South Dakota Administrative Code

Rule 67:54:06:19 Notice of adverse action. 67:54:06:19. Notice of adverse action. The Department of Social Services shall send a written notice if any of the following occurs: (1) The Department of Social Services has determined that the individual is no longer eligible under the…

Rule 67:54:06:19.01 Conference with staff from Department of Human Services or Department of Social Services. 67:54:06:19.01. Conference with staff from Department of Human Services or Department of Social Services. An individual may request a conference if any of the following o…

Rule 67:54:06:20 Record retention. 67:54:06:20. Record retention. The provider agency must maintain or supervise the maintenance of records necessary for the program's operation including records relating to applications, determinations of eligibility, the provision of services, …

Rule 67:54:06:21 Access to records. 67:54:06:21. Access to records. Within ten days after the Department of Human Services or the Department of Social Services notifies the provider agency, the provider agency must allow the State of South Dakota and federal agencies access to an…

Rule 67:54:06:22 Annual review. 67:54:06:22. Annual review. The URT must conduct an annual review of the consumer's record to determine the appropriateness and adequacy of the services being provided and to ensure that the services provided are consistent with the nature and seve…

Rule 67:54:07:01 Definitions. 67:54:07:01. Definitions. Terms used in this chapter mean: (1) "Case management services," services which are provided on behalf of a client; which are provided by professional staff, such as a case manager, psychologist, or nurse; and which are desi…

Rule 67:54:07:02 Eligibility for services. 67:54:07:02. Eligibility for services. An individual is eligible for TBI services if the individual meets the following requirements: (1) The individual has medical documentation from a licensed physician which contains a diagnosis of TB…

Rule 67:54:07:03 Application for services. 67:54:07:03. Application for services. An individual desiring to obtain TBI services must apply to a TBI service provider. A list of approved TBI service providers is available from the Department of Human Services. Source: 23 SDR 8, eff…

Rule 67:54:07:04 Department approval of client services -- Notice. 67:54:07:04. Department approval of client services -- Notice. After an individual requests services from a TBI provider, the TBI service provider must prepare a preplacement assessment and, within five working da…

Rule 67:54:07:05 TBI rehabilitation service plan. 67:54:07:05. TBI rehabilitation service plan. After the Department of Human Services has approved the individual as a TBI client and the TBI service provider has accepted the individual as a TBI client, the interdisciplinary team …

Rule 67:54:07:06 Covered services. 67:54:07:06. Covered services. Services payable under this chapter are limited to cognitive training and case management services. Source: 23 SDR 8, effective July 21, 1996. General Authority: SDCL 28-6-1. Law Implemented: SDCL 28-6-1.

Rule 67:54:07:07 Termination of services. 67:54:07:07. Termination of services. The provider may terminate services provided under this chapter if any of the following occurs: (1) The client can no longer benefit from the services provided; (2) The client is physically threatenin…

Rule 67:54:07:08 Notice of adverse action. 67:54:07:08. Notice of adverse action. If the client is no longer eligible for Medicaid, the Department of Social Services will send a written notice to the recipient. This notice shall inform the recipient that he or she is no longer el…

Rule 67:54:07:09 Participating provider. 67:54:07:09. Participating provider. To participate in the delivery of TBI services, a provider must meet the following requirements: (1) Must be certified by the Department of Human Services as a community support provider. If the provide…

Rule 67:54:07:10 Provider agreement with Department of Human Services. 67:54:07:10. Provider agreement with Department of Human Services. A provider agreement between the Department of Human Services and the TBI service provider shall specify the provider's service limits and the…

Rule 67:54:07:11 Required cost reports. 67:54:07:11. Required cost reports. Each year the TBI service provider must complete and submit a cost report to the Department of Human Services by November 15. The cost report must be on the cost reporting form available from the Departme…

Rule 67:54:07:12 Record retention. 67:54:07:12. Record retention. The TBI service provider must maintain or supervise the maintenance of records necessary for the program's operation including records relating to applications, determinations of eligibility, the provision of servi…

Rule 67:54:07:13 Access to records. 67:54:07:13. Access to records The TBI service provider must allow the agencies of this state and federal agencies access to and copies of all information, data, reports, and records maintained by the provider and relating to the services provi…

Rule 67:54:07:14 Basis of payment -- Payment limits. 67:54:07:14. Basis of payment -- Payment limits. The Department of Human Services shall establish the rate of payment by June 1 each year. The rate of payment is based on reasonable and allowable costs reported on the cost repo…

Rule 67:54:07:15 Billing requirements. 67:54:07:15. Billing requirements. Claims must be submitted at the provider's usual and customary charge and must contain the Procedure Code W5100. Claims must be submitted to the Department of Human Services. The Department of Human Service…

Rule 67:54:07:16 Claim requirements. 67:54:07:16. Claim requirements. A claim for services provided under this chapter must be submitted on a form which contains the following information: (1) The recipient's full name; (2) The recipient's medical assistance identification number…

Rule 67:54:07:17 Utilization review. 67:54:07:17. Utilization review. The utilization review team must conduct, at least annually, an on-site review to determine whether the TBI program is an appropriate placement; whether the services delivered are appropriate for the client, me…

Rule 67:54:07:18 Application of other chapters. 67:54:07:18. Application of other chapters. In addition to the rules contained in this chapter, providers and recipients must meet the requirements of chapters 67:16:01, 67:16:26, 67:16:33, 67:16:34, 67:16:35, and, if applicable, 67…

Rule 67:54:08:01 Repealed. 67:54:08:01. Definitions. Repealed. Source: 35 SDR 88, effective October 23, 2008; 43 SDR 80, effective December 5, 2016.

Rule 67:54:08:02 Repealed. 67:54:08:02. Covered services. Repealed. Source: 35 SDR 88, effective October 23, 2008; 43 SDR 80, effective December 5, 2016.

Rule 67:54:08:03 Repealed. 67:54:08:03. Services not covered. Repealed. Source: 35 SDR 88, effective October 23, 2008; 43 SDR 80, effective December 5, 2016.

Rule 67:54:08:04 Repealed. 67:54:08:04. Treatment for chemical dependency for adolescents -- In-state. Repealed. Source: 17 SDR 37, effective September 11, 1990; 17 SDR 184, effective June 6, 1991; 18 SDR 209, effective June 23, 1992; transferred from § 67:16:11:03.04, 35 SDR 88,…

Rule 67:54:08:05 Repealed. 67:54:08:05. Treatment for chemically dependent or substance abusing pregnant women -- In-state. Repealed. Source: 35 SDR 88, effective October 23, 2008; 43 SDR 80, effective December 5, 2016.

Rule 67:54:08:06 Repealed. 67:54:08:06. Treatment for chemical dependency for adolescents -- Out-of-state. Repealed. Source: 18 SDR 209, effective June 23, 1992; 26 SDR 168, effective July 1, 2000; transferred from § 67:16:11:03.17, 35 SDR 88, effective October 23, 2008; 43 SDR 8…

Rule 67:54:08:07 Repealed. 67:54:08:07. Treatment for chemically dependent or substance abusing pregnant women -- Out-of-state. Repealed. Source: 35 SDR 88, effective October 23, 2008; 43 SDR 80, effective December 5, 2016.

Rule 67:54:08:08 Repealed. 67:54:08:08. Short-term relapse treatment for chemically-dependent or substance-abusing adolescents. Repealed. Source: 35 SDR 88, effective October 23, 2008; 43 SDR 80, effective December 5, 2016.

Rule 67:54:08:09 Repealed. 67:54:08:09. Prior authorization required for care beyond established service limit. Repealed. Source: 35 SDR 88, effective October 23, 2008; 43 SDR 80, effective December 5, 2016.

Rule 67:54:08:10 Repealed. 67:54:08:10. Rate of payment -- Treatment for chemical dependency. Repealed. Source: 17 SDR 37, effective September 11, 1990; 17 SDR 184, effective June 6, 1991; 18 SDR 209, effective June 23, 1992; 21 SDR 68, effective October 13, 1994; 22 SDR 94, effe…

Rule 67:54:08:11 Repealed. 67:54:08:11. Claim requirements -- Chemical dependency or substance abuse. Repealed. Source: 17 SDR 37, effective September 11, 1990; 18 SDR 78, effective November 4, 1991; 19 SDR 26, effective August 23, 1992; 19 SDR 128, effective March 11, 1993; 20 S…

Rule 67:54:08:12 Repealed. 67:54:08:12. Recognizing tribal program as a participating provider. Repealed. Source: 35 SDR 88, effective October 23, 2008; 43 SDR 80, effective December 5, 2016.

Rule 67:54:08:13 Repealed. 67:54:08:13. Application of other chapters. Repealed. Source: 35 SDR 88, effective October 23, 2008; 43 SDR 80, effective December 5, 2016.

Rule 67:54:09:01 Definitions. 67:54:09:01. Definitions. Terms used in this chapter mean: (1) "Activities of daily living," routine activities that an individual would normally do every day such as eating, bathing, dressing, toileting, and transferring; (2) "Companion services," n…

67:54:09:02. Covered family support services. For a participant who meets the requirements of §§ 67:54:09:12 and 67:54:09:13, the following family support services are covered under this chapter: (1) Specialized medical and adaptive equipment and supplies; (2) Service coordinatio…

Rule 67:54:09:03 Specialized medical and adaptive equipment and supplies. 67:54:09:03. Specialized medical and adaptive equipment and supplies. Specialized medical and adaptive equipment and supplies include devices, controls, or appliances not covered under article 67:16. The eq…

Rule 67:54:09:04 Service coordination. 67:54:09:04. Service coordination. Service coordination includes the following: (1) Coordination of services that will assist the participant to gain access to needed medical, social, and other needed services; (2) Ongoing monitoring of the …

Rule 67:54:09:05 Respite care services. 67:54:09:05. Respite care services. Respite care services include care services needed on a short-term basis because of the absence of the primary care giver or to provide temporary relief to the primary care giver. Respite care may be prov…

Rule 67:54:09:06 Nutritional supplements. 67:54:09:06. Nutritional supplements. Nutritional supplements include nutritional supplements prescribed by a physician and not otherwise covered under article 67:16. The need for nutritional supplements shall be documented in the partici…

Rule 67:54:09:07 Personal care services. 67:54:09:07. Personal care services. Personal care services include the following: (1) Assistance with basic living skills such as eating, drinking, toileting, dressing, and personal hygiene; (2) Assistance with the preparation of meals, n…

Rule 67:54:09:08 Companion services. 67:54:09:08. Companion services. Companion services include the following: (1) Assistance with or supervision of laundry, shopping, or meal preparation, not to include the cost of the food; (2) Assistance or supervision with the acquisition, r…

Rule 67:54:09:09 Environmental accessibility adaptations. 67:54:09:09. Environmental accessibility adaptations. Environmental accessibility adaptations include modifications to the participant's home owned by the participant or the participant's family to ensure the participant's…

Rule 67:54:09:10 Supported employment services. 67:54:09:10. Supported employment services. Supported employment services are employment services for an eligible participant who, because of the participant's disability, needs intensive, ongoing support to perform in a work settin…

Rule 67:54:09:11 Vehicle modification -- Exclusions. 67:54:09:11. Vehicle modification -- Exclusions. Vehicle modification consists of adaptations or alterations to an automobile that is the participant's primary means of transportation. The adaptations shall be documented in the…

67:54:09:11.01. Specialized therapy. Specialized therapy means: (1) Art therapy used to: (a) Increase awareness of self and others; (b) Cope with symptoms, stress, or traumatic experiences; and (c) Enhance cognitive abilities; (2) Music therapy, provided individually or in groups…

Rule 67:54:09:12 Eligibility for family support services. 67:54:09:12. Eligibility for family support services. The department shall apply the provisions of chapters 67:16:01, 67:46:01 through 67:46:05, inclusive, 67:46:07, and 67:46:08 when determining eligibility for services p…

Rule 67:54:09:13 Service restrictions. 67:54:09:13. Service restrictions. An individual may not receive family support services if already receiving services under chapter 67:54:04, 67:54:06, or 67:44:03. An individual may not be a resident of any of the following facilities when…