Author: A. Ant, CADC-II, Licensing & Accreditation Expert
Disclaimer: This content is provided for general informational purposes only and should not be construed as legal, regulatory, or licensing advice. Requirements change frequently. Consult qualified professionals for guidance specific to your situation.
Nobody in South Dakota will ask whether the state needs your psychiatric beds. The Department of Health’s November 2025 moratorium report dates the end of Certificate of Need review to 1988, and the only bed limit left applies to nursing facilities. What a new inpatient psychiatric program does need is a hospital license from the South Dakota Department of Health (DOH) under SDCL chapter 34-12 and ARSD 44:75, with an annual fee set by bed count. The state’s involuntary mental health holds run on a separate track, through facilities the Department of Social Services designates.
Where a South Dakota Psychiatric Bed Can Sit
The first three columns repeat the statutes and rules. Where a cell says “our reading,” it is our interpretation.
| Setting | Agency | Authority | What it means for an operator |
|---|---|---|---|
| Psychiatric hospital or hospital psychiatric unit | DOH, Office of Health Facilities Licensure and Certification | SDCL 34-12, ARSD 44:75 | A hospital license. The rules list general, specialized, critical access and rural emergency hospitals and never use the word “psychiatric,” so placing a psychiatric hospital in those categories is our reading |
| Appropriate Regional Facility | Department of Social Services (DSS) | SDCL 27A-10-1.2, ARSD 67:63 | A designation for facilities that take involuntary mental health holds, with its own 24-hour reporting rule |
| Community mental health center services such as CARE and IMPACT | DSS Office of Licensing and Accreditation | SDCL 27A-5, ARSD 67:62 | Accredited as part of a community mental health center, not licensed as a stand-alone residential setting |
| Residential program for co-occurring substance use | DSS and DOH | ARSD 67:61 and 44:78 | Covered in South Dakota Drug and Alcohol Inpatient Treatment Licensing |
We did not find a separate South Dakota license for a residential home serving adults with mental illness outside those categories. If your model is a staffed house rather than a hospital or a community mental health center program, ask DSS and DOH together which of them, if either, would claim it before you sign anything.
The Hospital License Is the Gate
SDCL 34-12-2 says no person or entity “may establish, conduct, or maintain” a health care facility in South Dakota “without first obtaining a license from the South Dakota Department of Health.” The penalty in 34-12-18 is a Class 1 misdemeanor. ARSD 44:75:01:01 defines the licensed “facility” as “the place of business licensed as a general hospital, specialized hospital, critical access hospital, or rural emergency hospital,” and DOH’s specialized hospitals page describes an acute care hospital as one “with an organized medical staff with permanent facilities that include inpatient beds.” A freestanding psychiatric hospital would fit there by our reading. A psychiatric unit added to an existing general hospital would, as we read it, operate under that hospital’s license, though DOH has not said so in writing.
DOH does not post a ready-made application. Its licensure page asks for a written request, and “Application forms will be sent when eligibility for licensure or certification is evident.” Expect questions about location, fiscal viability and ownership, and plan the building around DOH’s statement that buildings “must meet state and federal construction, electrical, and plumbing requirements specific for the intended use.” Filing, renewal and change of ownership run through DOH’s online system at sdhls.org. For hospital certification questions DOH names Heidi Durband (605-910-7186), and for licensure Julie Jenssen (605-773-3901). The mailing address is 600 East Capitol Avenue, Pierre, SD 57501.
The annual hospital fee in SDCL 34-12-6 climbs with size: $1,000 for 25 beds or fewer, $1,500 for 26 to 50, $2,000 for 51 to 100, $3,000 for 101 to 150, $4,000 for 151 to 200 and $5,000 above that.
Holds, Designations and What DSS Does Here
SDCL 27A-10-1.2 has DSS designate Appropriate Regional Facilities to admit people apprehended under the emergency mental illness sections, 27A-10-2 and 27A-10-3. To qualify, a facility needs overnight residential capacity to stabilize acute psychiatric or behavioral symptoms, admissions at any hour of any day, on-site personnel around the clock and medical personnel reachable around the clock, among other conditions. The application route is ARSD 67:63:02:01: “A facility seeking to operate as an appropriate regional facility shall submit an application requesting designation to the department,” with a description of how it meets the statute. Once designated, the facility answers to its own reporting rule, ARSD 67:63:03:05, which calls for a report to DSS “within 24 hours” of any sentinel event, a client’s death among them, followed by a fuller report within 72 hours. A hospital that wants these admissions should raise designation with the DSS Division of Behavioral Health (605.367.5236) early, because the statute makes it a DSS decision separate from the DOH license.
Reporting Events to DOH
ARSD 44:75:01:07, last amended effective October 27, 2025, names the events a licensed hospital must report, among them an attempted suicide by a patient, suspected abuse or neglect, a death from other than natural causes on facility property, a missing patient, a fire, and a loss of utilities or critical equipment lasting more than 24 hours. The report goes “through the department’s online reporting system” and is due “within twenty-four hours of the discovery of the event,” with investigation results within five working days. DOH publishes a provider event report form, and its listed contact for event reporting is Jolene Juneau (605-773-6373).
Ketamine on a South Dakota Psychiatric Unit
South Dakota’s hospital rules and its Board of Nursing guidance say nothing about ketamine. The federal citations below are quoted from their sources, and the way we fit them to a psychiatric unit is our own reading.
A licensed hospital is the most natural place in South Dakota to give a first ketamine or esketamine dose to someone admitted for depression, because the approvals sit inside the hospital’s own medical staff. A Medicare-participating hospital must have a formulary system “established by the medical staff” and keep “Current and accurate records” of “the receipt and disposition of all scheduled drugs” (42 CFR 482.25). Ketamine is one of those drugs. Its federal schedule is III (21 CFR 1308.13(c)(7)), and DEA rules say “A separate registration is required for each principal place of business or professional practice” (21 CFR 1301.12(a)). South Dakota adds its own layer: anyone handling controlled substances in the state, whether prescribing, administering or dispensing them, needs a DOH controlled substance registration.
For the nursing side, the Board of Nursing’s 2022 Elective IV Infusion and Medication Therapy Guidelines have RNs giving IV therapy as ordered by a qualified prescriber and state that “It is not within the RN scope to prescribe, order, or procure drugs or substances for medication administration.” The guidelines do not mention ketamine, and we found no board position on it. Spravato is narrower than ketamine. Its FDA label says it “can only be administered at healthcare settings certified in the SPRAVATO REMS program,” and the Medication Guide requires monitoring “for at least 2 hours” after each dose.
We have not researched how South Dakota handles consent to psychotropic medication for a person under an involuntary hold, so we would write the first protocol for voluntary patients and bring hospital counsel in before extending it to anyone held involuntarily. We would not start a series at an Appropriate Regional Facility that is only holding someone pending a hearing.
Setting Up the Outpatient Hand-Off
A psychiatric admission is short and a ketamine series is not, so line up who will prescribe after discharge early in the stay and send dose records with the discharge summary once the patient signs a release. That receiving practice needs a structure South Dakota’s statute allows. SDCL 36-4-8.1 states that “a corporation may not practice medicine or osteopathy,” then lets a corporation employ a physician if the agreement does not touch the physician’s independent medical judgment, does not let the corporation earn more from the physician’s work than reasonable facility, equipment or administrative charges allow, and does not “Remain effective for a period of more than three years, after which it may be renewed by both parties annually.” The ketamine section of South Dakota Drug and Alcohol Outpatient Treatment Licensing goes through how a stand-alone clinic fits that statute.
Staffing an Inpatient Psychiatric Program
A hospital unit is built around physicians and nurses first, since the hospital definition starts with an organized medical staff. The therapy team is where the state’s wage data helps. In BLS’s May 2025 OEWS data, South Dakota’s substance abuse, behavioral disorder and mental health counselors sit at $53,650 at the median, $45,650 at the 25th percentile and $62,660 at the 75th, while the national median is $59,350. Four therapists at that median total $214,600 a year by our arithmetic, before psychiatry, nursing and benefits. The counselor license ladder in South Dakota gives a hospital room to hire early-career therapists without lowering the bar. The Board of Examiners for Counselors and Marriage and Family Therapists issues the LPC first, and the LPC-MH only once the counselor has logged 2,000 direct client contact hours in a clinical setting, with 100 hours of supervision, under a Plan of Supervision the board has approved. An LPC-MH clinical lead supervising LPCs who are earning those hours, at LPC pay, commonly holds therapy payroll 40 to 60 percent below a team made up entirely of LPC-MHs. On the floor, one RN supervising several LPNs keeps the nursing budget below an all-RN schedule. Beds and patient acuity settle the final headcount.
Delays We Would Plan Around for a South Dakota Psychiatric Unit
Most of the stalls we would expect come from the building. With no CON review to set the calendar, DOH’s construction and life safety review is what we expect to set the pace. The other recurring problem is assuming a hospital license brings involuntary holds with it, when the Appropriate Regional Facility designation is a separate DSS decision.
Frequently Asked Questions
Which South Dakota agency licenses a psychiatric hospital?
The Department of Health, under SDCL chapter 34-12 and ARSD 44:75. The rules license hospitals as general, specialized, critical access or rural emergency hospitals, and by our reading a psychiatric hospital falls in one of those. The annual fee runs from $1,000 for 25 beds or fewer to $5,000 above 200 beds.
Is there a Certificate of Need review for psychiatric beds in South Dakota?
No. DOH’s 2025 moratorium report puts the repeal of South Dakota’s Certificate of Need in 1988. The bed moratorium that remains applies to nursing facilities.
Can a South Dakota hospital accept involuntary mental health holds?
Only after a separate step. SDCL 27A-10-1.2 ties emergency mental illness admissions to facilities DSS designates as Appropriate Regional Facilities, and ARSD 67:63:02:01 sets out the application. Designated facilities report sentinel events to DSS within 24 hours. Talk with the DSS Division of Behavioral Health about designation before planning on hold patients.
Sizing a psychiatric unit for a South Dakota hospital license? We can look at the plan with you.
Sources
- SDCL chapter 34-12, including 34-12-1.1, 34-12-2, 34-12-6 and 34-12-18: SDCL 34-12 (checked October 15, 2026)
- ARSD 44:75:01, including 44:75:01:01 (facility definition) and 44:75:01:07 (event reporting, amended effective October 27, 2025): ARSD 44:75:01 (checked October 15, 2026)
- DOH, Healthcare Facility Licensure (application process, online system, building requirements): Healthcare Facility Licensure (checked October 15, 2026)
- DOH, Specialized Hospitals: Specialized Hospitals (checked October 15, 2026)
- DOH, Health Facility Licensure contacts: Contacts (checked October 15, 2026)
- DOH, provider event report: Report a Healthcare Facility Event (checked October 15, 2026)
- DOH, 2025 Nursing Facility Moratorium Report (CON repeal in 1988): Moratorium report (PDF) (checked October 15, 2026)
- ARSD article 67:63 (Appropriate Regional Facility), including 67:63:02:01 (application for designation) and 67:63:03:05 (sentinel event notification): ARSD 67:63 (checked October 15, 2026)
- SDCL 27A-10-1.2 (designation of appropriate regional facilities): SDCL 27A-10-1.2 (checked October 15, 2026)
- ARSD article 67:62, chapter list (CARE, IMPACT), via Justia: ARSD 67:62 (checked October 15, 2026)
- DSS Division of Behavioral Health, Staff Directory (February 2026): Staff Directory (PDF) (checked October 15, 2026)
- SDCL 36-4-8.1 (corporate practice of medicine): SDCL 36-4-8.1 (checked October 15, 2026)
- DOH, Controlled Substance Registration: Controlled Substance Registration (checked October 15, 2026)
- South Dakota Board of Nursing, Elective IV Infusion and Medication Therapy Guidelines (2022): IV infusion guidelines (PDF) (checked October 15, 2026)
- eCFR, 42 CFR 482.25: Hospital pharmaceutical services (checked October 15, 2026)
- 21 CFR 1308.13(c)(7), via Cornell LII: Ketamine in Schedule III (checked October 15, 2026)
- 21 CFR 1301.12(a), via Cornell LII: Separate DEA registration for each location (checked October 15, 2026)
- U.S. FDA, Spravato prescribing information and Medication Guide: Spravato label (PDF) (checked October 15, 2026)
- Board of Examiners for Counselors and Marriage and Family Therapists: FAQ and LPC-MH (checked October 15, 2026)
- U.S. Bureau of Labor Statistics, OEWS May 2025, SOC 21-1018: South Dakota OEWS and national estimates (checked October 15, 2026)
Leave a Reply