South Dakota Administrative Code

67:45:03:07. Written report of review. Within fifteen calendar days following the conference described in § 67:45:03:06, the nurse consultant shall send to the facility a written report detailing the results of the review. The written report is the department's final decision. So…

67:45:03:08. Payment adjustment due to review of assessment. The department shall adjust a facility's payment if a review of a resident results in either an increase or a decrease in the payment amount the nursing facility should have received on behalf of a resident. The payment…

67:45:03:09. Nursing facility to provide resident's clinical record. The nursing facility shall provide the nurse consultant with the clinical record of each resident being reviewed. The resident's clinical record must include clear, concise, descriptive, and dated documentation …

67:45:03:10. Record retention. The facility shall retain the documentation necessary to support each resident's assessment for a minimum of six years. Source: 26 SDR 21, effective August 24, 1999; 50 SDR 11, effective August 7, 2023. General Authority: SDCL 28-6-1. Law Implemente…

67:45:03:11. Cases of suspected fraud -- Investigation -- Restitution. If the department receives a report that suggests fraud or abuse has occurred or is occurring in a facility, the department must immediately investigate to determine the validity of the report. Nothing contain…

67:45:03:12. Fair hearing. A facility may appeal an adverse decision made under the provisions of this chapter. A request for a fair hearing must be made within ten calendar days after the nursing facility receives the written notice of the department's final decision. A facility…

Rule 67:46:01:01 Definitions. 67:46:01:01. Definitions. Terms used in this article mean: (1) "AFDC," the aid to families with dependent children program as it existed on July 16, 1996, under the provisions of article 67:12; (2) "Applicant," an individual who has filed an applicat…

67:46:01:02. Eligibility requirements. The following individuals are eligible for medical assistance: (1) A parent or other caretaker relative of a dependent child eligible for Medicaid under the provisions of chapter 67:46:12; (2) A person who is a recipient of a money payment u…

Rule 67:46:01:03 Eligibility starting date. 67:46:01:03. Eligibility starting date. Unless otherwise specified, eligibility for medical assistance begins with the first day of the month the department receives the application if the applicant meets all the requirements for assist…

Rule 67:46:01:04 Repealed. 67:46:01:04. Choosing a provider. Repealed. Source: Copied from § 67:16:01:04, effective August 23, 1992; repealed, 41 SDR 93, effective December 3, 2014.

Rule 67:46:01:05 Repealed. 67:46:01:05. Payment of Medicare buy-in premiums. Repealed. Source: Copied from § 67:16:01:06, effective August 23, 1992; 19 SDR 141, effective March 25, 1993; repealed, 41 SDR 93, effective December 3, 2014.

Rule 67:46:01:06 Confidential information. 67:46:01:06. Confidential information. Information in the department's possession that concerns an applicant or recipient is considered confidential and its use is limited to purposes directly related to the administration of the medical…

Rule 67:46:01:06.01 Release of confidential information. 67:46:01:06.01. Release of confidential information. An individual or entity outside the department requesting confidential information about an applicant or recipient must make the request in writing. The information being…

Rule 67:46:01:07 Identification card. 67:46:01:07. Identification card. The department shall issue an identification card to an individual eligible for medical services under this article. The individual must show this identification card to the medical provider when requesting s…

Rule 67:46:01:08 Fair hearings. 67:46:01:08. Fair hearings. Providers, applicants, and recipients shall be entitled to fair hearings in accordance with the provisions of SDCL 28-6-6 and chapter 67:17:02. Source: Copied from § 67:16:01:17, effective August 23, 1992; 21 SDR 162, ef…

Rule 67:46:01:09 Medical assistance for refugees. 67:46:01:09. Medical assistance for refugees. Medical assistance must be provided to refugees who are eligible for assistance under chapter 67:46:15. Source: 2 SDR 10, effective August 12, 1975; 7 SDR 66, 7 SDR 89, effective July …

Rule 67:46:01:10 Medical assistance for qualified alien. 67:46:01:10. Medical assistance for qualified alien. A qualified alien is ineligible for assistance under this article for five years unless the alien meets the requirements contained in Pub. L. No. 104-193, § 402(b)(2) (11…

Rule 67:46:01:11 Application for assistance. 67:46:01:11. Application for assistance. Except for those individuals covered under subdivisions 67:46:01:02(2), (3), (8), (12), (22), or (24), an individual desiring medical assistance under this article or someone acting on the indiv…

Rule 67:46:01:12 Social security numbers. 67:46:01:12. Social security numbers. As a condition of eligibility, each applicant for assistance must furnish the department with the applicant's social security number. Source: 24 SDR 24, effective August 31, 1997. General Authority: S…

Rule 67:46:01:13 Individual to supply required information. 67:46:01:13. Individual to supply required information. As a condition of eligibility, an individual applying for or receiving assistance under this article must provide the department with the necessary verification to …

Rule 67:46:01:14 Availability of income and resources. 67:46:01:14. Availability of income and resources. An individual applying for or receiving medical assistance must take advantage of all income and resources to which the individual is entitled, including items such as social…

Rule 67:46:01:15 Recovery of overpayments. 67:46:01:15. Recovery of overpayments. If medical assistance is paid on behalf of an individual and the department subsequently finds that the individual was ineligible for the medical assistance benefits paid, the department considers t…

Rule 67:46:01:16 Declaration and documentation of citizenship required. 67:46:01:16. Declaration and documentation of citizenship required. An applicant or recipient must declare his or her citizenship or alien status. An applicant or recipient who declares that he or she is a ci…

Rule 67:46:01:17 State residency determinations -- General provisions. 67:46:01:17. State residency determinations -- General provisions. An applicant or recipient must be a resident of the state of South Dakota to be eligible for long-term care assistance. An individual's state …

Rule 67:46:01:18 Residency -- Placement by states in an outo-of-state long-term care facility. 67:46:01:18. Residency -- Placement by states in an out-of-state long-term care facility. If a state arranges for an individual to be placed in a long-term care facility located in anot…

Rule 67:46:01:19 No specified period of residence required. 67:46:01:19. No specified period of residence required. The department shall not deny long-term care assistance to an eligible individual in a long-term care facility who has not resided in South Dakota for a specified p…

Rule 67:46:01:20 Incapabililty of indicating intent. 67:46:01:20. Incapability of indicating intent. The department shall consider an individual incapable of indicating intent if the individual meets one of the following: (1) The individual has been judged legally incompetent by …

Rule 67:46:01:21 Residency determinations -- Individuals under age 21 residing in long-term care facilities. 67:46:01:21. Residency determinations -- Individuals under age 21 residing in long-term care facilities. The state of residence for an individual under age 21 who is resid…

Rule 67:46:01:22 Residency determinations -- Individuals under age 21 not residing in a long-term facility. 67:46:01:22. Residency determinations -- Individuals under age 21 not residing in a long-term care facility. The state of residence for individuals under age 21 who are not…

Rule 67:46:01:23 Residency determinations -- Individuals aged 21 and over residing in long-term care facilities -- Capable of indicating intent. 67:46:01:23. Residency determinations -- Individuals aged 21 and over residing in long-term care facilities -- Capable of indicating in…

Rule 67:46:01:24 Residency determinations -- Individuals aged 21 and over residing in long-term facilities -- Incapable of indicating intent before age 21. 67:46:01:24. Residency determinations -- Individuals aged 21 and over residing in long-term care facilities -- Incapable of …

Rule 67:46:01:25 Residency determinations -- Individuals aged 21 and over residing in long-term care facilities -- Incapable of indicating intent after age 21. 67:46:01:25. Residency determinations -- Individuals aged 21 and over residing in long-term care facilities -- Incapable…

Rule 67:46:01:26 Residency determinations -- Individuals aged 21 and over not residing in a long-term care facility. 67:46:01:26. Residency determinations -- Individuals aged 21 and over not residing in a long-term care facility. The state of residence for individuals aged 21 and…

Rule 67:46:01:27 Disputed residency cases. 67:46:01:27. Disputed residency cases. If two states dispute an individual's state of residence and the dispute cannot be resolved according to §§ 67:46:01:17 to 67:46:01:26, inclusive, the state where the individual is physically locate…

Rule 67:46:01:28 Residence determination when individual leaves the state. 67:46:01:28. Residence determination when individual leaves the state. The South Dakota residency requirement for an applicant or recipient of long-term care assistance, in case of temporary leave from the…

Rule 67:46:02:01 Definitions. 67:46:02:01. Definitions. Terms used in this chapter mean: (1) "Long-term care," continuing 24-hour service in a medical, nursing, or intermediate care facility, assisted living facility, or adult foster home; participation in the home and community-…

Rule 67:46:02:02 Signed application required. 67:46:02:02. Signed application required. The applicant shall personally sign an application, and the department shall verify the application in accordance with § 67:46:02:03. If the applicant is incompetent, incapacitated, or decease…

Rule 67:46:02:03 Determining eligibility. 67:46:02:03. Determining eligibility. Initial and continuing eligibility for long-term care assistance shall be determined by the department on the basis of statements submitted by the applicant or recipient of long-term care assistance a…

Rule 67:46:02:04 Prompt determinations. 67:46:02:04. Prompt determinations. The notification of approval or denial of long-term care assistance shall be mailed to the applicant within 45 days after the date of application. Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR…

Rule 67:46:02:05 Application of time standard. 67:46:02:05. Application of time standard. The time standard set by § 67:46:02:04 applies except in unusual circumstances, including a failure or delay on the part of an examining physician to provide necessary information or an emer…

Rule 67:46:02:06 Case record to contain facts. 67:46:02:06. Case record to contain facts. If the applicant voluntarily withdraws an application, the department shall send a notice to the applicant to confirm the withdrawal and shall enter the action in the case record. If the app…

Rule 67:46:02:07 Informing applicant. 67:46:02:07. Informing applicant. Applicants shall be informed about eligibility requirements and conditions, coverage, scope of program, related services available, the rights and responsibilities of the applicant or recipient, and the depar…

Rule 67:46:02:08 Review of continuing eligibility. 67:46:02:08. Review of continuing eligibility. The department shall redetermine continuing eligibility for long-term care and medical assistance at least once every 12 months. Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7…

Rule 67:46:02:09 Reporting change of circumstances. 67:46:02:09. Reporting change of circumstances. Any change in circumstances affecting an individual's eligibility shall be reported by the recipient to the department within 30 days of the date the change occurred. Source: 2 SDR…

Rule 67:46:02:10 Prompt action for continuing eligibility. 67:46:02:10. Prompt action for continuing eligibility. Upon receipt of information which affects continued eligibility for long-term care assistance, a redetermination of eligibility shall be made within 30 days. The reci…

Rule 67:46:03:01 Responsibility for information. 67:46:03:01. Responsibility for information. The applicant or recipient of long-term care shall have the primary responsibility of furnishing the department information necessary to determine eligibility or ineligibility for long-t…

Rule 67:46:03:02 Aged, blind, or disabled. 67:46:03:02. Aged, blind, or disabled. Long-term care assistance shall be provided to an eligible aged, blind, or disabled applicant or recipient meeting one of the following: (1) The individual is at least 65 years of age at the time of…

Rule 67:46:03:03 Long-term care residency requirement and beginning of eligibility. 67:46:03:03. Long-term care residency requirement and beginning of eligibility. The department shall approve long-term care assistance or medical services for an eligible individual if the individ…

Rule 67:46:03:04 Transferred. 67:46:03:04. Transferred to § 67:46:01:17.

Rule 67:46:03:05 Transferred. 67:46:03:05. Transferred to § 67:46:01:18.