South Dakota Administrative Code

Rule 67:48:02:01 Definitions. 67:48:02:01. Definitions. Terms used in this chapter mean: (1) "Contiguous property," all land adjacent to the home including land separated only by roads, rivers, streams, and similar features and not separated by intervening property owned by anoth…

Rule 67:48:02:02 Individuals subject to liens and estate recoveries. 67:48:02:02. Individuals subject to liens and estate recoveries. Any payment of medical assistance by or through the department is a debt due to the department if the individual is residing in any of the followi…

Rule 67:48:02:03 Lien filed for medical assistance. 67:48:02:03. Lien filed for medical assistance. A lien created under the provisions of SDCL 28-6-24 may be filed against an individual's home and other real property in which the individual has a legal interest. Real property in…

Rule 67:48:02:04 Lien on home prohibited under certain circumstances. 67:48:02:04. Lien on home prohibited under certain circumstances. The department may not place a lien on an individual's home if there is a reasonable expectation, based on the individual's medical, nursing, an…

Rule 67:48:02:05 Recovery against an individual's estate. 67:48:02:05. Recovery against an individual's estate. If the department provided any of the services specified in SDCL 28-6-23, and the individual has since died, the department shall seek to recover from the individual's …

Rule 67:48:02:06 Recovery when individual would have been ineligible for assistance. 67:48:02:06. Recovery when individual would have been ineligible for assistance. If the department finds that the individual owned property or other assets which would have made the individual in…

Rule 67:48:02:07 Fair hearing. 67:48:02:07. Fair hearing. A surviving spouse who is dissatisfied with the determination made under § 67:48:02:08 may request a fair hearing. If a fair hearing is requested because of the imposition of a lien, the only issue which may be raised at t…

Rule 67:48:02:08 Recovery against estate of surviving spouse -- Petition to limit financial responsibility -- Determination of value of estate. 67:48:02:08. Recovery against estate of surviving spouse -- Petition to limit financial responsibility -- Determination of value of esta…

Rule 67:48:03:01 Reserved. 67:48:03:01. Reserved.

Rule 67:48:03:02 Provider to reimburse department for services paid by both the department and another payment source -- Time limit for reimbursing department. 67:48:03:02. Provider to reimburse department for services paid by both the department and another payment source -- Tim…

Rule 67:48:04:01 Reserved. 67:48:04:01. Reserved.

Rule 67:48:04:02 Policyholder to reimburse department for services paid by both Medicaid and insurance -- Time limit for reimbursing department. 67:48:04:02. Policyholder to reimburse department for services paid by both Medicaid and insurance -- Time limit for reimbursing depart…

Rule 67:48:04:03 Limit on attorney fees. 67:48:04:03. Limit on attorney fees. For purposes of SDCL 28-6-7.1, attorney fees payable by the department are limited to the following: (1) If the department has agreed to the terms of a settlement which the individual's attorney has neg…

Rule 67:48:05:01 Definitions. 67:48:05:01. Definitions. Terms used in this chapter mean: (1) "Child care assistance" or "child care services," payments made by the department to a child care provider for caring for the child of an individual who qualifies to receive assistance wi…

Rule 67:48:05:02 Recovery of overpayments -- Funds paid in error. 67:48:05:02. Recovery of overpayments -- Funds paid in error. The department shall consider that funds were paid in error if any of the following occurs: (1) The department pays the provider for child care services…

Rule 67:48:05:03 Benefit paid in error as a result of intentional program violation. 67:48:05:03. Benefit paid in error as result of intentional program violation. A benefit paid in error includes a payment made as a result of an intentional program violation. An IPV exists if an…

Rule 67:48:05:04 Intentional program violation disqualification hearing. 67:48:05:04. Intentional program violation disqualification hearing. If the department finds evidence that indicates an intentional program violation has occurred, the department may initiate an administrati…

Rule 67:48:05:05 Hearing waiver. 67:48:05:05. Hearing waiver. An individual accused of committing an IPV may waive the right to an administrative hearing for the first or second violations. If the individual waives this right, the department may initiate a collection action again…

Rule 67:48:05:06 Notice of hearing. 67:48:05:06. Notice of hearing. If the individual chooses not to sign the IPV waiver, the department shall schedule an IPV hearing. At least 30 days before the date of the hearing, the department shall send written notice to the individual susp…

Rule 67:48:05:07 Individual's rights -- Administrative disqualification hearing. 67:48:05:07. Individual's rights -- Administrative disqualification hearing. If the department notifies an individual suspected of committing an IPV that an administrative disqualification hearing is…

Rule 67:48:05:08 Hearing may be held in absence of accused individual -- Department to conduct new hearing if good cause found for individual's absence. 67:48:05:08. Hearing may be held in absence of accused individual -- Department to conduct new hearing if good cause found for …

Rule 67:48:05:09 Postponement of IPV hearing. 67:48:05:09. Postponement of IPV hearing. An IPV hearing may be postponed once if the individual requesting the postponement makes the request at least 10 days before the scheduled hearing. Source: 28 SDR 111, effective February 20, 2…

Rule 67:48:05:10 Disqualification hearing decision. 67:48:05:10. Disqualification hearing decision. The hearing officer shall conduct the hearing, arrive at a decision, and notify the individual and the department of the final decision within 90 days after the date the individual…

Rule 67:48:05:11 Disqualification -- Notice -- Penalties. 67:48:05:11. Disqualification -- Notice -- Penalties. If an IPV exists, the department shall disqualify the individual from participating in the child care services program for the following lengths of time: (1) For the fi…

Rule 67:48:05:12 Consolidation of administrative disqualification hearing with fair hearing. 67:48:05:12. Consolidation of administrative disqualification hearing with fair hearing. The department may combine a fair hearing and an administrative disqualification hearing into a si…

Rule 67:49:01:01 Reserved. 67:49:01:01. Reserved.

Rule 67:49:01:02 Medicaid program -- Use of federal methods and rules for survey, certification, and enforcement of nursing facilities. 67:49:01:02. Medicaid program -- Use of federal methods and rules for survey, certification, and enforcement of nursing facilities. Unless other…

Rule 67:54:03:01 Definitions. 67:54:03:01. Definitions. Terms used in this chapter mean: (1) "Intermediate care facility for individuals with intellectual disabilities" or "ICF-IID," an institution which has as its primary function the provision of health and rehabilitative servi…

Rule 67:54:03:02 Eligibility for ICF/IID services. 67:54:03:02. Eligibility for ICF/IID services. To be eligible for ICF/IID services under Medicaid, the following criteria must be met: (1) The individual must be eligible for Medicaid under article 67:16; (2) The individual must …

Rule 67:54:03:03 Criteria for determining developmental disability -- Facility to maintain documentation. 67:54:03:03. Criteria for determining developmental disability -- Facility to maintain documentation. The facility must maintain in the individual's medical record a copy of …

Rule 67:54:03:04 Determination of need for ICF/IID services -- Initial level of care and annual redetermination. 67:54:03:04. Determination of need for ICF/IID services -- Initial level of care and annual redetermination. An individual is in need of ICF/IID services if the Invent…

Rule 67:54:03:05 Repealed. 67:54:03:05. Facility to complete Inventory for Client and Agency Planning (ICAP). Repealed. Source: 18 SDR 224, effective July 13, 1992; 21 SDR 34, effective August 29, 1994; 22 SDR 188, effective July 8, 1996; 26 SDR 150, effective May 21, 2000; repea…

Rule 67:54:03:06 Repealed. 67:54:03:06. On-site review and inspection. Repealed. Source: 18 SDR 224, effective July 13, 1992; 26 SDR 150, effective May 21, 2000; repealed, 37 SDR 133, effective January 18, 2011.

Rule 67:54:03:07 Utilization review. 67:54:03:07. Utilization review. Services provided by an ICF/IID are subject to utilization review on the following four levels: (1) At the time of eligibility determination; (2) After discharge from a hospital; (3) During claims processing; o…

Rule 67:54:03:08 Payment limits. 67:54:03:08. Payment limits. Payment to an ICF/IID for services provided to an eligible individual may not be made until the requirements of this chapter are met and the facility is actually providing services to the individual. Payment to facilit…

Rule 67:54:03:09 Payments for reserved bed days. 67:54:03:09. Payments for reserved bed days. No payment may be made to an ICF/IID for reserving a bed during the individual's absence. Source: 18 SDR 224, effective July 13, 1992; 26 SDR 150, effective May 21, 2000; 37 SDR 133, eff…

Rule 67:54:03:10 Application of other rules. 67:54:03:10. Application of other rules. Unless otherwise specified, the following chapters apply to this chapter: (1) Chapter 67:16:26 -- Third-party liability; (2) Chapter 67:16:33 -- Provider enrollment; (3) Chapter 67:16:34 -- Reco…

Rule 67:54:03:11 Repealed. 67:54:03:11. Claim requirements. Repealed. Source: 18 SDR 224, effective July 13, 1992; repealed, 37 SDR 133, effective January 18, 2011.

Rule 67:54:03:12 Repealed. 67:54:03:12. Claim requirements -- New residents. Repealed. Source: 18 SDR 224, effective July 13, 1992; repealed, 37 SDR 133, effective January 18, 2011.

Rule 67:54:04:01 Definitions. 67:54:04:01. Definitions. Terms used in this chapter mean: (1) "CPS," community support provider; (2) "Functional limitation," a deficit that is indicated by a score that is at least two standard deviations below the mean on a standardized adaptive b…

Rule 67:54:04:02 Long-term care requirements apply to HCBS 67:54:04:02. Long-term care requirements apply to HCBS. All provisions of chapters 67:16:01 and 67:46:02 to 67:46:06, inclusive, and 67:46:08 apply to HCBS unless otherwise specified in this chapter. Source: 10 SDR 79, ef…

Rule 67:54:04:03 Financial eligibility requirements. 67:54:04:03. Financial eligibility requirements. HCBS may be available to an individual who meets one of the following requirements: (1) Is receiving TANF, SSI, or a foster care maintenance payment under Title IV-E of the Socia…

Rule 67:54:04:03.01 Notification of eligibility. 67:54:04:03.01. Notification of eligibility. The Department of Social Services shall send the participant notice of eligibility pursuant to § 67:46:08:02. Source: SL 2013, ch 128, § 3, effective July 1, 2013. General Authority: SDC…

Rule 67:54:04:04 General eligibility -- Ineligible if SSI disability benefits denied. 67:54:04:04. General eligibility -- Ineligible if SSI disability benefits denied. In addition to qualifying under § 67:54:04:03, an individual must meet the following requirements: (1) Be develo…

Rule 67:54:04:05 Criteria for determining developmental disabilities -- Documentation required. 67:54:04:05. Criteria for determining developmental disabilities -- Documentation required. The provider shall maintain documentation signed by a physician or psychologist which indica…

67:54:04:06. Preplacement assessment. Before home and community-based services (HCBS) are approved for an individual, the proposed HCBS provider shall complete an Integrated Case-Based Applied Pathology (ICAP). The ICAP must indicate a substantial functional limitation, in at lea…

Rule 67:54:04:07 Repealed. 67:54:04:07. Physician's statement. Repealed. Source: 10 SDR 79, effective February 1, 1984; 12 SDR 151, effective March 16, 1986; 15 SDR 154, effective April 9, 1989; transferred from § 67:16:27:07, effective August 23, 1992; repealed, SL 2013, ch 128,…

Rule 67:54:04:08 Repealed. 67:54:04:08. Physical examination -- Documentation required. Repealed. Source: 10 SDR 79, effective February 1, 1984; transferred from § 67:16:27:08, effective August 23, 1992; 26 SDR 150, effective May 21, 2000; repealed, SL 2013, ch 128, § 6, effectiv…

Rule 67:54:04:09 Residential limitations on eligibility. 67:54:04:09. Residential limitations on eligibility. Residents of hospitals, skilled nursing facilities, intermediate care facilities, or intermediate care facilities for individuals with intellectual disabilities may apply…

Rule 67:54:04:10 Individual service plan. 67:54:04:10. Individual service plan. Each HCBS participant shall have an ISP prepared according to § 46:11:05:03. Source: 10 SDR 79, effective February 1, 1984; 15 SDR 68, effective November 6, 1988; transferred from § 67:16:27:10, effec…