South Dakota Medical Cannabis Practitioner Certification — In-Person Required

Last verified: May 2026

Who Can Certify

Under SDCL § 34-20G-1, only the following SD-licensed practitioners may certify patients:

• Medical Doctors (MD)
• Doctors of Osteopathic Medicine (DO)
• Physician Assistants (PA)
• Advanced Practice Registered Nurses (APRN)

SD’s inclusion of PAs and APRNs is broader than some state programs (Alabama, for example, restricts certification to MDs and DOs only). The broader practitioner pool helps account for patient access in rural SD where MD coverage is thin.

The Bona Fide Practitioner-Patient Relationship Requirement

SD’s certification standard requires a bona fide practitioner-patient relationship. The standard means:

• The practitioner has responsibility for the patient’s qualifying condition, OR
• The practitioner has received a referral from another practitioner who has that responsibility, AND
• The practitioner has personally evaluated the patient (chart review alone is insufficient), AND
• The practitioner has access to the patient’s medical history, AND
• The practitioner maintains ongoing care responsibility for the qualifying condition.

The bona fide standard is meant to distinguish certifying practitioners from "cert mill" practices that exist in some other states — storefront operations that issue cards in 5-minute encounters with minimal evaluation. SDDOH has signaled it will scrutinize practice patterns for compliance.

The In-Person Examination Requirement

SD law specifically requires an in-person physical examination for certification. Telehealth certifications are not permitted. Renewal certifications must also be done in person. The in-person requirement contrasts with most other state medical-cannabis programs, many of which permit telehealth certification subject to standard practitioner-patient-relationship standards.

The in-person rule has practical access implications:

• Rural patients in counties without local certifying practitioners must drive to metro areas (often 1–2 hours each way).
• Disabled or homebound patients face access challenges in remote areas.
• Annual renewal requires another in-person visit, not a telehealth check-in.

The Certification Visit Process

The certification visit is a clinical encounter at which the practitioner:

• Reviews the patient’s medical history and current diagnosis.
• Conducts an in-person physical examination.
• Confirms one or more of the qualifying conditions or symptoms under SDCL § 34-20G-1(8).
• Documents conventional-treatment-failure where applicable.
• Discusses cannabis pharmacology, drug interactions, and contraindications.
• Recommends a starting dosage and product form.
• Issues the certification document.

Visit fees are not regulated by SDDOH and vary widely — common fees range from $100 to $300. Many practices do not accept insurance for the certification visit; some do.

Why the Roster Is Modest

219 approved practitioners (April 2026) is a modest figure for a state with approximately 4,000 licensed physicians plus PAs and APRNs. Reasons:

• Federal scheduling concerns. Cannabis remains Schedule I federally despite the April 2026 Schedule III rescheduling. Practitioners worry about DEA enforcement and federal prosecution exposure.
• Hospital and academic affiliations. Many practitioners employed by federally-funded hospitals (Sanford, Avera with their federal-grant components) face employer-policy constraints.
• Insurance and malpractice considerations. Some malpractice carriers do not cover cannabis certification or impose surcharges.
• Time and CME burden. Required SDDOH registration and specific cannabis-pharmacology training create friction.
• Limited revenue opportunity. Visit fees of $100–$300 produce limited revenue given the relatively small SD patient pool.

Geographic Distribution

The certifying-practitioner roster is concentrated in:

• Sioux Falls metro — the largest concentration; Sanford and Avera affiliates plus independent practices.
• Rapid City metro — a smaller but functional concentration.
• Pierre, Aberdeen, Brookings, Yankton, Vermillion, Watertown — each with a few certifying practitioners.

Counties without resident certifying practitioners require patients to travel to metro areas. Rural Pine Ridge, Cheyenne River, and other reservation populations may have access through tribal-program practitioners (though tribal-program certifications operate under tribal law, not SDDOH state law).

The Discipline & Compliance Backstop

Practitioners who certify outside the requirements (no qualifying condition, missing conventional-treatment-failure documentation, "cert mill" patterns, etc.) face:

• SDDOH certification-authority revocation.
• South Dakota Board of Medical Examiners disciplinary action.
• Potential controlled-substance prescribing investigation.

In June 2025, AG Jackley’s office charged a former SDDOH employee with four counts of falsifying her own medical-cannabis card — a notable enforcement action signaling that program-integrity prosecution is real.

Related on this site: Becoming a South Dakota Medical Canna..., SD Medical Cannabis Dose & Supply, Initiated Measure 26 (2020).