reglab/statecodes huggingface dataset:
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:05 - Recoveries - Child care services › Section 67:48:05:02 - Recovery of overpayments - Funds paid in error

Current through Register Vol. 51, page 10, July 15, 2024
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 and subsequently finds
  that the individual on whose behalf the funds were paid was ineligible for
  child care assistance;
(2) The
  department pays the provider for child care services on behalf of an individual
  who was eligible for child care assistance but the department subsequently
  finds that the amount of assistance paid exceeded the amount of benefits
  payable;
(3) The department pays
  the provider for child care services and subsequently finds that the provider
  was not entitled to the benefits; or
(4) The department pays child care services
  grant funds to a provider and the provider fails to fulfill the requirements of
  the grant.
Child care assistance paid in error as a result of an intentional
	 program violation constitutes a debt to and is subject to recovery by the
	 department according to the provisions and limits of this chapter. Child care
	 assistance paid in error that is not the result of an intentional program
	 violation constitutes a debt to and is subject to recovery by the department
	 according to the provisions and limits of article 67:47.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-61.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:05 - Recoveries - Child care services › Section 67:48:05:03 - Benefit paid in error as a result of intentional program violation

Current through Register Vol. 51, page 10, July 15, 2024
A benefit paid in error includes a payment made as a result of an
	 intentional program violation. An IPV exists if any of the following
	 occurs:
(1) The individual pleads
  guilty or nolo contendere to fraud;
(2) The individual waives the right to a
  disqualification hearing; or
(3) An
  administrative hearing officer or a court of appropriate jurisdiction finds
  that the individual made a false or misleading statement or misrepresented,
  concealed, or withheld facts or intentionally acted to mislead, misrepresent,
  conceal, withhold facts, or propound a falsity for the purpose of establishing
  or maintaining eligibility under article 67:48 or increasing or preventing a
  reduction in the amount of benefits payable.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-61.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:05 - Recoveries - Child care services › Section 67:48:05:04 - Intentional program violation disqualification hearing

Current through Register Vol. 51, page 10, July 15, 2024
If the department finds evidence that indicates an intentional program
	 violation has occurred, the department may initiate an administrative
	 disqualification hearing or may refer the matter to federal, state, or local
	 officials for further legal action.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-61.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:05 - Recoveries - Child care services › Section 67:48:05:05 - Hearing waiver

Current through Register Vol. 51, page 10, July 15, 2024
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 against the
	 individual to recover the amount of the overpayment.
If the individual suspected of having committed an IPV chooses not to
	 sign a waiver, the department shall hold an administrative disqualification
	 hearing to determine whether an IPV occurred.
An IPV hearing is held according to the provisions of SDCL chapter 1-26
	 and ARSD chapter 67:17:02, unless otherwise specified in this
	 chapter.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-61.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:05 - Recoveries - Child care services › Section 67:48:05:06 - Notice of hearing

Current through Register Vol. 51, page 10, July 15, 2024
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 suspected of having
	 committed the IPV. The notice must be sent by certified mail with return
	 receipt requested and must include the following information:
(1) The date, time, and location of the
  hearing;
(2) The charge against the
  individual;
(3) A summary of the
  evidence and a statement of how and where the individual may examine the
  evidence;
(4) A warning that the
  decision by the hearing officer will be based solely on information provided by
  the department if the individual fails to appear at the hearing;
(5) A statement that the individual may
  request a postponement of the hearing if the request is made to the department
  at least 10 days prior to the scheduled hearing;
(6) A statement that the individual has 10
  days from the date of the scheduled hearing to present good cause for failing
  to appear at the hearing in order to receive a new hearing;
(7) A description of the penalties that
  result from a determination that the individual has committed an IPV and a
  statement indicating which penalty is applicable to the individual;
(8) A statement that the hearing does not
  preclude the department from prosecuting the individual for an IPV in a
  criminal court action or from collecting the overpayment;
(9) A listing of individuals or organizations
  that provide free legal representation to individuals alleged to have committed
  an IPV;
(10) An explanation that
  the individual may waive the right to appear at an administrative
  disqualification hearing; and
(11)
  A statement of the individual's right to remain silent concerning the charge
  and that anything said or signed by the individual concerning the charge may be
  used against the individual in a court of law.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-61.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:05 - Recoveries - Child care services › Section 67:48:05:07 - Individual's rights - Administrative disqualification hearing

Current through Register Vol. 51, page 10, July 15, 2024
If the department notifies an individual suspected of committing an IPV
	 that an administrative disqualification hearing is scheduled, the individual
	 has the following rights:
(1) To
  examine the documents and records to be used at the hearing at a reasonable
  time before the date of the hearing as well as during the hearing;
(2) To present the case or have it presented
  by legal counsel or another person;
(3) To bring witnesses;
(4) To advance arguments;
(5) To question or refute any testimony or
  evidence, including an opportunity to confront and cross-examine witnesses;
  and
(6) To submit evidence to
  establish pertinent facts and circumstances in the case.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-61.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:05 - Recoveries - Child care services › Section 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

Current through Register Vol. 51, page 10, July 15, 2024
If the individual cannot be located or fails to appear at an IPV
	 hearing without good cause, the hearing examiner shall conduct the hearing
	 without the individual being represented. The hearing examiner shall consider
	 the evidence to determine whether an intentional program violation was
	 committed. If the individual is found to have committed an intentional program
	 violation but a hearing examiner later determines that the individual had good
	 cause for not appearing, the previous decision is no longer valid and the
	 department shall conduct a new hearing. The hearing examiner who originally
	 ruled on the case may conduct the new hearing.
If good cause for failure to appear is based on a showing of nonreceipt
	 of the hearing notice, the individual has 30 days after the date of the written
	 notice of the hearing decision to claim good cause. In all other instances, the
	 individual has 10 days from the date of the scheduled hearing to present
	 reasons for failing to appear. The hearing examiner shall enter the good cause
	 decision into the record.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-61.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:05 - Recoveries - Child care services › Section 67:48:05:09 - Postponement of IPV hearing

Current through Register Vol. 51, page 10, July 15, 2024
An IPV hearing may be postponed once if the individual requesting the
	 postponement makes the request at least 10 days before the scheduled
	 hearing.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-61.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:05 - Recoveries - Child care services › Section 67:48:05:10 - Disqualification hearing decision

Current through Register Vol. 51, page 10, July 15, 2024
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 was notified of the hearing. If the hearing
	 is postponed, the 90-day limit is extended by the length of the
	 postponement.
The decision must be based on clear and convincing evidence that
	 demonstrates that the individual committed and intended to commit an
	 IPV.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-61.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:05 - Recoveries - Child care services › Section 67:48:05:11 - Disqualification - Notice - Penalties

Current through Register Vol. 51, page 10, July 15, 2024
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 first occurrence,
  one year;
(2) For the second
  occurrence, two years; and
(3) For
  the third occurrence, permanently.
If the disqualified individual is a provider, the individual may not
	 apply for any child care grants or receive any grant funding during the period
	 of the disqualification.
The department shall notify the individual in writing before the
	 disqualification becomes effective.
A disqualification penalty remains in effect without the possibility of
	 an administrative stay unless a court of appropriate jurisdiction reverses the
	 finding on which the penalty was based. The duration of the disqualification
	 penalty is not subject to review.
If a disqualification penalty and other sanctions or penalties apply,
	 the disqualification penalty must be adhered to and is in addition to any other
	 sanction or penalty that may be imposed by law for the same
	 offense.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-61.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:05 - Recoveries - Child care services › Section 67:48:05:12 - Consolidation of administrative disqualification hearing with fair hearing

Current through Register Vol. 51, page 10, July 15, 2024
The department may combine a fair hearing and an administrative
	 disqualification hearing into a single hearing if the factual issues arise out
	 of the same, or related, circumstances and the household receives prior notice
	 that the hearings will be combined.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-61.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:49 - Enforcement of remedies for nursing facility deficiencies › Chapter 67:49:01 - Enforcement of remedies for nursing facility deficiencies › Section 67:49:01:02 - Medicaid program - Use of federal methods and rules for survey, certification, and enforcement of nursing facilities

Current through Register Vol. 51, page 10, July 15, 2024
Unless otherwise specified in this article, in complying with the
	 federal requirements for the survey, certification, and enforcement of skilled
	 nursing facilities and nursing facilities, the Department of Social Services
	 shall follow the regulations set forth in
	 42 C.F.R §§
										488.400 to
	 488.456, inclusive, as amended to
	 January 1, 2013.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:03 - Intermediate care for individuals with intellectual or developmental disabilities › Section 67:54:03:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
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 services
  for individuals with intellectual disabilities or who have other developmental
  disabilities;
(2) "Utilization
  review team," a team consisting of a physician, a registered nurse, and a
  qualified developmental disability professional as defined in SDCL
  27B-1-17; and
(3) "Utilization review," the utilization
  review team's assessment of the necessity for initial medical care and
  rehabilitation services and the periodic reassessment of the continued need for
  such care and services.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:03 - Intermediate care for individuals with intellectual or developmental disabilities › Section 67:54:03:02 - Eligibility for ICF-IID services

Current through Register Vol. 51, page 10, July 15, 2024
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 be developmentally
  disabled according to §
									67:54:03:03; and
(3) The utilization review team must have
  determined that the individual is in need of ICF/IID services pursuant to
  §
									67:54:03:04.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:03 - Intermediate care for individuals with intellectual or developmental disabilities › Section 67:54:03:03 - Criteria for determining developmental disability - Facility to maintain documentation

Current through Register Vol. 51, page 10, July 15, 2024
The facility must maintain in the individual's medical record a copy of
	 documentation signed by a physician or psychologist which indicates that the
	 individual is developmentally disabled. An individual is considered
	 developmentally disabled if the individual meets all of the following
	 criteria:
(1) The individual has a
  severe, chronic disability attributable to intellectual disability, cerebral
  palsy, epilepsy, head injury, brain disease, autism, or another condition which
  is closely related to intellectual disability and requires treatment or
  services similar to those required for individuals with intellectual
  disabilities. To be closely related to intellectual disability, a condition
  must cause impairment of general intellectual functioning or adaptive behavior
  similar to that of intellectual disability;
(2) The disability manifested itself before
  the individual reached the age of 22; and
(3) The disability is likely to continue
  indefinitely.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:03 - Intermediate care for individuals with intellectual or developmental disabilities › Section 67:54:03:04 - Determination of need for ICF-IID services - Initial level of care and annual redetermination

Current through Register Vol. 51, page 10, July 15, 2024
An individual is in need of ICF/IID services if the Inventory for
	 Client and Agency Planning (ICAP) completed under § 67:54:03:05 shows that
	 the individual has a substantial functional limitation in three or more of the
	 following functional areas:
(1)
  Self-care -- the daily activities enabling a person to meet basic life needs
  for food, hygiene, and appearance;
(2) Receptive and expressive language --
  communication involving verbal and nonverbal behavior that enables a person to
  understand others and to express ideas and information to others;
(3) Learning/general cognitive competence --
  the ability to acquire new behaviors, perceptions, and information and to apply
  the experiences to new situations;
(4) Mobility -- the ability to use fine or
  gross motor skills to move from one place to another with or without mechanical
  aids;
(5) Self-direction -- the
  management of one's social and personal life; the ability to make decisions
  affecting and protecting one's self-interests;
(6) Capacity for independent living -- based
  on age, the ability to live without extraordinary assistance; and
(7) Economic self-sufficiency -- the
  maintenance of financial support.
The utilization review team must annually redetermine that the
	 individual continues to need ICF/IID services.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Inventory for Client and Agency Planning (ICAP)
, 1986,
		published by Riverside Publishing Company, 425 Spring Lake, Itasca, Illinois
		60134-2079; 25 response booklets
		$45.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:03 - Intermediate care for individuals with intellectual or developmental disabilities › Section 67:54:03:05 and 67:54:03:06 - Facility to complete Inventory for Client and Agency Planning (ICAP). Repealed

Current through Register Vol. 51, page 10, July 15, 2024
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:03 - Intermediate care for individuals with intellectual or developmental disabilities › Section 67:54:03:07 - Utilization review

Current through Register Vol. 51, page 10, July 15, 2024
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; or
(4) At the annual
  classification and review.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:03 - Intermediate care for individuals with intellectual or developmental disabilities › Section 67:54:03:08 - Payment limits

Current through Register Vol. 51, page 10, July 15, 2024
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 facilities shall be made in behalf of a recipient for
	 resident days only. Resident days include the day of admission but exclude the
	 day of discharge.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:03 - Intermediate care for individuals with intellectual or developmental disabilities › Section 67:54:03:09 - Payments for reserved bed days

Current through Register Vol. 51, page 10, July 15, 2024
No payment may be made to an ICF/IID for reserving a bed during the
	 individual's absence.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:03 - Intermediate care for individuals with intellectual or developmental disabilities › Section 67:54:03:10 - Application of other rules

Current through Register Vol. 51, page 10, July 15, 2024
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 -- Records;
  and
(4) Chapter 67:16:35 --
  Claims.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:03 - Intermediate care for individuals with intellectual or developmental disabilities › Appendix A - Criteria for Inventory for Client and Agency Planning (ICAP)

Current through Register Vol. 51, page 10, July 15, 2024
APPENDIX A
CRITERIA FOR INVENTORY FOR CLIENT AND AGENCY PLANNING
	 (ICAP)
PERSONAL
SOCIAL AND
COMMUNITY
AGE
LIVING
COMMUNICATION
LIVING
0
336
340
343
1
376
388
373
2
405
428
394
3
423
429
409
4
432
440
420
5
444
448
431
6
451
453
441
7
457
456
452
8
461
463
461
9
468
468
469
10
473
475
476
11
479
482
482
12
484
486
489
13
490
488
494
14
493
490
497
15
497
493
501
16
500
497
503
17
502
500
507
18
505
501
510
19
505
504
513
20
507
507
516
21
509
509
518
22
510
511
520
23
512
515
521
24
516
516
524
25
517
518
525
26
520
519
527
27
522
521
529
28
525
522
530
29
528
522
530
30
531
523
530
31
533
524
531
32
534
524
531
33
534
525
531
34
534
525
531
35
534
525
531
36
534
526
531
37
534
526
530
38
534
526
530
39
534
527
530
40
534
527
530
41
534
527
530
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
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 behavior
  instrument score;
(3) "Home and
  community-based services," or "HCBS," the services listed in §
									67:54:04:14 that are provided by a
  certified provider to participants who, without these services, would require
  placement in an intermediate care facility for individuals with intellectual
  disabilities;
(4) "ICAP," inventory
  for client and agency planning;
(5)
  "Individual service plan" or "ISP," a single plan for the provision of services
  and supports to the participants that is directed by the participant, is
  outcome-oriented, and is intended to specify all needed assessments, supports,
  and training;
(6) "ISP team," a
  team composed of the coordinator, the participant, the participant's parent or
  guardian if the participant is under 18 and anyone else the participant
  desires;
(7) "Participant," a
  person receiving services or support under the provisions of these
  articles;
(8) "Provider," a private
  organization or a cooperative educational service unit which provides HCBS
  under this chapter and is certified by the Department of Human Services under
  article 46:11 and article 46:13 as a community support provider as defined in
  subdivision 27B-1-17(4);
(9)
  "QDDP," qualified developmental disability professional; and
(10) "TANF," temporary assistance for needy
  families.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Definition of qualified developmental disabilities professional,
		SDCL 27B-1-4; Definition of cooperative educational service units, SDCL
		13-5-31.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:02 - Long-term care requirements apply to HCBS

Current through Register Vol. 51, page 10, July 15, 2024
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.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:03 - Financial eligibility requirements

Current through Register Vol. 51, page 10, July 15, 2024
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 Social
  Security Act; or
(2) Is aged,
  blind, or disabled and has an income less than 300 percent of the SSI standard
  benefit but is not eligible for SSI.
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
Definitions, §
											67:16:01:01.
Definitions, 20
		C.F.R. §
												416.1101.
SSI standard benefit amount, §
											67:46:04:13.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:03.01 - Notification of eligibility

Current through Register Vol. 51, page 10, July 15, 2024
The Department of Social Services shall send the participant notice of
	 eligibility pursuant to §
									67:46:08:02.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:04 - General eligibility - Ineligible if SSI disability benefits denied

Current through Register Vol. 51, page 10, July 15, 2024
In addition to qualifying under §
									67:54:04:03, an individual must
	 meet the following requirements:
(1)
  Be developmentally disabled according to §
									67:54:04:05;
(2) Be appropriate for HCBS placement
  according to §
									67:54:04:06; and
(3) Be in need of and eligible for placement
  in an intermediate care facility for individuals with intellectual disabilities
  according to §
									67:54:03:04.
An individual who has been denied social security or SSI disability
	 benefits based on a disability is ineligible for HCBS.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Living arrangements -- Payment limitation -- Documentation required,
		§
											67:54:04:13.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:05 - Criteria for determining developmental disabilities - Documentation required

Current through Register Vol. 51, page 10, July 15, 2024
The provider shall maintain documentation signed by a physician or
	 psychologist which indicates that the individual is developmentally disabled.
	 An individual is considered developmentally disabled if the individual meets
	 all of the following criteria:
(1) The
  individual has a severe, chronic disability attributable to intellectual
  disability, cerebral palsy, epilepsy, head injury, brain disease, or autism or
  any other condition, other than mental illness, closely related to intellectual
  disability and requires treatment or services similar to those required for
  individuals with intellectual disabilities. To be closely related to
  intellectual disability, a condition must cause impairment of general
  intellectual functioning or adaptive behavior similar to that of intellectual
  disability;
(2) The disability
  manifested itself before the individual reached age 22; and
(3) The disability is likely to continue
  indefinitely.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:06 - Preplacement assessment

Current through Register Vol. 51, page 10, July 15, 2024
Before home and community-based services (HCBS) is approved for an
	 individual, the proposed HCBS provider shall complete an Integrated Case-Based
	 Applied Pathology (ICAP). The ICAP shall indicate a substantial functional
	 limitation in at least three of the seven areas listed in §
									67:54:03:04. The proposed HCBS
	 provider shall submit the ICAP to the Division of Developmental Disabilities,
	 Department of Human Services, using the ICAP Compuscore software. The division
	 shall receive this data upon the initiation of HCBS, as changes to the data
	 occur, and annually on January 15th. For an individual's record to be valid,
	 the evaluation date may not be more than 13 months old. The Compuscore software
	 generates standardized domain scores for each of its adaptive behavior
	 sections: motor skills, social and communication skills, personal living
	 skills, and community living skills.
No deficit exists if the following criteria are met:
(1) Self care: The personal living skills
  domain score exceeds the age-related criterion in Appendix A at the end of
  chapter 67:54:03 and, for individuals over four years of age, the individual
  has no arm/hand limitations in daily activities (ICAP item C8=1);
(2) Language: The social and communication
  skills domain score exceeds the age-related criterion in Appendix A at the end
  of chapter 67:54:03 and, for individuals over four years of age, the individual
  speaks (ICAP item A7=3);
(3)
  Learning/cognition: The individual does not have an intellectual disability
  (ICAP item C1=1);
(4) Mobility: The
  individual walks (ICAP item C9=1) and, for individuals over four years of age,
  no mobility assistance is needed (ICAP item C10=1);
(5) Self-direction: The general maladaptive
  index is in the normal range (ICAP, GMI> -11), the individual's community
  living skills domain score exceeds the age-related criterion in Appendix A at
  the end of chapter 67:54:03, and there is no psychiatric diagnosis (neither
  ICAP items B11 nor B12 checked);
(6) Independent living: The individual's
  community living skills domain score exceeds the age-related criterion in
  Appendix A at the end of chapter 67:54:03 and, for individuals 18 years of age
  and older, the recommended residential placement is "independent in own home or
  rental unit" (ICAP, page 10, F2="3"); and
(7) Economic self-sufficiency: The
  individual's recommended daytime program (ICAP item G2) is "competitive
  employment."
A substantial deficit is present if the preceding criteria are not
	 met.
General Authority:
SDCL
		28-6-1(1)(4)(6).
Law Implemented:
SDCL
		28-6-1(1)(4)(6).
Inventory for Client and Agency Planning (ICAP)
, 1986,
		published by Riverside Publishing Company, 425 Spring Lake, Itasca, Illinois
		60134-2079; 25 response booklets $45.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:09 - Residential limitations on eligibility

Current through Register Vol. 51, page 10, July 15, 2024
Residents of hospitals, skilled nursing facilities, intermediate care
	 facilities, or intermediate care facilities for individuals with intellectual
	 disabilities may apply for HCBS; however, these individuals may not be
	 residents of one of these facilities when the HCBS services are
	 provided.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:10 - Individual service plan

Current through Register Vol. 51, page 10, July 15, 2024
Each HCBS participant shall have an ISP prepared according to §
									46:11:05:03.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:11 - Parent's income and resources

Current through Register Vol. 51, page 10, July 15, 2024
The income and resources of the parents or guardians of children
	 receiving assistance from school districts or the state section for special
	 education may not be considered when determining the child's eligibility or
	 when budgeting for HCBS.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Long-term care eligibility, ch 67:46:03.
Long-term care income requirements, ch 67:46:04.
Determining amount of HCBS assistance, §
											67:54:04:12.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:12 - Determining amount of HCBS assistance

Current through Register Vol. 51, page 10, July 15, 2024
Payment for HCBS is based on the difference between the participant's
	 income, minus allowable deductions, and the participant's monthly care costs.
	 If the participant meets the requirements of subdivision 67:54:04:03(1), none
	 of the participant's income is credited to the monthly care costs. If the
	 participant meets the requirements of subdivision 67:54:04:03(2), the
	 department applies the following criteria to determine the amount of assistance
	 a participant is eligible to receive from the department to meet the
	 participant's monthly care costs:
(1)
  Apply the provisions of chapter 67:46:06, with the exception of §
									67:46:06:05;
(2) If the participant is married, apply the
  provisions of chapter 67:46:07, with the exception of subdivision
  67:46:07:10(1);
(3) Allow a
  deduction equal to the supplemental security income (SSI) standard benefit
  amount for the participant's personal needs; and
(4) If the participant is employed, allow a
  deduction of $400 from gross wages.
The Department of Social Services shall pay its share of the costs
	 directly to the provider agency. The participant is responsible for paying the
	 participant's share directly to the provider agency.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
SSI standard benefit amount, §
											67:46:04:13(2).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:14 - Covered services

Current through Register Vol. 51, page 10, July 15, 2024
Home and community-based services covered and payable under this
	 chapter consist of the following only if they are not otherwise payable under
	 article 67:16:
(1) Day
  habilitation;
(2) Prevocational
  services;
(3) Service
  coordination;
(4) Supported
  employment;
(5) Medical equipment
  and drugs;
(6) Nursing;
  and
(7) Other medically related
  services such as speech, hearing, and language.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Early and periodic screening, ch
		67:16:11.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:18 - Initial level of care

Current through Register Vol. 51, page 10, July 15, 2024
The following documentation is required to determine the initial level
	 of care:
(1) A completed ICAP that
  indicates a minimum of three substantial functional limitations;
(2) A copy of the psychological
  evaluation;
(3) An HCBS Waiver
  Choice and Rights Form signed by a CSP staff member and the individual, the
  individual's parent if the individual is under 18 years of age, or the
  individual's guardian; and
(4) A
  provisional plan of care that designates the specific waiver service that the
  individual will receive.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:18.01 - Redetermination of level of care

Current through Register Vol. 51, page 10, July 15, 2024
The level of care shall be reviewed and completed annually for each
	 participant receiving waiver services. The HCBS provider shall update the ICAP
	 data as changes occur and every three years and submit it to the division. The
	 QDDP, as defined in SDCL subdivision 27B-1-17(14), shall review the ICAP data
	 annually to ensure continued eligibility that indicates at least three
	 substantial functional limitations. The QDDP shall forward a copy of the
	 completed Level of Care Determination form to the CSP and the Department of
	 Social Services upon completion of the review.
General Authority:
SDCL
		28-6-1(1)(4)(6).
Law Implemented:
SDCL
		28-6-1(1)(4)(6).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:19 - Conditions of provider participation - Certification - Agreement

Current through Register Vol. 51, page 10, July 15, 2024
To participate in the delivery of HCBS, providers shall be approved by
	 the Department of Human Services according to article 46:11. Providers shall
	 have a signed provider agreement with the Department of Human Services and the
	 Department of Social Services. These agreements must be renewed
	 annually.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:20 and 67:54:04:21 - Agreement to provide services - Limit on number of clients. Repealed

Current through Register Vol. 51, page 10, July 15, 2024
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:22 - Extent of payment

Current through Register Vol. 51, page 10, July 15, 2024
The department shall pay a facility for the days a participant is
	 enrolled with the provider. Enrolled days include the day of admission but
	 exclude the day of discharge.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Payments during temporary absences, §
											67:54:04:23.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:23 - Payments during temporary absences

Current through Register Vol. 51, page 10, July 15, 2024
Payment shall be made on behalf of an eligible participant when it is
	 necessary to reserve that participant's HCBS position during temporary
	 absences. Payment shall be made for a maximum of five days if the absence is
	 due to admission to an acute care general hospital for an acute
	 condition.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:24 - Basis of payment

Current through Register Vol. 51, page 10, July 15, 2024
Payment to a participating provider for services provided shall be
	 determined by the Department of Human Services.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:25 - Utilization review

Current through Register Vol. 51, page 10, July 15, 2024
Services provided under this chapter are subject to the following
	 utilization reviews:
(1) At the time
  of eligibility determination;
(2)
  During claim processing;
(3) During
  postpayment reviews; and
(4) At the
  time of the annual 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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:26 - Application of other chapters

Current through Register Vol. 51, page 10, July 15, 2024
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, and 67:16:35.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:04 - Home and community-based services › Section 67:54:04:27 - Right to request a fair hearing

Current through Register Vol. 51, page 10, July 15, 2024
A participant or a participant's parent or guardian who is dissatisfied
	 with a determination regarding services under this chapter may request a fair
	 hearing in accordance with chapter 67:17:02.
A participant may request assistance with the fair hearing process from
	 an advocate.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:05 - Nursing facility for individuals with a mental disease › Section 67:54:05:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Terms used in this chapter mean:
(1) "Interdisciplinary team," a team under
  the auspices of a nursing home or the Department of Human Services which
  consists of a physician who is either a psychiatrist or is supervised by a
  psychiatrist, a qualified mental health professional, and other professionals,
  as appropriate, which prepares a plan of care for an individual admitted to a
  nursing facility for individuals with a mental disease;
(2) "Mental disease," the verifiable
  existence and manifested persistence of a severe mental illness as defined in
  SDCL 27A-1-1, which requires
  specialized psychiatric services beyond monitoring of psychotropic
  medication;
(3) "Nursing facility
  for individuals with mental disease," a facility licensed as a nursing home by
  the Department of Health which is maintained and operated for the express or
  implied purpose of providing care for individuals with mental disease who
  require specialized psychiatric services and professional nursing care under
  the direction of a physician 24 hours a day;
(4) "Plan of care," the individual treatment
  plan developed and supervised by an interdisciplinary team which is designed to
  obtain improvement in the individual's functioning and alleviate the need for
  specialized psychiatric services at the earliest possible time;
(5) "Specialized psychiatric services,"
  continuous and aggressive therapies and activities which direct and reduce
  behavior symptoms, improve an individual's level of functioning, are contained
  in an individual's plan of care, and require supervision of a psychiatrist for
  the treatment of an acute episode of a severe mental illness;
(6) "Utilization control team," a team under
  the auspices of the Department of Human Services which consists of a qualified
  mental health professional as defined in SDCL
  27A-1-3 and a registered
  nurse.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:05 - Nursing facility for individuals with a mental disease › Section 67:54:05:02 - Eligibility for medical assistance

Current through Register Vol. 51, page 10, July 15, 2024
An individual with a mental disease is eligible for medical assistance
	 if the following criteria are met:
(1)
  The individual is eligible for Medicaid under article 67:46;
(2) The service is a covered Medicaid service
  under article 67:16;
(3) The
  utilization control team has determined that the individual has a severe mental
  illness and requires care in a nursing facility for individuals with a mental
  disease;
(4) The annual
  redetermination of the need for continued care, if applicable, is current;
  and
(5) The facility meets the
  individual's needs.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:05 - Nursing facility for individuals with a mental disease › Section 67:54:05:03 - Criteria used to determine existence of mental disease

Current through Register Vol. 51, page 10, July 15, 2024
The utilization control team shall determine an individual's need for
	 specialized psychiatric services based on a psychiatric evaluation that
	 verifies the existence and manifested persistence of a severe mental illness
	 which requires specialized psychiatric treatment beyond monitoring of
	 psychotropic medication.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Definition of "severe mental illness," SDCL
		27A-1-1.