South Dakota Administrative Code

Rule 67:46:05:51 Assets held in common with another person. 67:46:05:51. Assets held in common with another person. If an asset is held by an individual in common with another person in joint tenancy, tenancy in common, or similar arrangement, the asset or the affected portion of…

Rule 67:46:05:52 Disclosure of annuities 67:46:05:52. Disclosure of annuities. An individual applying for long-term care medical assistance and an individual whose eligibility is being reviewed for purposes of determining whether the individual continues to be eligible for long-t…

Rule 67:46:05:53 Annuities -- Department becomes remainder beneficiary. 67:46:05:53. Annuities -- Department becomes remainder beneficiary. Pursuant to 42 U.S.C. § 1396p(e), as amended to August 1, 2006, the department becomes a preferred remainder beneficiary of any interest the…

Rule 67:46:05:54 Repealed. 67:46:05:54. Treatment of annuities. Repealed. Source: 33 SDR 44, effective August 31, 2006; 35 SDR 166, effective December 24, 2008; 45 SDR 82, effective December 10, 2018.

Rule 67:46:05:55 Treatment of admission or entrance fee of applicant or recipient residing in continuing care retirement or life care community. 67:46:05:55. Treatment of admission or entrance fee of applicant or recipient residing in continuing care retirement or life care commu…

Rule 67:46:06:01 Scope of chapter. 67:46:06:01. Scope of chapter. Rules contained in this chapter are applied after financial eligibility is established according to chapter 67:46:04 and are used to determine the amount of long-term care assistance an individual is eligible to re…

Rule 67:46:06:02 Definitions. 67:46:06:02. Definitions. Terms used in this chapter have the same meaning as those defined in § 67:46:04:02. Source: 2 SDR 74, effective May 13, 1976; 5 SDR 109, effective July 1, 1979; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 9 SDR 133, effectiv…

Rule 67:46:06:03 Income for determining long-term care assistance. 67:46:06:03. Income for determining long-term care assistance. For purposes of determining the amount of long-term care assistance, income is considered according to subdivisions 67:46:04:03(1) to (5), inclusive; …

Rule 67:46:06:04 Supplemental payment to long-term care facility. 67:46:06:04. Supplemental payment to long-term care facility. The department shall pay a participating home and community based waiver provider or nursing facility for amounts not covered by an eligible individual'…

67:46:06:05. Deduction for personal needs. An applicant or recipient residing in a nursing or intermediate care facility is allowed: (1) A deduction of one hundred dollars per month to cover personal needs; (2) If earning income, an additional deduction for personal needs up to a…

Rule 67:46:06:06 Deduction for premiums. 67:46:06:06. Deduction for premiums. If an applicant's or recipient's income is used to pay the applicant's or recipient's health insurance premiums, the department allows a deduction from the income for the amount paid. The premium may be…

Rule 67:46:06:07 Deduction for dependents -- No community spouse. 67:46:06:07. Deduction for dependents -- No community spouse. If a recipient does not have a community spouse, as defined in SDCL 28-6-16, but the recipient's home is maintained for a dependent relative, a deductio…

Rule 67:46:06:08 Repealed. 67:46:06:08. Supplemental security income. Repealed. Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982; 9 SDR 133, effective April 27, 1983; transferred from § 67:16:21:09, effective…

Rule 67:46:06:09 Treatment of income for less than a full month's residence. 67:46:06:09. Treatment of income for less than a full month's residence. Whenever the residence period in a long-term care facility is less than a full month, the recipient's income shall not be applied …

Rule 67:46:06:10 Basis of payment for program benefits. 67:46:06:10. Basis of payment for program benefits. Payment for program benefits shall be based on the difference between the individual's available income and the monthly rate for the provider of the individual's choice, in…

Rule 67:46:06:11 Payment made to facility or representative payee. 67:46:06:11. Payment made to facility or representative payee. For an individual residing in a nursing or intermediate care facility, the department issues long-term care assistance payments directly to the facili…

Rule 67:46:06:12 Deduction for home maintenance. 67:46:06:12. Deduction for home maintenance. An applicant or recipient residing in a nursing or intermediate care facility is allowed a deduction in the amount of the SSI benefit standard minus $60 for the maintenance of the home o…

Rule 67:46:07:01 Definitions. 67:46:07:01. Definitions. Terms defined in SDCL 28-6-16 have the same meaning in this chapter. In addition, terms used in this chapter mean: (1) "Initial eligibility," the original determination of eligibility during a continuous period of institutio…

Rule 67:46:07:02 Assessment of community spouse's share of resources. 67:46:07:02. Assessment of community spouse's share of resources. The department shall assess a couple's combined countable resources to determine the community spouse's share if all of the following occur: (1)…

Rule 67:46:07:03 Repealed. 67:46:07:03. Determination of spousal share. Repealed. Source: 16 SDR 203, effective May 27, 1990; transferred from § 67:16:32:03, effective August 23, 1992; 30 SDR 166, effective July 1, 2004; 31 SDR 107, effective February 1, 2005; 33 SDR 124, effecti…

Rule 67:46:07:04 Application of existing resource rules to spousal share of resources. 67:46:07:04. Application of existing resource rules to spousal share of resources. When determining the spousal share of resources, the department shall apply the rules established in chapter 6…

Rule 67:46:07:05 Long-term care eligibility. 67:46:07:05. Long-term care eligibility. Individuals wishing to apply for long-term care assistance must apply as provided in chapter 67:46:02. Eligibility other than financial shall be determined according to chapters 67:46:01 and 67:…

Rule 67:46:07:06 Initial month of eligibility. 67:46:07:06. Initial month of eligibility. When determining initial eligibility for long-term care assistance for an institutionalized spouse in a nursing or intermediate care facility or who is receiving HCBS or HCBWS, the community…

Rule 67:46:07:07 Retroactive eligibility. 67:46:07:07. Retroactive eligibility. When determining retroactive eligibility at the time of the initial eligibility determination, the department shall deduct the community spouse's share from the couple's combined countable resources f…

Rule 67:46:07:08 Consideration of resources at time of redetermination of eligibility or reapplication for assistance. 67:46:07:08. Consideration of resources at time of redetermination of eligibility or reapplication for assistance. At the time of redetermination of eligibility …

Rule 67:46:07:09 Determination of amount of long-term care assistance for institutionalized spouse. 67:46:07:09. Determination of amount of long-term care assistance for institutionalized spouse. Sections 67:46:07:10 to 67:46:07:13, inclusive, and chapter 67:46:06, except for §§ …

Rule 67:46:07:10 Order of deductions from institutionalized spouse's income. 67:46:07:10. Order of deductions from institutionalized spouse's income. Deductions from the income of the institutionalized spouse shall be allowed in the following order: (1) The personal needs allowan…

Rule 67:46:07:11 Deduction for maintenance of community spouse. 67:46:07:11. Deduction for maintenance of community spouse. The institutionalized spouse is allowed a deduction from the institutionalized spouse's income for the maintenance needs of the community spouse. The deduct…

67:46:07:12. Computation of community spouse's maintenance allowance and excess shelter allowance. The community spouse's monthly minimum maintenance allowance is one hundred fifty percent of the federal poverty income level, established in accordance with § 67:11:01:03, for two …

Rule 67:46:07:13 Deduction for maintenance of dependents living with community spouse. 67:46:07:13. Deduction for maintenance of dependents living with community spouse. The institutionalized spouse is allowed a deduction from the institutionalized spouse's income for the mainten…

Rule 67:46:07:14 Determination of income of community spouse and dependents. 67:46:07:14. Determination of income of community spouse and dependents. When determining income for the community spouse or dependent, the department shall apply §§ 67:46:04:01 to 67:46:04:09, inclusive…

Rule 67:46:07:15 Loss of community spouse status. 67:46:07:15. Loss of community spouse status. When a change in circumstances results in an individual no longer having a community spouse or an institutionalized spouse, the community spouse status is considered lost at the beginn…

Rule 67:46:07:16 Medical eligibility for community spouse or dependent. 67:46:07:16. Medical eligibility for community spouse or dependent. Repealed. Source: 16 SDR 203, effective May 27, 1990; transferred from § 67:16:32:16, effective August 23, 1992; repealed, 41 SDR 93, effect…

Rule 67:46:07:17 Fair hearings. 67:46:07:17. Fair hearings. If either spouse is dissatisfied with the determinations made under this chapter, a fair hearing may be requested only after the conditions contained in SDCL 28-6-17 have been met. Fair hearings shall be conducted accord…

Rule 67:46:08:01 Required timely and adequate notice. 67:46:08:01. Required timely and adequate notice. Timely and adequate notice shall be mailed to each recipient detailing the reason for a proposed action which may result in termination or reduction of payment or inability to …

Rule 67:46:08:02 Adequate notice to applicants. 67:46:08:02. Adequate notice to applicants. A written notice to applicants for services under this article shall be sent at the time the decision is made approving or rejecting each application. This written notice shall include a s…

Rule 67:46:08:03 Suspension of timely notice and the application of adequate notice. 67:46:08:03. Suspension of timely notice and the application of adequate notice. The department may dispense with timely notice as provided in § 67:46:08:01 and mail adequate notice to a recipien…

Rule 67:46:08:04 Right to a conference. 67:46:08:04. Right to a conference. A recipient of long-term care whose assistance is being rejected, terminated, suspended, held, or reduced may request a conference or a hearing. The conference may not interfere with any time schedule est…

Rule 67:46:08:05 Notice of right to request waiver of period of ineligibility -- Assets transferred at less than fair market value -- Ineligibility due to home equity limit. 67:46:08:05. Notice of right to request waiver of period of ineligibility -- Assets transferred at less th…

Rule 67:46:09:01 Definitions. 67:46:09:01. Definitions. Terms used in this chapter mean: (1) "Active treatment," a continuous program of specialized training, treatment, health services, and related services provided to help an individual achieve the highest functioning level pos…

Rule 67:46:09:02 Repealed. 67:46:09:02. Application required -- Time for determining eligibility -- Notice. Repealed. Source: 19 SDR 26, effective August 23, 1992; repealed, 41 SDR 93, effective December 3, 2014.

Rule 67:46:09:03 Repealed. 67:46:09:03. Prerequisites for eligibility. Repealed. Source: 19 SDR 26, effective August 23, 1992; repealed, 41 SDR 93, effective December 3, 2014.

Rule 67:46:09:04 Eligibility requirements. 67:46:09:04. Eligibility requirements. To be eligible, all of the following requirements must be met: (1) The child is under the age of 19; (2) A physician designated by the department has determined that the child is disabled according …

Rule 67:46:09:05 Physician's orders required. 67:46:09:05. Physician's orders required. The child's attending physician must order the services for the child and must determine that home services are appropriate. Documentation verifying these findings must be available to the dep…

Rule 67:46:09:06 Team to determine level of care. 67:46:09:06. Team to determine level of care. The team shall determine whether the child requesting assistance under this chapter needs one of the following levels of care: (1) Acute care hospital; (2) Specialized hospital; (3) Nu…

Rule 67:46:09:07 Level of care -- Acute care hospital. 67:46:09:07. Level of care -- Acute care hospital. A child may qualify for an acute care hospital level of care if the child meets the following requirements: (1) The child has a medical condition which requires nursing servi…

Rule 67:46:09:08 Level of care -- Specialized hospital. 67:46:09:08. Level of care -- Specialized hospital. A child may qualify for a specialized hospital level of care if the child requires direct professional nursing services seven days a week and one of the following condition…

Rule 67:46:09:09 Level of care -- Nursing facility. 67:46:09:09. Level of care -- Nursing facility. A child may qualify for a nursing facility level of care when all of the following conditions are met: (1) The child requires continuing professional nursing services which have be…

Rule 67:46:09:10 Level of care -- ICF-IID. 67:46:09:10. Level of care -- ICF-IID. The team may assign an individual to an ICF-IID level of care when all of the following conditions are met: (1) The child requires a continuous active treatment program; (2) The child requires direc…

Rule 67:46:09:11 Determination of intellectual disability. 67:46:09:11. Determination of intellectual disability. A clinical psychologist may determine that a child has an intellectually disability for the purposes of subdivision 67:46:09:10(5) if the child meets one of the follo…