1
46:11:03:02. Critical incident reports -- Submission to division. The provider shall
give verbal notice of any critical incident 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 business 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 report must contain a description of the incident, specifying what happened, when it
happened, and where it happened. The report shall also include any action taken by the provider
necessary to ensure the participant’s safety and the safety of others and any preventative
measures taken by the provider to reduce the likelihood of similar incidents occurring in the
future. The division may request further information or follow-up related to the critical incident.
The provider shall 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 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.
General Authority: SDCL 27B-2-26(4).
Law Implemented: SDCL 27B-2-26.
Cross-Reference: Communicable disease control, chapter 44:20.
Other rights not limited by receipt of services--Certain practices prohibited, SDCL 27B-8-
42.
3
46:11:03:10. Restoration plans. The participant’s team shall develop a restoration plan
when a participant’s rights have been restricted. The participant and the participant’s team shall
develop a plan which shall include how the rights will be restored in part or in whole, based on
the participant’s progress with their individualized service plan. The restoration plan shall be
reviewed as specified 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 restoration plan shall describe the rights that will be restored and shall 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-2-26, 27B-8-52.
4
46:11:04:02. Accounting systems, cost reporting and annual audits. The provider
shall maintain an accounting system pursuant to Generally Accepted Accounting Principles
(GAAP). If required by the department, the 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 be completed and filed with the department within the fourth month five months
following the end of the provider's reporting period.
An audit conducted in accordance with this section shall contain, as part of the
supplementary information, a cost report as outlined by the department. If applicable, the audit
shall 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 to perform the audit.
For either an entity-wide, independent financial audit or an OMB Uniform Guidance 2
CFR 200 audit a 2 C.F.R. Part 200 Subpart F audit (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 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.
General Authority: SDCL 27B-2-26(2).
Law Implemented: SDCL 27B-2-26.
5
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.
6
46:11:04:07. Insurance. A provider must carry insurance that includes general liability,
property coverage, workers’ compensation, and automobile liability, and fidelity bonding
insurance. A provider who provides nursing services under this title or other professional
services, 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-2-26.
7
46:11:06:15. Monitor participant safety. The provider of direct HCB services shall
document, in a format prescribed by the secretary, all incidents, injuries, and medication errors
that impact the health, safety, and welfare of each participant. The documentation shall include
the location of the incident, injury or medication error, and level of staff and medical personnel
involvement. The provider of direct HCB services shall maintain a log of all participant
incidents, injuries, and medication errors.
The provider of direct HCB services shall collect, document and submit to the division, at
least annually the findings of the data analysis perform an analysis of the data collected during
the review period and submit the findings of the analysis to the division, at least annually, in a
format prescribed by the secretary.
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-2-26(5).
8
46:11:08:01. Description of services. CHOICES waiver services must be tailored to the
preferences and priorities of each participant. Each participant must receive at least one of the
following waiver services each month:
(1) Assistive technology services, including:
(a) The evaluation of 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) Services consisting of purchasing, leasing, or otherwise providing for the acquisition
of assistive technology devices for the participant;
(c) Services consisting of selecting, designing, fitting, customizing, adapting,
applying, maintaining, repairing, or replacing assistive technology devices;
(d) Coordination and use of necessary therapies, interventions, or services
with assistive technology devices, such as therapies, interventions, or services associated
with other services in the participant’s ISP;
(e) Training or technical assistance for the participant, or, where appropriate, the family
members, guardians, advocates, or authorized representatives of the participant in the
operation and/or maintenance of the assistive technology device; or
(f) Training or technical assistance for professionals or other persons who provide
services to, employ, or are otherwise substantially involved in the major life functions of
participants in the operation and/or maintenance of the assistive technology device.
9
(1)(2) Case management to include:
(a) Developing the individualized service plan (ISP) ISP utilizing the state's
standardized ISP;
(b) Promoting and documenting participant involvement in the ISP monitoring process;
(c) Documenting the ISP team meeting and making sure scheduling facilitates
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 quarter with each 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 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 planning;
10
(n) Assisting participants in selecting services and supports;
(o) Assisting participants to identify individual budgets;
(p) Assessing individual eligibility status and referring individuals to necessary
eligibility resources;
(q) Assisting individuals to access integrated community employment;
(r) Ensuring the human rights committee or the behavior support committee, or both,
has afforded due process; 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:
(a) Services to assist the participant to gain opportunities for meaningful life experiences,
in coordination with the participant's personal goals and supports, and 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;
(3)(4) Career exploration to include:
(a) Services that are designed to assist participants in identifying and developing skills
that prepare them for integrated competitive jobs and compensation at or above minimum wage,
11
but not less than customary wage and level of benefits paid by the employer for similar work
performed by employees without disabilities;
(b) Services that are time limited; and
(c) Services intended to result in paid employment and work experience to further career
development and individual integrated community-based employment;
(4)(5) Residential habilitation to include:
(a) Services provided to a participant living in the participant's own home, including a
participant living with other family members; and
(b) Assistance with acquisition, retention, or improvement in:
(i) Activities of daily living;
(ii) Food preparation;
(iii) Money management;
(iv) Safety skills; and
(v) Social and adaptive skills necessary to enable the participant to reside in a
non-institutional setting;
(5)(6) Supported employment to include services that are intensive with ongoing supports that
enable the participant for whom competitive employment, at or above the minimum wage, is
unlikely absent the provision of supports and who, because of the participant’s disabilities, needs
supports to perform in a regular work setting; or
12
(6)(7) Medical equipment and drugs to include devices, controls, or appliances, specified in
the 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;
(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;
(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;
13
(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.
General Authority: SDCL 27B-2-26(3)(9).
Law Implemented: SDCL 27B-2-26(3)(9).
14
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 critical
incident 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 business 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 report must contain a description of the incident, specifying what happened, when it
happened, 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 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 unless the parent or guardian is accused of the incident.
15
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-2-26(1)(2)(4).
16
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 medications Medications.
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.
17
46:17:04:17 Staff orientation training.
46:17:04:18 Communication with parents or legal guardians.
18
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, each person supported may request annual human rights review.
The person’s case manager shall, during each annual ISP team meeting, include discussion about
the person’s medications and whether human rights committee review is requested. The case
manager 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-2-26.