necessary to ensure the participant’s participant's safety and the safety of others, and
any preventative measures taken by the provider to reduce the likelihood of a similar incidents
incident occurring in the future. The division may request further information or follow-up
related to the critical incident.
The provider shall must notify the participant's parent if the participant is under 18
eighteen years of age, or the participant's guardian, if any, that a critical incident report has been
submitted and the reason why the report was submitted, unless the parent or guardian is accused
of the incident.
Source: 22 SDR 104, effective February 13, 1996; 26 SDR 96, effective January 24, 2000;
27 SDR 63, effective December 31, 2000; 40 SDR 102, effective December 3, 2013; 43 SDR 9,
effective August 2, 2016.
3 General Authority: SDCL 27B-2-26(4).
Law Implemented: SDCL 27B-1-14, 27B-1-15(2), 27B-2-26.
Cross-ReferenceCross-References: Communicable disease control, chapter 44:20.
Other rights not limited by receipt of services--Certain practices prohibited, SDCL 27B-8-
42.
Communicable disease control, article 44:20.
4 46:11:03:10. Restoration plans. The participant’s A participant's team shall must
develop a restoration plan when a participant’s the participant's rights have been restricted. The
participant and the participant’s participant's team shall develop a plan which shall include that
provides how the participant's rights will are to be restored, in part or in whole, based on the
participant's progress with the participant's individualized service plan. The restoration plan shall
must be reviewed as specified in the restoration plan, or at least annually, by the participant, or
the participant's parent if the participant is under 18 eighteen years of age, or the participant's
guardian, if any, and by the human rights committee.
A The restoration plan shall must describe the participant's rights that will are to be
restored and shall must be individualized, outcome-based, attainable, and measurable, and time-
limited.
Source: 40 SDR 102, effective December 3, 2013.
General Authority: SDCL 27B-2-25, 27B-2-26(4).
Law Implemented: SDCL 27B-1-14, 27B-1-15(2), 27B-2-26, 27B-8-52.
5 46:11:04:02. Accounting systems, cost reporting and annual audits. The A provider
shall maintain an accounting system pursuant to compliant with Generally Accepted Accounting
Principles (GAAP). If required by the department, the A provider must submit to the department
a copy of an annual, entity-wide, independent financial audit that shall be conducted by a
certified public accountant who is not an employee of the provider or a member of its board of
directors. The audit shall must be completed and filed with the department within the fourth
month following five months of the end of the provider's reporting period.
An audit conducted in accordance with this section shall must contain, as part of the
supplementary information, a cost report as outlined by the department. If applicable, the audit
shall must be conducted in accordance with the Federal Office of Management and Budget
(OMB) Uniform Guidance 2 CFR Chapter I, Chapter II, Part 200, et.al. Uniform Administrative
Requirements, Cost Principles, and Audit Requirements for Federal Awards 2 C.F.R. Part 200
Subpart F (July 1, 2026), by an auditor approved by the Auditor General auditor general to
perform the audit.
For either an entity-wide, independent financial audit or an OMB Uniform Guidance 2
CFR 200 audit an audit conducted in accordance with 2 C.F.R. Part 200 Subpart F (July 1, 2026),
the provider shall assure resolution of all interim audit findings. The provider shall facilitate and
aid any such reviews, examinations, and agreed upon procedures in any review, examination, or
agreed-upon procedure that the department or any contractor may perform.
Source: 22 SDR 104, effective February 13, 1996; 27 SDR 63, effective December 31,
2000; 40 SDR 102, effective December 3, 2013; 43 SDR 9, effective August 2, 2016.
6 General Authority: SDCL 27B-2-26(2).
Law Implemented: SDCL 27B-1-14, 27B-1-15(2), 27B-2-26.
Reference: Office of Management and Budget (OMB) Uniform Guidance: Cost
Principles, Audit, and Administrative Requirements for Federal Awards. Copies are
available free of charge from the following website: https://federalregister.gov/a/2013-30465.
7 46:11:04:07. Insurance. A provider must carry insurance that includes general liability,
property coverage, workers’ worker's compensation, and automobile liability, and fidelity
bonding insurance. A provider who provides nursing services or other professional services
under this title must also carry professional liability insurance.
Source: 22 SDR 104, effective February 13, 1996; 27 SDR 63, effective December 31,
2000; 40 SDR 102, effective December 3, 2013; 43 SDR 9, effective August 2, 2016.
General Authority: SDCL 27B-2-26(2).
Law Implemented: SDCL 27B-1-14, 27B-1-15(2), 27B-2-26.
8 46:11:06:15. Monitor participant safety. The A provider of direct HCB services shall
must document all incidents, injuries, and medication errors that impact the health, safety, and
welfare of each participant. The documentation shall must include the location of the incident,
injury, or medication error, and the levelnumber of staff and or medical personnel involvement.
The Each provider of direct HCB services shall maintain a log of all participant incidents,
injuries, and medication errors.
TheEach provider of direct HCB services shall collect, document and submit to the
division, at least annually the findings of the data analysis must analyze the documentation kept
in accordance with this rule for the preceding calendar year and submit the analysis, in the
format prescribed by the department, to the department by February 15 of the year following the
analysis period.
Source: 27 SDR 63, effective December 31, 2000; 40 SDR 102, effective December 3,
2013; 43 SDR 9, effective August 2, 2016.
General Authority: SDCL 27B-2-26(5).
Law Implemented: SDCL 27B-1-14, 27B-1-15(2), 27B-2-26(5).
9 46:11:08:01. Description of services. A participant's designated conflict-free case
manager, ISP team, and providers must tailor CHOICES waiver services must be tailored to the
preferences and priorities of each participant. Each participant must shall receive at least one of
the following waiver services each month:
(1) Assistive technology services as follows:
(a) Evaluating the assistive technology needs of the participant, including a
functional evaluation of the impact of the provision of appropriate assistive technology
and appropriate services to the participant in the customary environment of the participant;
(b) Purchasing, leasing, or otherwise providing for the acquisition
of assistive technology devices for the participant;
(c) Selecting, designing, fitting, customizing, adapting, applying, maintaining,
repairing, or replacing assistive technology devices;
(d) The coordination and use of necessary therapies, interventions, or services
with assistive technology devices;
(e) Training or technical assistance in the operation or maintenance of an assistive
technology device for the participant, or, where appropriate, the participant's family member,
guardian, advocate, or authorized representative; or
(f) Training or technical assistance in the operation or maintenance of an assistive
technology device for professionals or other persons who provide services to, employ, or are
otherwise substantially involved in the major life functions of the participant;
(1)(2) Case management to include as follows:
10 (a) Developing the an individualized service plan (ISP) utilizing the state's
standardized ISP;
(b) Promoting and documenting participant the participant's involvement in the
ISP monitoring process;
(c) Documenting the ISP team meeting and making sure meetings and ensuring
scheduling facilitates the participation of all members;
(d) Observing, monitoring, and documenting the implementation of the ISP at
least quarterly;
(e) Meeting minimally, for one face-to-face visit per each quarter with each the
participant;
(f) Ensuring implementation and revisions of the ISP;
(g) Reviewing critical incident reports;
(h) Reviewing instances of abuse, neglect, or exploitation, participant health and
safety, or other pertinent information;
(i) Submitting monthly quality reports summarizing case management activities;
(j) Assisting participants the participant in finding paid and unpaid natural
supports;
(k) Arranging, reviewing, and approving assessments;
(l) Administering the inventory for client and agency planning (ICAP):;
(m) Conducting person centered person-centered planning;
11 (n) Assisting participants the participant in selecting services and supports;
(o) Assisting participants to identify the participant in identifying individual
budgets;
(p) Assessing individual the participant's eligibility status and referring
individuals the participant to necessary eligibility resources;
(q) Assisting individuals to access the participant in accessing integrated
community employment;
(r) Ensuring the human rights committee or the behavior support committee, or
both, has have afforded due process to a participant when necessary; and
(s) Developing emergency backup plans in the event the case manager is out of
the office or is unavailable when the participant or the participant's family is in need of case
management services;
(2)(3) Day services to include as follows:
(a) Services to assist Assisting the participant to gain in gaining opportunities for
meaningful life experiences, in coordination with the participant's personal goals and supports,
and as agreed upon by the ISP team;.
(b) Services not limited to fixed site facilities; and
(c) Services that pay no wages for participation in activities; Day services cannot
be limited to fixed site facilities; and wages cannot be paid for a participant's participation in day
service activities.
(3)(4) Career exploration to include as follows:
12 (a) Services that are designed to assist participants Assisting the participant in
identifying and developing skills that prepare them to prepare the participant for integrated
competitive jobs and compensation at or above minimum wage, but not less than the customary
wage and level of benefits paid by the employer for similar work performed by employees
without disabilities;. Career exploration services
(b) Services that are time limited; and
(c) Services may not exceed twenty-four months and must be intended to result in
paid employment and work experience to further career development and individual integrated
community-based employment for the participant;
(4)(5) Residential habilitation to include as follows:
(a) Services provided to Serving a participant living in the participant's own
home, including a participant living with other family members; and by
(b) Assistance Assisting with acquisition, or retention of, or improvement in:
(i) Activities activities of daily living;,
(ii) Food food preparation;,
(iii) Money money management;,
(iv) Safety safety skills;, and
(v) Social social and adaptive skills necessary to enable the participant to
reside in a non-institutional setting;
13 (5)(6) Supported employment to include comprised of intensive services that are
intensive with and ongoing supports that enable the participant, for whom competitive
employment, at or above the minimum wage, is unlikely absent without the provision of supports
and who, because of the participant’s disabilities, needs supports, to perform in a regular work
setting; or
(6)(7) Medical equipment and drugs to include comprised of devices, controls, or
appliances, specified in the participant's ISP that enable a participant to increase the participant's
ability to perform activities of daily living, or to perceive, control, or communicate with the
environment in which they live; the participant lives
(7) Nursing services that are not available under the Medicaid state plan and are limited to:
(a) Screenings and assessments;
(b) Nursing diagnosis treatment;
(c) Staff training;
(d) Monitoring of medical care and related services;
(e) Policy and procedure development; and
(f) Review and response to medical emergencies, tuberculin tests, and phlebotomy for
hepatitis screening; or
(8) Other medically related services to include:
(a) Speech, hearing, and language services;
14 (b) Direct therapies, treatment, and services not available under the Medicaid state plan and
provided by:
(i) Physicians;
(ii) Psychiatrists;
(iii) Physician assistants;
(iv) Speech, physical, or occupational therapists;
(v) Pharmacists;
(vi) Optometrists;
(vii) Dentists or dental hygienists;
(viii) Audiologists;
(ix) Podiatrists;
(x) Chiropractors; or
(xi) Dietitians;
(c) Services, therapies, and treatments provided directly to the participant as indicated in
the ISP; and
(d) Evaluations, program design, direct services, staff training, policy, and procedure
review unless covered by the Medicaid state plan.
Source: 40 SDR 102, effective December 3, 2013; 43 SDR 9, effective August 2, 2016; 45
SDR 83, effective December 17, 2018; 49 SDR 48, effective November 22, 2022.
15 General Authority: SDCL 27B-2-26(3)(9).
Law Implemented: SDCL 27B-1-14, 27B-1-15(2), 27B-2-26(3)(9).
16 46:11:09:05. Critical incident report -- Submission to the division. A CSP, SP, or
qualified provider, providing service under this chapter, shall give verbal notice, of any of the
following critical incident incidents involving a participant, to the division no later than the end
of the division’s next business day or the CSP, SP, or qualified provider’s administrative business
day whichever occurs first from the time the CSP, SP, or qualified provider becomes aware of the
incident. The CSP, SP, or qualified provider shall submit a written critical incident report on a
form provided by the division. The report shall be submitted to the division within seven
calendar days after the verbal notice. A report shall be submitted in the following critical
instances:
(1) Death;
(2) Life-threatening illness or injury;
(3) Alleged instances of abuse, neglect, or exploitation against or by any participant;
(4) Changes in health or behavior that may jeopardize continued services;
(5) Illness or injury that resulted from unsafe or unsanitary conditions; or
(6) Any illegal activity that involves a participant.
The verbal notice must be provided no later than the end of the division's next business day
or the provider's next administrative business day, whichever occurs first, from the time the
provider becomes aware of the incident.
The provider shall also submit a written critical incident report utilizing the division's
online reporting system within seven business days after the initial verbal notice is made. The
report must contain a description of the incident, specifying what happened, when it happened,
17 and where it happened. The report must be dated and include the name of the individual
submitting the report.
The coordinator shall notify the participant’s participant's parent if the participant is under
18 eighteen years of age, or the participant’s guardian, if any, that a critical incident report has
been submitted and the reason why the report was submitted, unless the parent or guardian is
accused of the incident.
Source: 40 SDR 102, effective December 3, 2013; 44 SDR 65, effective October 16, 2017.
General Authority: SDCL 27B-2-26.
Law Implemented: SDCL 27B-1-14, 27B-1-15(2), 27B-2-26(1)(2)(4).
18 CHAPTER 46:17:04
SERVICE STANDARDS
46:17:04:01 Interdisciplinary team -- Composition and meetings.
46:17:04:02 Comprehensive functional assessment
46:17:04:03 Individual support plan.
46:17:04:04 Individual support plan development -- Participants.
46:17:04:05 QDDP monitoring and coordination of ISP.
46:17:04:06 Professional program staff.
46:17:04:07 Direct support professionals.
46:17:04:08 Highly restrictive procedures.
46:17:04:09 Time-out rooms.
46:17:04:10 Psychotropic medicationsMedications.
46:17:04:11 Medical restraint -- Order by physician, physician assistant, certified nurse
practitioner, or dentist.
46:17:04:12 Physical restraints.
46:17:04:13 Management of maladaptive behaviors.
46:17:04:14 Behavior support committee.
46:17:04:15 Human rights committee -- Composition.
46:17:04:16 Human rights committee -- Functions.
19 46:17:04:17 Staff orientation training.
46:17:04:18 Communication with parents or legal guardians.
20 46:17:04:10. Psychotropic medications Medications. Each plan for use of psychotropic
medications must identify the potential harmful effect of the medications in nontechnical terms
that all interdisciplinary team members can understand. Dosages, prescribed by the attending
physician, physician's assistant, or certified nurse practitioner, may not interfere with the person's
daily living activities. Usage must be approved by the interdisciplinary team as an integral part of
the ISP. The pharmacist, with input from the interdisciplinary team, shall monitor and document
the use of psychotropic medication at least quarterly for desired responses and adverse effects
Any use of medication by an ICF/IID for behavior on an as-needed basis is a highly restrictive
procedure and must meet the requirements of § 46:17:04:08. For medications that are not for
behavior on an as-needed basis, the person supported may request an annual human rights
review. The person's case manager shall, during each annual ISP team meeting, facilitate a
discussion about the person's medications and whether a human rights committee review is
requested. The QDDP shall document all discussions regarding medication during the ISP team
meeting.
Source: 26 SDR 96, effective January 24, 2000; 27 SDR 63, effective December 31, 2000;
37 SDR 69, effective October 18, 2010.
General Authority: SDCL 27B-2-26(3).
Law Implemented: 42 C.F.R. § 483.450 (October 1, 2002) SDCL 27B-1-14, 27B-1-15
(2), 27B-2-26.