How to start a NEMT business in South Dakota: secure transportation, rules, and rates
South Dakota has no NEMT broker. Transportation companies enroll directly with South Dakota Medicaid, members call them directly, and the state pays each trip from its fee schedule. For a private company the door is secure medical transportation, the wheelchair and stretcher van category, which carries a $1 million insurance rule and weekly vehicle inspections. Ambulatory community transportation is limited to governments, nonprofits, and companies already enrolled for secure transportation.
South Dakota NEMT at a glance
- Runs the program
- South Dakota Department of Social Services (DSS), South Dakota Medicaid
- Program
- South Dakota Medicaid transportation services: secure medical transportation, community transportation, and Non-Emergency Medical Travel (NEMT)
- How rides are arranged
- No broker: providers bill Medicaid directly. No broker. Members book with an enrolled secure or community transportation provider, and that provider bills South Dakota Medicaid directly for each trip.
- Brokers you will contract with
- None. Providers enroll with South Dakota Medicaid and bill it directly.
- State operating license
- No state NEMT license. Vehicles must be owned or registered to the provider and carry South Dakota commercial or exempt plates.
- EVV for NEMT trips
- Not required
- Medicaid enrollment
- 138,641 (May 2026, Medicaid and CHIP)
On this page
How Medicaid NEMT works in South Dakota
South Dakota Medicaid covers rides to medically necessary, covered services from enrolled providers, to the closest provider able to give the care unless the member has a written referral. Rides for a first prescription fill, an equipment fitting, or a pickup that cannot be mailed are covered too. Medicaid and CHIP members with full coverage qualify. Members book directly with an enrolled transportation provider and give it their Medicaid ID, and the provider checks eligibility before the trip.
Three programs cover non-ambulance rides. Secure medical transportation uses specially equipped vans for members confined to a wheelchair or needing a stretcher. Community transportation carries everyone else and is run by governments, nonprofits, and enrolled secure providers. The separate Non-Emergency Medical Travel (NEMT) program reimburses members for mileage, and for meals and lodging on long trips, when they travel outside their home city for care.
For a business owner that sets the path. A for-profit company enrolls as a secure medical transportation provider, and it can add community transportation only after it holds that secure enrollment. The rules are in ARSD chapter 67:16:25, and DSS updated both transportation billing manuals in August 2026.
Governing rule:ARSD 67:16:25: Transportation services
Who brokers Medicaid rides in South Dakota
South Dakota Medicaid is the only payer to contract with. There is no broker and no network to join beyond your own Medicaid enrollment.
| Broker | Serves | Provider sign-up |
|---|---|---|
| South Dakota Medicaid (direct enrollment, no broker) | Secure medical transportation (taxonomy 343800000X) and community transportation (343900000X) statewide, paid fee-for-service to enrolled providers.Since Online enrollment through the Provider Enrollment Portal since May 5, 2021. | Provider page |
DSS posts lists of secure and community transportation providers for members to call.
South Dakota Medicaid pays for up to four one-way community or secure trips per member per day. Cancelled trips and no-shows are not covered.
How to become a NEMT provider in South Dakota
Enrollment is direct with South Dakota Medicaid. The work is meeting ARSD 67:16:25 before you apply and keeping the records it lists after.
Pick the provider type
Secure medical transportation is open to companies, firms, and individuals with wheelchair or stretcher vans. Community transportation is limited to governmental entities, nonprofits registered with the South Dakota Secretary of State, and enrolled secure providers, and it must be domiciled in South Dakota or enrolled with Medicaid in its home state.
South Dakota Medicaid: Community Transportation manual (August 2026)
Get an NPI and a FEIN
Transportation providers enroll as billing providers under an organizational (Type 2) NPI, and incorporated entities need a FEIN tied to the legal business name. Payments go by electronic funds transfer, so have a letter from your bank ready.
Register the vehicles to the business
Vehicles must be owned by or registered to the provider, with South Dakota commercial or exempt plates. Each vehicle needs a securement device and an occupant restraint for every rider it will carry, plus a first aid kit and roadside safety equipment.
South Dakota Medicaid: Secure Medical Transportation manual (August 2026)
Buy the required insurance
Secure providers need at least $1,000,000 for bodily injury or death of any person in a single accident and $1,000,000 for property damage in a single accident, or a $1,000,000 single limit per occurrence. Keep the insurer's statement for each vehicle on file.
Enroll in the Provider Enrollment Portal
Start the enrollment online and email supporting documents to SDMedicaidPE@state.sd.us with your NPI and provider name. The record and documents must be complete within 30 days of starting, or the application is denied. Transportation providers also attach a vehicle details form for each vehicle, with its plate, VIN, garage address, and the counties it serves, and send an updated form after a significant, permanent change to the service area.
Document and bill each trip
Keep proof that the member was taken to a medical appointment and, for secure trips, that the member needed a wheelchair or stretcher. DSS recommends its Transportation Documentation Form. Claims list the origin and destination addresses, mileage is billed in whole miles only for the part of the trip outside city limits, and records are kept at least six years.
Vehicle and driver requirements in South Dakota
With no broker, the state rule is the whole rulebook. ARSD 67:16:25 sets detailed standards for secure providers and fewer for community transportation.
Vehicles
| Requirement | State rule | Broker contract |
|---|---|---|
| Ownership and plates | Owned by or registered to the provider, with South Dakota commercial or exempt plates. | No broker. Nothing is added by contract. |
| Daily check | Before each day's trips: fluids full, lights, signals, hazards, and wipers working, and tires with at least 2/32 inch of tread and no cuts or bulges. | No broker. |
| Weekly safety inspection | Every week or 1,000 miles, whichever comes first: oil and brake fluid, tire pressure, horn and brakes, instruments, fan belt, lift and ramp, securements, heat and cooling, emergency doors and windows. Record the date, odometer, and repairs. | No broker. DSS may inspect a vehicle unannounced after a complaint. |
| Securement and equipment | A securement device and a pelvic and upper torso restraint for each occupant (49 CFR 571.222), a first aid kit, safety equipment such as a fire extinguisher and warning triangles, and a posted no-smoking sign. | No broker. |
Drivers
| Requirement | State rule | Broker contract |
|---|---|---|
| Age and experience | At least 18, with one year as a licensed driver and a valid license for the class of vehicle. | No broker. Nothing is added by contract. |
| Driving record | No license suspension under SDCL chapter 32-12 and no DUI conviction in the past three years. The provider tracks and discloses each driver's traffic violations. | No broker. |
| Exclusion and fitness | Not excluded from federal health care programs or on the HHS OIG exclusion list. Hearing loss no greater than 30 decibels in the better ear, with or without an aid. | No broker. |
| Training | Before driving: ramp, lift, and securement operation, emergency and accident procedures including first aid, and fire extinguisher use. Drivers and attendants must be able to help riders in and out. | No broker. |
Insurance minimums in South Dakota
South Dakota puts a high liability floor in the Medicaid rule for secure transportation. General auto minimums apply to everyone else.
| Coverage | Minimum | Set by |
|---|---|---|
| Secure medical transportation | $1,000,000 bodily injury or death per person per accident and $1,000,000 property damage per accident, or $1,000,000 single limit per occurrence | ARSD 67:16:25:04.06 |
| Auto liability, any vehicle | $25,000 per person and $50,000 per accident bodily injury, $25,000 property damage | SDCL 32-35-70 |
| Community transportation | No Medicaid-specific amount. The state auto minimum applies. | ARSD 67:16:25 and SDCL 32-35-70 |
Does South Dakota require EVV for NEMT?
No. The federal EVV mandate covers personal care and home health services that require an in-home visit. South Dakota's transportation rules and its August 2026 transportation billing manuals include no EVV requirement.
Records carry the load instead. Secure providers keep dated proof of driver checks, training, equipment, weekly inspections, maintenance, insurance, accidents, and complaints. Every claim lists origin and destination addresses, and refusing a DSS vehicle inspection ends the provider's contract.
42 U.S.C. § 1396b(l): Electronic visit verification for personal care and home health
What changed in South Dakota in 2025 and 2026
South Dakota Medicaid and CHIP covered 138,641 people in May 2026 (124,199 on Medicaid), according to CMS monthly enrollment data.
The fee schedule effective July 1, 2026 pays $43.39 per secure van trip, $65.09 for a hospital-arranged discharge after an inpatient stay, and $109.66 per stretcher van trip, plus $2.61 per loaded mile outside city limits. An extra rider on the same trip pays half the base. Community transportation pays $5.20 for a taxi or in-city minibus trip, $7.80 for a minibus trip outside the city, and $1.04 per mile on trips of 21 miles or more outside the city. Secure van rates rose from $41.72 the year before.
Members, escorts, volunteer drivers, and nonprofit service organizations get 70 cents per mile under the Non-Emergency Medical Travel program, a rate in effect since December 1, 2025. Overnight trips to specialty care at least 150 miles away pay $40 a day for meals, or $150 a day with lodging.
All South Dakota Medicaid enrollment moves to the online Provider Enrollment Portal.
The overnight travel rate with lodging is set at $150 a day.
The state fiscal year 2026 transportation fee schedule sets the secure van base at $41.72.
Member, escort, and volunteer driver mileage is set at 70 cents per mile.
New transportation fees take effect: $43.39 secure van, $109.66 stretcher van, and $2.61 per loaded mile.
DSS updates the Secure Medical Transportation and Community Transportation billing manuals.
Frequently asked questions
- Is there a NEMT broker in South Dakota?
- No. South Dakota Medicaid enrolls transportation providers directly and pays them from its fee schedule. Members call an enrolled secure or community transportation provider themselves, and in-state rides need no broker authorization.
- Can a for-profit company provide ambulatory NEMT in South Dakota?
- Only through secure transportation. Community transportation providers must be a governmental entity, a nonprofit registered with the South Dakota Secretary of State, or an enrolled secure medical transportation provider. A private company enrolls for secure (wheelchair and stretcher) service first, then adds a community transportation enrollment.
- What insurance does a South Dakota NEMT provider need?
- Secure medical transportation providers need at least $1,000,000 per person for bodily injury or death and $1,000,000 for property damage per accident, or a $1,000,000 single limit per occurrence. Other vehicles follow the state minimum of $25,000 per person, $50,000 per accident, and $25,000 property damage.
- What are the driver requirements for secure medical transportation?
- Drivers must be at least 18 with a year of licensed driving, have no license suspension or DUI conviction in the past three years, not be on a federal exclusion list, and meet a hearing standard. Before driving they need training on the ramp, lift, and securements, emergency procedures with first aid, and the fire extinguisher.
- How much does South Dakota Medicaid pay for NEMT?
- From July 1, 2026, a secure van trip pays $43.39, a stretcher van trip $109.66, and loaded miles outside city limits $2.61 each. Community transportation pays $5.20 for a taxi or in-city minibus trip, $7.80 for a minibus trip outside the city, and $1.04 per mile on trips of 21 miles or more. Payment is the lower of the fee or your usual charge.
- Does South Dakota Medicaid pay for no-shows?
- No. Cancelled trips, including no-shows, are not covered for secure or community transportation.
- What is the South Dakota NEMT program?
- In South Dakota, NEMT means Non-Emergency Medical Travel, a member reimbursement program. It pays members 70 cents per mile for travel outside their home city, and meals and lodging when care is at least 150 miles away. Transportation companies bill under the secure or community transportation programs instead.
- Does South Dakota require EVV for NEMT?
- No. EVV covers in-home personal care and home health services. South Dakota transportation providers document trips with origin and destination addresses, transportation documentation forms, and the vehicle and driver records ARSD 67:16:25 requires.
Running NEMT in South Dakota with HealthRide
South Dakota providers bill Medicaid directly and keep every record the state may ask for. HealthRide captures signatures on screen and exports the trip log as CSV or PDF when South Dakota Medicaid asks for records.
Vehicle inspection tracking and driver credential expiration reminders help you stay ahead of the vehicle and driver records ARSD 67:16:25 lists, and every payment lands in one ledger.
Official resources
- South Dakota Medicaid: Transportation for recipients
- South Dakota Medicaid: Secure Medical Transportation manual (August 2026)
- South Dakota Medicaid: Community Transportation manual (August 2026)
- South Dakota Medicaid: Billing and policy manuals
- South Dakota Medicaid: Transportation services fee schedule (July 1, 2026)
- South Dakota Medicaid: Transportation services fee schedule (previous state fiscal year)
- ARSD 67:16:25: Transportation services
- South Dakota Medicaid: Provider enrollment and maintenance
- South Dakota Medicaid: Provider enrollment chart
- South Dakota Medicaid: Transportation provider vehicle details form
- South Dakota Medicaid: Non-Emergency Medical Travel (NEMT) program
- South Dakota Medicaid: Secure medical transportation providers
- South Dakota Medicaid: Community transportation providers
- SDCL 32-35-70: Owner's policy coverage and amount
- 42 U.S.C. § 1396b: Electronic visit verification requirement (subsection l)
- CMS: Medicaid and CHIP monthly enrollment data
HealthRide plans the whole day in one click and bills every ride.
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