Health Home Provider Application

Application

• Attachment 1 - Attestation
• Attachment 2 - Core Services Definitions
• Provider Standards

Application Submission

• After completing the application electronically, print it out and submit it with signed Attestation Forms for each designated provider to Health Homes, 700 Governors Dr, Pierre, SD 57501.
• Questions about the application can be emailed to CMforms@state.sd.us or calling 605.773.3495.
• Applications for new Health Homes are due one month prior to the start of the next quarter.  New quarters begin on April 1st, July 1st, October 1st and January 1st.  New applications must be received one month prior to that start date. 
• New Providers in existing Health Homes can be added at any time.