reglab/statecodes huggingface dataset:
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:01 - General provisions › Section 67:46:01:24 - Residency determinations - Individuals aged 21 and over residing in long term care facilities - Incapable of indicating intent before age 21

Current through Register Vol. 51, page 10, July 15, 2024
For a long-term care individual aged 21 or over who became incapable of
	 indicating intent before age 21, the state of residence is one of the
	 following:
(1) If the individual is
  neither married nor emancipated, the state of residence may be determined by
  one of the following:
(a) The state of
  residence is that of the parent's state of residence at the time of
  placement;
(b) The state of
  residence is that of the parent who files the application provided the
  individual is institutionalized in the parent's state of residence;
(c) If parental rights have been terminated
  and a legal guardian has been appointed, the state of residence is that of the
  guardian's state of residence at the time of placement; or
(d) If parental rights have been terminated
  and a legal guardian has been appointed, the state of residence is that of the
  guardian who files the application provided the individual is institutionalized
  in the guardian's state of residence;
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:01 - General provisions › Section 67:46:01:25 - Residency determinations - Individuals aged 21 and over residing in long-term care facilities - Incapable of indicating intent after age 21

Current through Register Vol. 51, page 10, July 15, 2024
For a long-term care applicant or recipient who became incapable of
	 indicating intent after age 20, the state of residence is the state in which
	 the individual is physically present unless another state makes the
	 placement.
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
Residency -- Placement by states in an out-of-state long-term care
		facility, §
											67:46:01:18; State residence --
		Individuals age 21 and over, 42 C.F.R. §
												435.403
		(i) (July 12,
		2006).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:01 - General provisions › Section 67:46:01:26 - Residency determinations - Individuals aged 21 and over not residing in a long term care facility

Current through Register Vol. 51, page 10, July 15, 2024
The state of residence for individuals aged 21 and over who are not
	 residing in a long-term care facility is one of the following:
(1) The state where the individual is living
  and
(a) intends to reside, including without
  a fixed address; or
(b) has entered
  the state with a job commitment or seeking employment, whether or not currently
  employed;
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:01 - General provisions › Section 67:46:01:27 - Disputed residency cases

Current through Register Vol. 51, page 10, July 15, 2024
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 located is the state of
	 residence.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:01 - General provisions › Section 67:46:01:28 - Residence determination when individual leaves the state

Current through Register Vol. 51, page 10, July 15, 2024
The South Dakota residency requirement for an applicant or recipient of
	 long-term care assistance, in case of temporary leave from the state, shall be
	 determined according to the following guidelines:
(1) An individual who leaves the state by
  choice without a declared intent to return is not considered a resident of this
  state for the purpose of determining eligibility for long-term care
  assistance;
(2) Assistance from
  South Dakota shall be terminated when a recipient meets the residence
  requirements for long-term care assistance in another state;
(3) When an individual lives in another state
  and declares an intention to make that state the individual's home, the
  department shall request the individual to contact the other state agency and
  apply for long-term care assistance. When the individual declares an intention
  to make another state the individual's home, long-term care assistance from
  South Dakota shall be discontinued; and
(4) An individual who receives any form of
  long-term care assistance from another state is not entitled to long-term care
  assistance from South Dakota in any month such assistance is received from the
  other state whether or not the individual is physically present in South
  Dakota.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Incapability of indicating intent, §
											67:46:01:20.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:02 - Application for long-term care › Section 67:46:02:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
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-based
  service programs under chapters 67:44:03 and 67:54:04; and
(2) "Application," the action by which an
  individual completes the department's application form for long-term care
  assistance or medical assistance. An application is not an inquiry, which is
  simply a request for information about eligibility requirements for long-term
  care assistance or medical assistance. An inquiry may be followed by an
  application.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:02 - Application for long-term care › Section 67:46:02:02 - Signed application required

Current through Register Vol. 51, page 10, July 15, 2024
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 deceased, an authorized representative may sign
	 the application on the applicant's behalf. The applicant may be assisted by an
	 individual of the applicant's choice or someone acting in a legal capacity for
	 the applicant in the various aspects of the application or in contacts with the
	 department.
General Authority:
SDCL
		28-6-1,
		28-6-5.
Law Implemented:
SDCL
		28-6-1,
		28-6-5.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:02 - Application for long-term care › Section 67:46:02:03 - Determining eligibility

Current through Register Vol. 51, page 10, July 15, 2024
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 about the facts that are
	 within the applicant's or recipient's knowledge and competence. Verification
	 through contacts is required for selected items, including family composition,
	 resources, and income.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:02 - Application for long-term care › Section 67:46:02:04 - Prompt determinations

Current through Register Vol. 51, page 10, July 15, 2024
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.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1,
		28-6-5.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:02 - Application for long-term care › Section 67:46:02:05 - Application of time standard

Current through Register Vol. 51, page 10, July 15, 2024
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 emergency beyond the
	 department's control causing a delay in a decision by the department. Case
	 records must be fully documented to show the cause of the delay in all
	 instances when delay occurs. The department's time standard for acting on
	 applications or continuing eligibility may not be used as a waiting period
	 before granting or denying benefits.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1,
		28-6-5.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:02 - Application for long-term care › Section 67:46:02:06 - Case record to contain facts

Current through Register Vol. 51, page 10, July 15, 2024
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 applicant dies or cannot be located, the
	 department shall file the application without action and enter a notation in
	 the case record. In all other cases, the applicant's or recipient's case record
	 shall contain supportive facts for each decision relating to approval or denial
	 of eligibility.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:02 - Application for long-term care › Section 67:46:02:07 - Informing applicant

Current through Register Vol. 51, page 10, July 15, 2024
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 department's time
	 standard in acting on applications. This information shall be given in writing
	 or orally as appropriate.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:02 - Application for long-term care › Section 67:46:02:08 - Review of continuing eligibility

Current through Register Vol. 51, page 10, July 15, 2024
The department shall redetermine continuing eligibility for long-term
	 care and medical assistance once every 12 months.
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
42 U.S.C. §
												1381 thru 1383,
		1972.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:02 - Application for long-term care › Section 67:46:02:09 - Reporting change of circumstances

Current through Register Vol. 51, page 10, July 15, 2024
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.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:02 - Application for long-term care › Section 67:46:02:10 - Prompt action for continuing eligibility

Current through Register Vol. 51, page 10, July 15, 2024
Upon receipt of information which affects continued eligibility for
	 long-term care assistance, a redetermination of eligibility shall be made
	 within 30 days. The recipient may be assisted by an individual of the
	 recipient's choice in the various aspects of the redetermination of
	 eligibility.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:01 - Responsibility for information

Current through Register Vol. 51, page 10, July 15, 2024
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-term care assistance. Failure of the
	 applicant or recipient to furnish the necessary information may result in the
	 rejection or termination of long-term care assistance.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1,
		28-6-5.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:02 - Aged, blind, or disabled

Current through Register Vol. 51, page 10, July 15, 2024
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 application;
(2)
  The individual has a central visual acuity of 20/200 or less in the better eye
  with the use of a correcting lens;
(3) The individual has limited vision: the
  widest diameter of the visual field subtends an angle no greater than 20
  degrees;
(4) The individual is
  unable to engage in substantial gainful activity because of a physical or
  mental impairment which can be expected to result in death or which has lasted
  or can be expected to last for a continuous period of at least 12 months;
  or
(5) The individual is a child
  under 18 years of age who is unable to engage in substantial gainful activity
  because of a mental or physical impairment which can be expected to result in
  death or which has lasted or can be expected to last for a continuous period of
  at least 12 months.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:03 - Long-term care residency requirement and beginning of eligibility

Current through Register Vol. 51, page 10, July 15, 2024
The department shall approve long-term care assistance or medical
	 services for an eligible individual if the individual is participating in a
	 home and community-based service program or resides in one of the following
	 facilities:
(1) A licensed hospital,
  nursing facility, intermediate care facility, or assisted living facility that
  has a Medicaid provider agreement with the department for the level of care and
  services provided; or
(2) An adult
  foster care facility licensed by the South Dakota Department of Health.
If an eligible individual's income minus $20 is less than the SSI
	 standard, long-term care assistance or medical assistance begins in the month
	 the person enters the facility, subject to §
										67:46:01:03.
If an eligible individual's income minus $20 is greater than the SSI
	 standard but does not exceed 300 percent of the SSI standard, long-term care
	 assistance or medical assistance begins the first day of a 30-consecutive-day
	 period of institutionalization, subject to §
										67:46:01:03. The
	 30-consecutive-day period is met if the requirements of this rule are met and
	 the individual dies before the 30th consecutive
	 day.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Home and community-based services, ch 67:54:04.
Home and community-based waiver services, ch 67:44:03.
SSI standard benefit amount, subdivision
		67:46:04:13(2).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:04 - Transferred to Section 67:46:01:17

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Incapability of indicating intent, §
											67:46:03:07.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:05 - Transferred to Section 67:46:01:18

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:06 - Transferred to Section 67:46:01:19

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:07 - Transferred to Section 67:46:01:20

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
State residence -- Individual considered incapable of indicating
		intent, 42 C.F.R. §
												435.403; Definition of qualified
		developmental disability professional, 42 C.F.R. §
		442.401.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:08 - Transferred to Section 67:46:01:21

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
State residence -- Individuals under age 21,
		42 C.F.R. §
												435.403
		(h).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:09 - Transferred to Section 67:46:01:22

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
Assistance applications and eligibility, chapter 67:12:01; State
		residence, 42 C.F.R.
		435.403 (July 12,
		2006).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:10 - Transferred to Section 67:46:01:23

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:11 - Transferred to Section 67:46:01:24

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
State residence -- Individuals under age 21,
		42 C.F.R. §
												435.403
		(h).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:12 - Transferred to Section 67:46:01:25

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Residency -- Placement by states in an out-of-state long-term care
		facility, §
											67:46:03:05.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:13 - Transferred to Section 67:46:01:26

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
State residence, 42 C.F.R. 435.403 (July 12,
		2006).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:14 - Transferred to Section 67:46:01:27

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:15 - Transferred to Section 67:46:01:28

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Incapability of indicating intent, §
											67:46:03:07.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:18 - Determination of disability

Current through Register Vol. 51, page 10, July 15, 2024
The disability/incapacity consultation team shall determine disability
	 following the guidelines for the SSI program provided in
	 42 U.S.C. §§
										1382 c(a)(3)(A) to 1382c(a)(3)(C), inclusive,
	 as of July 1, 2014, based on medical evidence supplemented by a social history.
	 Medical evidence may be a physician's report, a copy of the physician's
	 records, or the findings of a physical examination completed for this purpose.
	 An individual who is receiving social security or SSI disability benefits meets
	 the long-term care assistance disability requirements.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:19 - Determination of blindness

Current through Register Vol. 51, page 10, July 15, 2024
Blindness, according to §
									67:46:03:02, shall be determined
	 by an ophthalmologist designated by the department. Based on an
	 ophthalmologist's or optometrist's report and evaluation, the ophthalmologist
	 shall determine whether the disability requires long-term care. If the
	 individual is receiving social security disability benefits or SSI benefits
	 based on blindness, the individual is considered to meet the blindness
	 requirements for long-term care assistance.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:20 - Cessation of determination of blindness

Current through Register Vol. 51, page 10, July 15, 2024
An individual shall be ineligible for long-term care assistance when
	 either of the following occurs:
(1)
  The individual has applied for and has been denied social security disability
  or SSI benefits based on blindness; or
(2) The department has determined that the
  blindness does not require long-term care.
If an individual is ineligible based on subdivision (1), the department
	 may not overrule the decision.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Determination of blindness, §
											67:46:03:19.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:21 - Cessation of disability

Current through Register Vol. 51, page 10, July 15, 2024
An individual is ineligible for long-term care assistance when either
	 of the following occurs:
(1) The
  disability/incapacity consultation team, following §
									67:46:03:18, inclusive, determines
  that a disability ceases to exist; or
(2) The individual has been denied social
  security or SSI disability benefits based on a disability.
If an individual is ineligible based on subdivision (2) of this
	 section, the department may not overrule the decision.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:22 - Release of medical information

Current through Register Vol. 51, page 10, July 15, 2024
No medical information may be obtained unless the department secures
	 the applicant's written consent. Refusal to sign an authorization for the
	 release of this information shall make the applicant ineligible for long-term
	 care assistance.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:23 - Payment for examinations

Current through Register Vol. 51, page 10, July 15, 2024
Physical examinations requested by the department for the purpose of
	 determining an applicant's or recipient's eligibility and level of care shall
	 be paid for by the department in accordance with §§
									67:16:01:09 and
	 67:16:01:11. The applicant or
	 recipient shall obtain written authorization for the examination from the
	 department and shall present the authorization to the person conducting the
	 examination.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:03 - Long-term care eligibility › Section 67:46:03:24 - Absence of regulations regarding conditions of eligibility

Current through Register Vol. 51, page 10, July 15, 2024
In the absence of specific regulations on income and resource
	 requirements for long-term care assistance not otherwise defined in chapters
	 67:16:01 to 67:16:16, inclusive, eligibility decisions shall be based on the
	 SSI requirements in 42
	 U.S.C. §§
										1382 to
	 1383, inclusive, as amended,
	 December 1, 1980.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:01 - Scope of chapter

Current through Register Vol. 51, page 10, July 15, 2024
The rules contained in this chapter are used to determine if an
	 individual is financially eligible, based on the individual's current month's
	 income, to receive long-term care assistance or medical assistance from the
	 department.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:02 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Terms used in this chapter mean:
(1) "Assets," the income and resources of an
  individual and the individual's spouse, including any income or resource which
  the individual or the individual's spouse is entitled to receive but does not
  because of some action or inaction on the part of any of the individuals listed
  in §
									67:46:05:32.01;
(2) "Income," unless specifically excluded in
  §
									67:46:04:03, any money or in-kind
  payments before deductions;
(3)
  "Irregular income," income received no more than once a calendar quarter from
  each income source; and
(4)
  "Regular income," income received more than once a calendar quarter from the
  same source and at a relatively fixed amount.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Third-party liability, ch 67:16:26; Income from other benefit
		programs -- Overpayments, §
											67:46:04:04.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:03 - Items not considered income when determining eligibility for long-term care or medical assistance

Current through Register Vol. 51, page 10, July 15, 2024
The following are not considered income when determining eligibility
	 for long-term care or medical assistance:
(1) Third-party payments to medical
  providers;
(2) County welfare
  payments to medical providers;
(3)
  Money paid by a school district for educational purposes;
(4) Income tax or sales tax
  refunds;
(5) Unearned irregular
  income from all sources which totals $20 or less per month;
(6) The following payments from the Veterans'
  Administration:
(a) The $90 reduced pension
  benefit for single veterans or surviving spouses of veterans in nursing
  facilities who are Medicaid recipients;
(b) Aid and attendance allowance;
(c) The clothing allowance for veterans with
  a service-connected disability for which the veteran uses a prosthetic or
  orthopedic appliance;
(d)
  Educational assistance;
(e) A
  payment adjustment for unusual medical expenses; and
(f) A payment to a Vietnam veteran's child
  who has spina bifida;
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:04 - Income from other benefit programs - Overpayments

Current through Register Vol. 51, page 10, July 15, 2024
Income from other benefit programs includes amounts withheld by that
	 program to recover overpayments made to an individual.
If an applicant or recipient was receiving long-term care assistance,
	 medical assistance, adult foster care, or assisted living at the time an
	 overpayment was made by the other benefit program and if the overpaid amount
	 was considered as income by the department when received, the overpayment may
	 not be reconsidered by the department at the time the overpaid amount is
	 subsequently withheld from the individual by the other benefit
	 program.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:05 - Determining monthly gross income. Repealed

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:06 - Income considered in month received

Current through Register Vol. 51, page 10, July 15, 2024
The department considers income in the month received unless it is
	 specifically excluded in §
									67:46:04:03.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Definitions, §
											67:46:04:02; Income not spent in
		month received, §
											67:46:05:40.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:08 - Income before application

Current through Register Vol. 51, page 10, July 15, 2024
Income received by the applicant before the month of initial
	 application is not considered as income when determining eligibility for
	 long-term care assistance or medical assistance unless the application is for
	 retroactive medical eligibility as in §
									67:46:01:03.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Disposal of resources for purposes of establishing eligibility for
		services, §
											67:46:05:06.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:09 - Verification of income. Repealed

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:10 - Income considered

Current through Register Vol. 51, page 10, July 15, 2024
For purposes of determining eligibility for long-term care assistance,
	 an individual's income is determined according to the following:
(1) For an unmarried individual, the
  department considers only the individual's income;
(2) For a child born in a hospital and
  continuously hospitalized for 30 or more consecutive days from the date of
  birth, the department considers only the income available to the child during
  this confinement. The parent's or stepparent's income is not
  considered;
(3) For a child who
  does not meet the criteria contained in subdivision (2) of this section, the
  department considers the parent's or stepparent's income available to the child
  in the calendar month of entry to a hospital, nursing facility, or intermediate
  care facility. After the calendar month of entry, the department considers only
  the income of the parent or stepparent that is actually contributed to the
  child;
(4) For a married couple, if
  one spouse enters a hospital, nursing facility, or intermediate care facility
  and is not expected to remain in the facility for 30 consecutive days, the
  department considers the couple's combined income available to each other. If
  the spouse's stay exceeds 29 days, the requirements of chapter 67:46:07
  apply;
(5) For a married couple of
  which only one spouse participates in either an HCBS or HCBWS program but is
  not expected to receive services for 30 consecutive days, the department
  considers the couple's combined income available to each other. If the spouse's
  participation in HCBS or HCBWS exceeds 29 days, the requirements of chapter
  67:46:07 apply;
(6) For a married
  couple, if both spouses enter a long-term care facility during the same
  calendar month, the department considers the couple's combined income available
  to each other and shared equally in the calendar month of entry regardless of
  room occupancy. After the calendar month of entry, the department treats the
  couple as separate individuals and considers only that income which is actually
  available to the individual; and
(7) For a married couple living together
  during the calendar month that one spouse enters assisted living or adult
  foster care, the department considers the couple's combined income available to
  each other in the calendar month of entry. After the calendar month of entry,
  the department considers only that income which is available to the spouse in
  assisted living or adult foster care. If the spouse is entering an assisted
  living facility and is receiving benefits through HCBS or HCBWS, the provisions
  of subsection (5) apply.
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
Financial responsibility of relatives and other individuals,
		42 C.F.R. §
												435.602.
Spousal impoverishment, ch
		67:46:07.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:11 and 67:46:04:12 - Twenty dollar income disregard - Exceptions. [Repealed]

Current through Register Vol. 51, page 10, July 15, 2024
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:13 - Department to refer certain individuals to Social Security Administration to apply for supplemental security income

Current through Register Vol. 51, page 10, July 15, 2024
The department must refer an individual to the Social Security Administration to apply for supplemental security income if the individual's income minus twenty dollars is less than:
(1) The standard thirty-dollar supplemental security income payment, if the individual is living in a medical or nursing facility; or
(2) The supplemental security income standard benefit amount of nine hundred and forty-three dollars, if the individual is not institutionalized but living in an adult foster care home or an assisted living facility.
General Authority:
SDCL  28-6-1.
Law Implemented:
SDCL  28-6-1(6).
Long-term care residency requirement and beginning of eligibility, §
											67:46:03:03.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:14 - Ineligibility when income exceeds three hundred percent of maximum supplemental security income standard

Current through Register Vol. 51, page 10, July 15, 2024
An individual who is in a medical or nursing facility or is
	 participating in a home and community-based waiver program is ineligible to
	 receive assistance under this article when the individual's monthly income
	 exceeds three hundred percent of the maximum supplemental security income
	 standard benefit amount.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Long-term care residency requirement and beginning of eligibility,
		§
											67:46:03:03.
Supplemental security income standard benefit amount, §
											67:46:04:13(2).
Establishment of trust, §
											67:46:05:33.01.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:15 - Ineligibility when income exceeds monthly care rates for assisted living or adult foster care

Current through Register Vol. 51, page 10, July 15, 2024
An individual not receiving home and community based waiver services
	 and who is in an assisted living facility or in adult foster care is ineligible
	 to receive assistance under this article when the individual's net income
	 exceeds the monthly care rates after application of the budgeting regulations
	 contained in §§
									67:46:06:03 to
	 67:46:06:07,
	 inclusive.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Long-term care residency requirements and beginning of eligibility,
		§
											67:46:03:03.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:16 - Income from trust

Current through Register Vol. 51, page 10, July 15, 2024
The income from a trust that is considered available to the beneficiary
	 is the maximum payment that is permitted under the terms of the trust assuming
	 the full exercise of discretion by the trustee, whether or not that discretion
	 is exercised.
If a trust instrument is not specific as to the beneficiary's ownership
	 interest, the income is divided by the number of owners.
A payment made from the trust to the beneficiary or for the benefit of
	 the beneficiary is income and is considered under the provisions of this
	 chapter.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Consideration of revocable and irrevocable trusts, §
											67:46:05:32.02.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:17 - Income from real property held in trust by the federal government. Repealed

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:18

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:19

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Calculating period of ineligibility, §
											67:46:05:09.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:04 - Long-term care income requirements › Section 67:46:04:20 - Absence of an income regulation

Current through Register Vol. 51, page 10, July 15, 2024
In the absence of specific regulations or income requirements for
	 long-term care assistance not otherwise defined in this article, decisions
	 shall be based on the current SSI regulations as provided in
	 42 U.S.C. §§
										1382 and
	 1383, as amended to July 1,
	 2014.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:05 - Long-term care resource requirements › Section 67:46:05:02 - Value of liquid resources

Current through Register Vol. 51, page 10, July 15, 2024
Liquid resources, other than cash, are valued according to their equity
	 values.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:05 - Long-term care resource requirements › Section 67:46:05:03 - Value of nonliquid resources

Current through Register Vol. 51, page 10, July 15, 2024
Nonliquid resources are valued according to their equity value, except
	 as otherwise provided for automobiles.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Personal property excluded from resources, §
											67:46:05:31.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:05 - Long-term care resource requirements › Section 67:46:05:04 - Determining fair market value

Current through Register Vol. 51, page 10, July 15, 2024
The fair market value of property or contractual rights to receive
	 money must be determined by one of the following:
(1) A real estate appraiser;
(2) A Bureau of Indian Affairs realty
  office;
(3) An average of three
  estimates from individuals, other than the applicant or recipient, who are
  familiar with property values within the geographic area;
(4) A Farm Home Administration
  office;
(5) A bank or savings and
  loan official;
(6) An agency that
  specializes in discounting contractual rights using amortization schedules,
  current property values, or other pertinent data; or
(7) One hundred percent of the county tax
  valuation unless:
a. The county tax valuation
  notice is more than a year old based on its date of issue; or
b. The county tax valuation notice pertains
  to a special purpose assessment, unless it also provides a fair market value
  assessment, which can be used; or
c. The county tax valuation assessment is
  under appeal; or
d. The county tax
  valuation assessment is based on something other than fair market value, such
  as agricultural, mining or industrial; or
e. The county tax valuation notice provides
  either no assessment ratio or only a range.
The applicant or recipient must provide documentation to the department
	 which establishes the property's or contract's fair market value. The
	 department reserves the right to obtain and use independent fair market
	 valuations when, in its judgment, the valuations submitted are too high or too
	 low.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:05 - Long-term care resource requirements › Section 67:46:05:05 - Absence of a resource regulation

Current through Register Vol. 51, page 10, July 15, 2024
In the absence of specific regulations or resource requirements for
	 long-term care assistance not otherwise defined in this article, decisions
	 shall be based on the current SSI regulations as provided in
	 42 U.S.C. §§
										1382 and
	 1383.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:05 - Long-term care resource requirements › Section 67:46:05:06 - Disposal of resources for purposes of establishing eligibility

Current through Register Vol. 51, page 10, July 15, 2024
An individual is ineligible for long-term care services if an asset or
	 an interest in an asset owned by the individual or the individual's spouse is
	 transferred by the individual, the individual's spouse, or a person acting for
	 and legally authorized to execute a contract for the individual or the
	 individual's spouse for less than fair market value on or after the look back
	 date specified in § 67:46:05:06.01. Unless otherwise specified in §
									67:46:05:08.01 or 67:46:05:38, the
	 value of the transferred asset is the difference between the fair market value
	 at the time of the transfer and the amount of compensation received, if
	 any.
This type of transfer is presumed to have been made for the purpose of
	 establishing eligibility for long-term care services under this article, unless
	 the individual furnishes clear and convincing evidence that the assets were
	 either transferred exclusively for some other reason or the individual intended
	 to dispose of them at fair market value or for other valuable
	 consideration.
Medicaid-qualifying trusts are irrebuttably presumed to have been made
	 for the purpose of establishing eligibility for services under this
	 article.
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
Transfer of home property not affecting eligibility, §
											67:46:05:16.
Transfer of other property not affecting eligibility, §
											67:46:05:17.
Treatment of potential payments from Medicaid qualifying trusts,
		42 U.S.C. §
												1396 a(k).
Rebuttal of intent to transfer, §
											67:46:05:11.
Look-back period, 42 U.S.C. §
												1396
		p(c)(1)(B)(i).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:05 - Long-term care resource requirements › Section 67:46:05:06.01 - Disposal of assets - Look-back periods

Current through Register Vol. 51, page 10, July 15, 2024
The department shall use the following look-back periods when
	 determining whether an asset was transferred for less than fair market value:
(1) The look-back period extends back
  to the date 60 months before the first date on which the individual is
  institutionalized and applies for long-term care assistance; and
(2) If the asset was transferred to a trust
  or similar legal device, the look-back period extends back to the date 60
  months before the first date the individual is institutionalized and applies
  for long-term care assistance.
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
Look-back period, 42 U.S.C. §
												1396
		p(c)(1)(B)(i).