South Dakota Administrative Code

Rule 67:46:09:12 Cost not to exceed cost of medical institutional care. 67:46:09:12. Cost not to exceed cost of medical institutional care. Based on the level of care determination, the actual itemized cost of all Medicaid covered services provided in the home may not exceed 100 …

Rule 67:46:09:13 Reviews for continued eligibility. 67:46:09:13. Reviews for continued eligibility. The team shall review a child's case at least annually to determine if the child continues to meet the eligibility requirements of this chapter. If the team determines that the chi…

Rule 67:46:09:14 Notice when case closed. 67:46:09:14. Notice when case closed. If the department determines that the individual is no longer eligible for services under this chapter, it shall send a written notice to the child's parent, guardian, or other authorized representati…

Rule 67:46:10:01 Definitions. 67:46:10:01. Definitions. Terms used in this chapter mean: (1) "Chronic renal failure," a phase of renal functional impairment which can no longer be favorably influenced by conservative management and which requires long-term, continuing dialysis or…

Rule 67:46:10:02 Application to establish initial eligibility -- Refusal to comply. 67:46:10:02. Application to establish initial eligibility -- Refusal to comply. An individual suffering from chronic renal failure may complete and submit to the department a signed application fo…

Rule 67:46:10:03 Application to establish continuing eligibility. 67:46:10:03. Application to establish continuing eligibility. A recipient of services under this chapter must submit a new, signed application upon request of the department or at least annually. If the recipient f…

Rule 67:46:10:04 Eligibility requirements. 67:46:10:04. Eligibility requirements. An individual is eligible for benefits under this chapter if all of the following requirements are met: (1) The individual is a resident of South Dakota; (2) The individual is either a citizen of th…

Rule 67:46:10:05 Income considered. 67:46:10:05. Income considered. When determining income eligibility, the department considers the household's earned and unearned income. For a salaried household member, earned income includes income in cash or in kind, before deductions, such…

Rule 67:46:10:06 Exclusions from resources. 67:46:10:06. Exclusions from resources. All resources are considered available to the household unless excluded. The following resources are excluded: (1) Personal residence and the contiguous land; (2) Personal property, such as househ…

Rule 67:46:10:07 Eligibility determination. 67:46:10:07. Eligibility determination. Applications shall be reviewed by the department and approval or rejection shall be made to the applicant in writing within sixty days from the date of application. Approval for assistance, when g…

Rule 67:46:10:08 Program limitations. 67:46:10:08. Program limitations. All payments for assistance and services under the chronic renal disease program shall be made within the budget limitation of the program. Source: 2 SDR 88, effective July 1, 1976; 7 SDR 66, 7 SDR 89, effect…

Rule 67:46:10:09 Scope of services and benefits. 67:46:10:09. Scope of services and benefits. Services and benefits payable under the program include: (1) Institutional dialysis; (2) Home dialysis, including supplies, equipment, and special water softeners; (3) Renal transplants;…

Rule 67:46:10:10 Basis of payment. 67:46:10:10. Basis of payment. Payment for services under the program shall be made to the provider. All payments for services provided shall be based on the criteria used to establish rates for services and benefits in chapters 67:16:02, 67:16:…

Rule 67:46:10:11 Payment limit. 67:46:10:11. Payment limit. Total payments made on behalf of an individual eligible under this chapter may not exceed $5,000 in a fiscal year. Source: 2 SDR 88, effective July 1, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 7 SDR 121, effectiv…

Rule 67:46:10:12 Claim submission limit. 67:46:10:12. Claim submission limit. All claims for services provided under this chapter must be submitted to the department according to the provisions of § 67:16:35:04. Source: 9 SDR 28, effective September 5, 1982; transferred from § 67…

Rule 67:46:10:13 Date of eligibility. 67:46:10:13. Date of eligibility. Eligibility for benefits under this chapter shall start with the first day of the month in which the application is signed. Source: 2 SDR 88, effective July 1, 1976; 6 SDR 66, effective January 10, 1980; 7 SD…

Rule 67:46:10:14 Provider limitations. 67:46:10:14. Provider limitations. Payments to medical providers under the program shall be limited to providers qualified for reimbursement from the Medicare program administered by the social security administration. Source: 2 SDR 88, effe…

Rule 67:46:10:15 Medical eligibility. 67:46:10:15. Medical eligibility. Medical eligibility for benefits under this chapter is limited to persons who meet both of the following criteria: (1) Presence of terminal irreversible renal failure of such severity that conservative manage…

Rule 67:46:10:16 Acceptance for treatment. 67:46:10:16. Acceptance for treatment. The person must be accepted for evaluation and treatment by a renal disease center which has been certified as such by the Medicare program administered by the social security administration. Source…

Rule 67:46:10:17 Repealed. 67:46:10:17. Base income disregard.Repealed. Source: 7 SDR 121, effective July 2, 1981; 9 SDR 11, effective August 1, 1982; transferred from § 67:16:23:18, effective August 23, 1992; repealed, 21 SDR 86, effective December 29, 1994.

Rule 67:46:10:18 Copayment. 67:46:10:18. Copayment. A recipient of benefits under this chapter must make a copayment to the provider. The amount of the copayment is five percent of the amount allowed in § 67:46:10:10. Source: 7 SDR 121, effective July 2, 1981; 9 SDR 11, effective…

Rule 67:46:11:01 Definitions. 67:46:11:01. Definitions. Terms defined in § 67:16:01:01 have the same meaning when used in this chapter. In addition, terms used in this chapter mean: (1) "BIA," the bureau of Indian affairs; (2) "Coinsurance," that portion of the medical costs allo…

Rule 67:46:11:02 Long-term care requirements applicable to QI, QMB and SLMB. 67:46:11:02. Long-term care requirements applicable to QI, QMB and SLMB. All provisions of chapters 67:46:02 to 67:46:05, inclusive, and 67:46:08 apply to QI, QMB and SLMB applicants and recipients unles…

Rule 67:46:11:03 Income eligibility. 67:46:11:03. Income eligibility. After the $20 disregard, income for a QMB individual may not exceed 100 percent of the federal poverty level established in § 67:11:01:03. If the individual's countable income is 100 percent of the federal pove…

Rule 67:46:11:04 Repealed. 67:46:11:04. Deduction from income for dependent child. Repealed. Source: 15 SDR 171, effective May 15, 1989; 16 SDR 203, effective May 27, 1990; transferred from § 67:16:30:04, effective August 23, 1992; 19 SDR 141, effective March 25, 1993; 21 SDR 162…

Rule 67:46:11:05 Deduction for court-ordered support or support enforced by OCSE. 67:46:11:05. Deduction for court-ordered support or support enforced by OCSE. The department shall deduct from the ineligible spouse's income that portion of the income paid under court order or enf…

Rule 67:46:11:06 Items not considered income when determining QI, QMB or SLMB eligibility. 67:46:11:06. Items not considered income when determining QI, QMB or SLMB eligibility. In addition to those items contained in § 67:46:04:03, the following items are not considered income w…

Rule 67:46:11:07 Income from self-employment. 67:46:11:07. Income from self-employment. The net income from self-employment is considered earned income. Net income is the taxable income declared on the individual's most recent income tax return. If a tax return was not filed or w…

Rule 67:46:11:08 Deduction from earned income. 67:46:11:08. Deduction from earned income. A deduction of $65 plus one-half of the remainder is deducted from the total monthly earned income. If the individual is living with a spouse, the earned income deduction applies to the coup…

Rule 67:46:11:09 Income disregard. 67:46:11:09. Income disregard. The department shall disregard $20 a month from the applicant's or recipient's unearned income unless the income is from a source based on need, such as certain veterans' benefits, TANF, or BIA general assistance. …

Rule 67:46:11:10 Repealed. 67:46:11:10. Resource limit. Repealed. Source: 15 SDR 171, effective May 15, 1989; transferred from § 67:16:30:10, effective August 23, 1992; 19 SDR 141, effective March 25, 1993; 41 SDR 7, effective July 29, 2014; 41 SDR 93, effective December 3, 2014;…

Rule 67:46:11:11 Disposal of resources. 67:46:11:11. Disposal of resources. The value of resources disposed of and no longer owned by the individual are not considered. The provisions of §§ 67:46:05:06 and 67:46:05:07 do not apply. Source: 15 SDR 171, effective May 15, 1989; tran…

Rule 67:46:11:12 Date of eligibility. 67:46:11:12. Date of eligibility. Benefits for individuals eligible for QMB begin with the month after the month in which the individual is determined eligible. Eligibility starting dates outlined in § 67:46:01:03 do not apply. Benefits for i…

Rule 67:46:11:13 Payment limits. 67:46:11:13. Payment limits. If an individual is eligible for QMB, payment is limited to Medicare premiums, deductibles, coinsurance, and copayment for Part A and Part B of Medicare. If an individual is eligible for SLMB, payment is limited to the…

Rule 67:46:12:01 Definitions. 67:46:12:01. Definitions. Terms used in this chapter mean: (1) "Caretaker relative," a relative of a dependent child by blood, adoption, or marriage with whom the child is living, who assumes primary responsibility for the child's care (as may, but i…

Rule 67:46:12:02 Medicaid eligibility -- Parent/caretaker relative. 67:46:12:02. Medicaid eligibility -- Parent/caretaker relative. If a dependent child is living with a parent/caretaker relative, the parent/caretaker relative may be eligible for Medicaid if the following criteri…

Rule 67:46:12:03 Repealed. 67:46:12:03. Determination of principal wage earner.Repealed. Source: 24 SDR 24, effective August 31, 1997; repealed, 31 SDR 107, effective February 1, 2005.

Rule 67:46:12:04 Repealed. 67:46:12:04. Determining deprivation because of parents' unemployment.Repealed. Source: 24 SDR 24, effective August 31, 1997; repealed, 31 SDR 107, effective February 1, 2005.

Rule 67:46:12:05 Repealed. 67:46:12:05. Circumstances under which parent not considered unemployed.Repealed. Source: 24 SDR 24, effective August 31, 1997; repealed, 31 SDR 107, effective February 1, 2005.

Rule 67:46:12:06 Repealed. 67:46:12:06. Determining family size. Repealed. Source: 24 SDR 24, effective August 31, 1997; repealed, 41 SDR 7, effective July 29, 2014.

Rule 67:46:12:07 Repealed. 67:46:12:07. Consideration of income and resources. Repealed. Source: 24 SDR 24, effective August 31, 1997; repealed, 41 SDR 7, effective July 29, 2014.

Rule 67:46:12:08 Income limit -- Parent/caretaker relative.. 67:46:12:08. Income limit -- Parent/caretaker relative. To be eligible for assistance under this chapter a parent/caretaker relative's income, based on family size determined under the provisions of 42 C.F.R. § 435.603 …

Rule 67:46:12:09 Repealed. 67:46:12:09. Resource limit. Repealed. Source: 24 SDR 24, effective August 31, 1997; 31 SDR 107, effective February 1, 2005; repealed, 41 SDR 7, effective July 29, 2014.

Rule 67:46:12:10 Medicaid eligibility -- Pregnant woman. 67:46:12:10. Medicaid eligibility -- Pregnant woman. A pregnant woman is eligible for Medicaid if the following criteria is met: (1) She meets the general eligibility requirements of chapter 67:46:01; (2) She meets the requ…

67:46:12:11. Income limit -- Pregnant woman. To be eligible for assistance under this chapter, a pregnant woman may not have income which exceeds one hundred and thirty-eight percent of the federal poverty guidelines based on family size, for the current year. Source: 41 SDR 7, e…

Rule 67:46:12:12 Medicaid eligibility -- Children. 67:46:12:12. Medicaid eligibility -- Children. A child is eligible for Medicaid if the following criteria is met: (1) With the exception of § 67:46:01:14, the child meets the general eligibility requirements of chapter 67:46:01; …

Rule 67:46:12:13 Income level -- Children. 67:46:12:13. Income limit -- Children. To be eligible for assistance under this chapter a child's family income, based on family size, may not exceed 182% of the current year's federal poverty guidelines for that family size. Source: 41 …

Rule 67:46:12:14 Medicaid eligibility -- Other reasonable classifications of children. 67:46:12:14. Medicaid eligibility -- Other reasonable classifications of children. A child under age 21 is eligible for Medicaid assistance if the child; (1) Is in an adoption that is subsidize…

Rule 67:46:12:15 Income limit -- Other reasonable classifications of children 67:46:12:15. Income limit -- Other reasonable classifications of children. FAMILY SIZE MONTHLY GROSS INCOME LIMIT 1 $ 382 2 484 3 561 4 636 5 713 6 790 7 865 8 940 9 1016 10 1092 Source: 41 SDR 7, effec…

67:46:12:16. Medicaid eligibility -- Adult group. An individual may be eligible for Medicaid if the individual: (1) Is over age eighteen and under age sixty-five; (2) Is not pregnant; (3) Is not entitled to or enrolled to receive Medicare benefits; (4) Is not otherwise eligible f…