reglab/statecodes huggingface dataset:
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 67:46:05:43 - Time of resource eligibility determination

Current through Register Vol. 51, page 10, July 15, 2024
An applicant's resource eligibility is determined as of 12:01 a.m. on
	 the first day of the month of application. A recipient's resource eligibility
	 is redetermined as of 12:01 a.m. on the first day of each month. If the
	 applicant's or recipient's resources exceed the maximum resource limit as of
	 12:01 a.m. on the first day of the month but is within the limit at some time
	 during the month, the applicant or recipient is resource eligible for the
	 entire month.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Responsibility for information, §
											67:46:03:01; Separate burial funds
		excluded from resources, §
											67:46:05:45.
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 67:46:05:44 - Burial spaces excluded from resources

Current through Register Vol. 51, page 10, July 15, 2024
Burial spaces owned by the applicant or recipient are excluded from
	 resources if intended for use by any of the following individuals:
(1) The applicant or recipient and the
  applicant's or recipient's spouse;
(2) The applicant's or recipient's minor and
  adult children, stepchildren, and adopted children; or
(3) The applicant's or recipient's brothers,
  sisters, parents, adoptive parents, and the spouses of these persons.
Burial spaces include gravesites, crypts, mausoleums, urns or other
	 repositories, caskets, concrete vaults, and grave markers. If burial space
	 items are listed in a contract for services for a future need, these are
	 classified as burial funds under §
										67:46:05:45.
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
Resources defined -- Burial plots,
		20 C.F.R. §
												416.1201
		(a)(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 67:46:05:45 - Separate burial funds excluded from resources

Current through Register Vol. 51, page 10, July 15, 2024
Funds up to $1,500 each for the applicant or recipient and the
	 applicant's or recipient's spouse may be separately set aside for burial and
	 excluded from the applicant's or recipient's resources. Funds separately set
	 aside for burial include revocable burial contracts, burial trusts, or any
	 other separately identifiable assets intended for burial expenses. If the funds
	 are mixed with other resources not intended for burial, the exclusion does not
	 apply to any portion of the funds and the funds shall be treated as nonexcluded
	 resources.
The separate funds shall be clearly designated as burial funds. If the
	 separate funds are not clearly designated, the funds may be excluded if the
	 applicant states that the applicant intends to use the funds for burial and
	 submits documentary evidence of clearly designated funds within 30 days from
	 the date of application. This is an exception to §
									67:46:05:43.
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 67:46:05:46 - Increase in value of excluded burial funds

Current through Register Vol. 51, page 10, July 15, 2024
An increase in the value of excluded burial funds due to interest which
	 was left to accumulate and become a part of a separately identifiable burial
	 fund is excluded from resources.
An increase in the value of an excluded burial space is excluded from
	 resources.
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 67:46:05:47 - Reductions to separate burial funds

Current through Register Vol. 51, page 10, July 15, 2024
The $1,500 amount for separate burial funds allowed by §
									67:46:05:45 shall be reduced by
	 the equity value of an irrevocable burial trust, contract, or other irrevocable
	 arrangement which is available to meet the applicant's or recipient's burial
	 expenses and the face value of an insurance policy of $1,500 or less on the
	 applicant's or recipient's life if the policy is owned by the applicant or
	 recipient or the applicant's or recipient's spouse and if the cash surrender
	 value of the policy has been excluded from resources under §
									67:46:05:30.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Resource limit, §
											67:46:05:30.
Separate burial funds excluded from resources, §
											67:46:05:45.
Life insurance, §
											67:46:05:37.
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 67:46:05:48 - Pension funds. 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 67:46:05 - Long-term care resource requirements › Section 67:46:05:49 - Retroactive SSI and retroactive retirement, survivors, and disability income payments

Current through Register Vol. 51, page 10, July 15, 2024
Retroactive SSI payments and retroactive retirement, survivors, and
	 disability income payments are excluded from resources for six calendar months
	 following the month of receipt for individuals described in subdivisions
	 67:46:01:02(9), (18), (20), and (21).
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 67:46:05:50 - Exclusion of agent orange settlement payments

Current through Register Vol. 51, page 10, July 15, 2024
Payments received pursuant to the agent orange product liability
	 settlement are excluded from resources.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Pub. L. No. 101-201; Pub. L. No. 101-239.
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 67:46:05:51 - Assets held in common with another person

Current through Register Vol. 51, page 10, July 15, 2024
If an asset is held by an individual in common with another person in
	 joint tenancy, tenancy in common, or similar arrangement, the asset or the
	 affected portion of the asset is considered to have been transferred by the
	 individual when any action by any of the individuals listed in §
									67:46:05:32.01 reduces or
	 eliminates the individual's ownership or control of the asset.
When this occurs, the department shall establish a period of
	 ineligibility under the provisions of this chapter.
The provisions of SDCL
	 43-46-1 and chapter 67:48:02 apply
	 if an individual who has died had received medical benefits and had assets
	 which were held in common with another person.
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 67:46:05:52 - Disclosure of annuities

Current through Register Vol. 51, page 10, July 15, 2024
An individual applying for long-term care medical assistance and an
	 individual whose eligibility is being reviewed for purposes of determining
	 whether the individual continues to be eligible for long-term care assistance
	 must disclose the description of any interest the individual or the
	 individual's spouse has in an annuity or similar financial instrument. Failure
	 to disclose this information results in ineligibility for
	 assistance.
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
Disclosure of annuities required,
		42 U.S.C. §
												1396
		lp(e)(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 67:46:05:53 - Annuities - Department becomes remainder beneficiary

Current through Register Vol. 51, page 10, July 15, 2024
Pursuant to 42
	 U.S.C. §
										1396 p(e), as amended to August
	 1, 2006, the department becomes a preferred remainder beneficiary of any
	 interest the individual or the individual's spouse has in an annuity or similar
	 financial instrument purchased and owned after February 7,
	 2006.
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 67:46:05:54 - Treatment of annuities (Repealed)

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
Requirement for state to be named as a remainder beneficiary,
		42 U.S.C. §
												1396
		p(c)(1)(F).
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 67:46:05:55 - Treatment of admission or entrance fee of applicant or recipient residing in continuing care retirement or life care community

Current through Register Vol. 51, page 10, July 15, 2024
The entrance or admission fee for an applicant or recipient residing in
	 a continuing care retirement or life care community is a countable resource to
	 the extent that:
(1) The applicant or
  recipient can use the entrance or admission fee to pay for care if other
  resources or income of the applicant or recipient are insufficient to pay for
  such care;
(2) The applicant or
  recipient is eligible for a refund of any remaining entrance fee when the
  individual dies or terminates the continuing care retirement or life care
  community contract and leaves the community; and
(3) The entrance fee does not confer an
  ownership interest in the continuing care retirement or life care community.
For purposes of this section, an admission or entrance fee is a fee
	 that a state licensed, continuing care retirement or life care community
	 requires an individual to pay as a condition of admission before applying for
	 medical services. For purposes of this section, continuing care retirement or
	 life care community is an arrangement under which housing and health-related
	 services are provided or arranged through an organization for the enrollee
	 under an agreement that is effective for the life of the enrollee or for a
	 specified period.
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
Treatment of entrance fees of individuals residing in continuing
		care retirement communities, 42 U.S.C. §
												1396
		p(g).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:06 - Budgeting for long-term care › Section 67:46:06:01 - Scope of chapter

Current through Register Vol. 51, page 10, July 15, 2024
Rules contained in this chapter are applied after financial eligibility
	 is established according to chapter 67:46:04 and are used to determine the
	 amount of long-term care assistance an individual is eligible to receive 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 67:46:06 - Budgeting for long-term care › Section 67:46:06:02 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Terms used in this chapter have the same meaning as those defined in
	 §
									67:46:04:02.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:06 - Budgeting for long-term care › Section 67:46:06:03 - Income for determining long-term care assistance

Current through Register Vol. 51, page 10, July 15, 2024
For purposes of determining the amount of long-term care assistance,
	 income is considered according to subdivisions 67:46:04:03(1) to (5),
	 inclusive; §§
									67:46:04:04,
	 67:46:04:06 and 67:46:04:08 to
	 67:46:04:10, inclusive.
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 67:46:06 - Budgeting for long-term care › Section 67:46:06:04 - Supplemental payment to long-term care facility

Current through Register Vol. 51, page 10, July 15, 2024
The department shall pay a participating home and community based
	 waiver provider or nursing facility for amounts not covered by an eligible
	 individual's own income, insurance, a responsible third party or other state or
	 federal assistance programs.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Basis of payment for program benefits, §
											67:46:06:10.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:06 - Budgeting for long-term care › Section 67:46:06:05 - Deduction for personal needs

Current through Register Vol. 51, page 10, July 15, 2024
An applicant or recipient residing in a nursing or intermediate care facility is allowed:
(1) A deduction of one hundred dollars per month to cover personal needs;
(2) If earning income, an additional deduction for personal needs up to a maximum of the first seventy-five dollars of gross earned income per month; and
(3) If paying court-ordered child or spousal support, an additional deduction for personal needs up to the amount of child or spousal support actually paid out, not to exceed the court-ordered amount.
General Authority:
SDCL  28-6-1.
Law Implemented:
SDCL  28-6-1(6).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:06 - Budgeting for long-term care › Section 67:46:06:06 - Deduction for premiums

Current through Register Vol. 51, page 10, July 15, 2024
If an applicant's or recipient's income is used to pay the applicant's
	 or recipient's health insurance premiums, the department allows a deduction
	 from the income for the amount paid. The premium may be for participation in
	 the Medicare program or for private health insurance, or both. For the purpose
	 of deducting premiums from income, private health insurance is restricted to
	 those policies which insure payment for medical services rendered and medical
	 expenses incurred. It does not include a policy which insures an income
	 supplement while an individual is disabled. The policy must directly assist in
	 the payment of medical expenses. If a person is receiving benefits from an
	 income supplement insurance policy for a disability and the policy is not
	 includable under the criteria in this section, the premium payment made is
	 deductible from income when the payment is necessary to continue
	 benefits.
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 67:46:06 - Budgeting for long-term care › Section 67:46:06:07 - Deduction for dependents - No community spouse

Current through Register Vol. 51, page 10, July 15, 2024
If a recipient does not have a community spouse, as defined in SDCL
	 28-6-16, but the recipient's home is maintained for a dependent relative, a
	 deduction from the recipient's income necessary to maintain a minimum income
	 level for such a dependent is allowed based on family size. The deduction is
	 determined by taking 100 percent of the need standard for independent living
	 set in §
									67:12:06:04.01.
The need standard for the family size, minus any other income the
	 dependent relative may have, is then deducted from the recipient's income. When
	 determining the amount of the dependent's income, §§
									67:46:04:01 to
	 67:46:04:09, inclusive,
	 apply.
For purposes of this rule, a dependent relative is a son, daughter,
	 granddaughter, grandson, stepson, stepdaughter, mother, father stepmother,
	 stepfather, half sister, half brother, niece, nephew, grandmother, grandfather,
	 aunt, uncle, sister, brother, stepbrother, stepsister, first cousin, relatives
	 of the preceding generation denoted by the prefixes of grand, great, or
	 great-great; first cousin once removed; and great-great-great grandparent, and
	 spouses of any of the relatives specified, even though the marriage is
	 terminated by death or divorce, who is not currently receiving
	 SSI.
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
In-kind shelter considered unearned income -- Dependent living
		arrangement, §
											67:12:06:12; Institutionalized,
		aged, blind, or disabled individuals; determination of countable income,
		42 C.F.R. §
												435.733.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:06 - Budgeting for long-term care › Section 67:46:06:08 - Supplemental security 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 67:46:06 - Budgeting for long-term care › Section 67:46:06:09 - Treatment of income for less than a full month's residence

Current through Register Vol. 51, page 10, July 15, 2024
Whenever the residence period in a long-term care facility is less than
	 a full month, the recipient's income shall not be applied toward the cost of
	 care unless the recipient died or transferred to another long-term care
	 facility. In the event of death or transfer, the income shall be used as a
	 credit toward the cost of care.
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 67:46:06 - Budgeting for long-term care › Section 67:46:06:10 - Basis of payment for program benefits

Current through Register Vol. 51, page 10, July 15, 2024
Payment for program benefits shall be based on the difference between
	 the individual's available income and the monthly rate for the provider of the
	 individual's choice, in accordance with the provisions of this chapter and the
	 provisions of chapter 67:46:07, if applicable.
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 67:46:06 - Budgeting for long-term care › Section 67:46:06:11 - Payment made to facility or representative payee

Current through Register Vol. 51, page 10, July 15, 2024
For an individual residing in a nursing or intermediate care facility,
	 the department issues long-term care assistance payments directly to the
	 facility. For an individual residing in assisted living or adult foster care,
	 the department issues assistance payments to the individual with the facility
	 as the representative payee.
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 67:46:06 - Budgeting for long-term care › Section 67:46:06:12 - Deduction for home maintenance

Current through Register Vol. 51, page 10, July 15, 2024
An applicant or recipient residing in a nursing or intermediate care
	 facility is allowed a deduction in the amount of the SSI benefit standard minus
	 $60 for the maintenance of the home of the individual or couple for not longer
	 than 6 months if a physician has certified that the individual, or one member
	 of the institutionalized couple, is likely to return to the home within that
	 period.
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 67:46:07 - Community spouses › Section 67:46:07:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Terms defined in SDCL
	 28-6-16 have the same meaning in
	 this chapter. In addition, terms used in this chapter mean:
(1) "Initial eligibility," the original
  determination of eligibility during a continuous period of
  institutionalization.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:02 - Assessment of community spouse's share of resources

Current through Register Vol. 51, page 10, July 15, 2024
The department shall assess a couple's combined countable resources to
	 determine the community spouse's share if all of the following occur:
(1) An application for assistance with
  nursing facility or home and community based waiver services has been made or
  an institutionalized spouse, the community spouse, or the couple's authorized
  representative has requested the assessment;
(2) The institutionalized spouse was admitted
  to a hospital, nursing facility, or intermediate care facility or began
  receiving home and community based waivered services after September 29, 1989,
  and is expected to remain in the facility or continue receiving home and
  community-based waivered services for at least 30 consecutive days;
  and
(3) The institutionalized
  spouse has a community spouse.
The department must complete the assessment within 45 days of the
	 request unless delay is due to nonreceipt of documentation or verification from
	 the requesting party or a third party. The department may not use the time
	 standard as a waiting period or reason for not completing the assessment if
	 documentation has been provided.
The department shall apply the provisions of chapter 67:46:05 if the
	 spouse is entering an assisted living facility and is not receiving HCBS or
	 HCBWS or is entering an adult foster care facility.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
Definition of HCBS, §
											67:54:04:01; Definition of HCBWS,
		§
											67:44:03:01.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:03 - Determination of spousal share (Repealed)

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL 28-6-1, 28-6-18.
Law Implemented:
SDCL 28-6-1,
		28-6-18.
Community spouse resource allowance defined,
		42 U.S.C. §
												1396r-5(f)(2).
Fair hearings, ch 67:17:02.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:04 - Application of existing resource rules to spousal share of resources

Current through Register Vol. 51, page 10, July 15, 2024
When determining the spousal share of resources, the department shall
	 apply the rules established in chapter 67:46:05 to both the institutionalized
	 spouse and the community spouse.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:05 - Long-term care eligibility

Current through Register Vol. 51, page 10, July 15, 2024
Individuals wishing to apply for long-term care assistance must apply
	 as provided in chapter 67:46:02.
Eligibility other than financial shall be determined according to
	 chapters 67:46:01 and 67:46:03.
Financial eligibility shall be determined according to chapters
	 67:46:04 and 67:46:05.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:06 - Initial month of eligibility

Current through Register Vol. 51, page 10, July 15, 2024
When determining initial eligibility for long-term care assistance for
	 an institutionalized spouse in a nursing or intermediate care facility or who
	 is receiving HCBS or HCBWS, the community spouse's share must be deducted from
	 the couple's total countable resources.
If the institutionalized spouse was a former recipient during the same
	 continuous period of institutionalization, provisions of §
									67:46:07:08
	 apply.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
Definition of HCBS, §
											67:54:04:01; Definition of HCBWS,
		§
											67:44:03:01.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:07 - Retroactive eligibility

Current through Register Vol. 51, page 10, July 15, 2024
When determining retroactive eligibility at the time of the initial
	 eligibility determination, the department shall deduct the community spouse's
	 share from the couple's combined countable resources for each of the three
	 retroactive months.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:08 - Consideration of resources at time of redetermination of eligibility or reapplication for assistance

Current through Register Vol. 51, page 10, July 15, 2024
At the time of redetermination of eligibility or reapplication for
	 long-term care assistance during a continuous period of institutionalization,
	 resources held by the institutionalized spouse shall be considered for
	 eligibility according to chapter 67:46:05.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
Annual redetermination of eligibility, §
											67:46:02:08.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:09 - Determination of amount of long-term care assistance for institutionalized spouse

Current through Register Vol. 51, page 10, July 15, 2024
Sections 67:46:07:10 to 67:46:07:13, inclusive, and chapter 67:46:06,
	 except for §§
									67:46:06:02,
	 67:46:06:03, and 67:46:06:07,
	 shall be used to determine the amount of long-term care assistance the
	 institutionalized spouse is eligible to receive from the
	 department.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:10 - Order of deductions from institutionalized spouse's income

Current through Register Vol. 51, page 10, July 15, 2024
Deductions from the income of the institutionalized spouse shall be
	 allowed in the following order:
(1)
  The personal needs allowance specified in §
									67:46:06:05;
(2) The spousal maintenance and excess
  shelter allowance specified in §
									67:46:07:12;
(3) The maintenance allowance for dependents
  living with the community spouse as specified in §
									67:46:07:13;
(4) The deduction for premiums paid on health
  insurance policies according to §
									67:46:07:04; and
(5) Unpaid medical expenses incurred during a
  period which is no more than three months prior to the month of the most recent
  application for long term care services. The expenses must have been for
  necessary medical or remedial care services recognized under state law and
  prescribed by a physician that are not covered by Medicaid or any third
  party.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:11 - Deduction for maintenance of community spouse

Current through Register Vol. 51, page 10, July 15, 2024
The institutionalized spouse is allowed a deduction from the
	 institutionalized spouse's income for the maintenance needs of the community
	 spouse. The deduction is that amount remaining after subtracting the community
	 spouse's monthly income from the maintenance allowance and any excess shelter
	 allowance.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:12 - Computation of community spouse's maintenance allowance and excess shelter allowance

Current through Register Vol. 51, page 10, July 15, 2024
The community spouse's monthly minimum maintenance allowance is one hundred and fifty percent of the federal poverty income level, established in accordance with §
									67:11:01:03, for two persons, divided by twelve.
The excess shelter allowance is determined by subtracting thirty percent of the minimum maintenance allowance from the community spouse's shelter costs. Shelter costs include rent or mortgage costs, trailer parking space fees, taxes and insurance on the premises, and condominium or cooperative maintenance charges for the couple's principal residence. Shelter costs also include the applicable supplemental nutrition assistance program utility allowance pursuant to §
									67:13:01:02, 67:13:01:05, or 67:13:01:06.
Rent, mortgage, taxes, insurance, and condominium and cooperative maintenance charges paid less frequently than monthly are prorated.
The combined spousal allowances may not exceed three thousand eight hundred and fifty-three dollars and fifty cents, unless a greater allowance is provided for under a court order of support, or if, through the fair hearing process, it is determined that a greater amount of need exists because of circumstances resulting in financial duress.
These allowances are not permissible if the institutionalized spouse does not make the income available to the community spouse.
General Authority:
SDCL  28-6-1,  28-6-18.
Law Implemented:
SDCL  28-6-1(6),  28-6-17,  28-6-18(6).
Standard utility allowance, §
											67:13:01:02.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:13 - Deduction for maintenance of dependents living with community spouse

Current through Register Vol. 51, page 10, July 15, 2024
The institutionalized spouse is allowed a deduction from the
	 institutionalized spouse's income for the maintenance needs of dependents
	 living with the community spouse. The allowable deduction is an amount equal to
	 the standard community spouse's maintenance allowance determined according to
	 §
									67:46:07:12, minus the dependents'
	 monthly income, the result divided by one-third.
This deduction is permissible even if the institutionalized spouse does
	 not make the allowance available.
If a greater income allowance is specified under court order or through
	 the fair hearing process, the greater amount shall be used in place of the
	 limits in this section.
For purposes of this rule, the term "dependent" only includes minor or
	 dependent children, dependent parents, or dependent siblings of the
	 institutionalized or community spouse, including half-blood or adopted, who are
	 living with and may be claimed by either spouse for income tax
	 purposes.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:14 - Determination of income of community spouse and dependents

Current through Register Vol. 51, page 10, July 15, 2024
When determining income for the community spouse or dependent, the
	 department shall apply §§
									67:46:04:01 to
	 67:46:04:09,
	 inclusive.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:15 - Loss of community spouse status

Current through Register Vol. 51, page 10, July 15, 2024
When a change in circumstances results in an individual no longer
	 having a community spouse or an institutionalized spouse, the community spouse
	 status is considered lost at the beginning of the first full calendar month
	 following the change in circumstance.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:16 - Medical eligibility for community spouse or dependent

Current through Register Vol. 51, page 10, July 15, 2024
If the community spouse or a dependent of the institutionalized spouse
	 applies for medical assistance, that person's eligibility shall be determined
	 according to this article with the exception of this chapter.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:07 - Community spouses › Section 67:46:07:17 - Fair hearings

Current through Register Vol. 51, page 10, July 15, 2024
If either spouse is dissatisfied with the determinations made under
	 this chapter, a fair hearing may be requested only after the conditions
	 contained in SDCL
	 28-6-17 have been met. Fair
	 hearings shall be conducted according to chapter 67:17:02.
General Authority:
SDCL
		28-6-1,
		28-6-18.
Law Implemented:
SDCL
		28-6-1,
		28-6-18.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:08 - Long-term care notice requirements › Section 67:46:08:01 - Required timely and adequate notice

Current through Register Vol. 51, page 10, July 15, 2024
Timely and adequate notice shall be mailed to each recipient detailing
	 the reason for a proposed action which may result in termination or reduction
	 of payment or inability to authorize payment. The notice shall inform the
	 recipient of any changes in federal or state law requiring automatic grant
	 adjustments for classes of recipients and of a change in the manner or form of
	 payment to a protective, vendor, or two-party payment. This notice shall state
	 the specific regulations supporting the action taken and explain the
	 individual's right to and procedure for requesting a fair hearing, the right to
	 be represented by others at the hearing, and the time in which a hearing may be
	 requested. This timely notice shall be mailed ten days before the date of
	 action, which is the date when the recipient would normally receive an
	 assistance check or, in the case of a Medicaid recipient, ten days before the
	 intended change would be effective. In cases of probable fraud, notice of a
	 proposed action which may result in termination or reduction of payment or
	 inability to authorize payment shall be considered timely if mailed at least
	 five days before the action would become effective. This notice shall also
	 explain the circumstances under which assistance may be continued if a hearing
	 is requested. Timely and adequate notice is not required when the recipient of
	 a one-person case has died.
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 67:46:08 - Long-term care notice requirements › Section 67:46:08:02 - Adequate notice to applicants

Current through Register Vol. 51, page 10, July 15, 2024
A written notice to applicants for services under this article shall
	 be sent at the time the decision is made approving or rejecting each
	 application. This written notice shall include a statement of what action the
	 agency intends to take, the reasons for the intended agency action, the
	 specific regulations supporting such action, and an explanation of the
	 individual's right to and procedure for requesting a fair hearing, the right to
	 be represented by others at the hearing, and the time in which a hearing may be
	 requested. This notice shall explain the individual's right under the Civil
	 Rights Act of 1964. Nothing in this section shall be construed as indicating
	 that the department will pay for legal fees for representing applicants at
	 conferences or hearings held according to this section.
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 67:46:08 - Long-term care notice requirements › Section 67:46:08:03 - Suspension of timely notice and the application of adequate notice

Current through Register Vol. 51, page 10, July 15, 2024
The department may dispense with timely notice as provided in §
									67:46:08:01 and mail adequate
	 notice to a recipient of long-term care assistance no later than the effective
	 date of the intended change in any of the following situations:
(1) The department has factual information
  confirming the death of a recipient;
(2) The department receives a clear written
  statement signed by a recipient that the recipient no longer wishes assistance
  or that gives information which requires termination or reduction of
  assistance, and the recipient has indicated, in writing, that the recipient
  understands that this is the consequence of supplying such
  information;
(3) The change
  requires an adjustment to the budget and has no impact on the recipient's
  eligibility for benefits;
(4) The
  recipient's whereabouts are unknown and mail from the department directed to
  the recipient has been returned by the post office or facility indicating no
  known forwarding address;
(5) The
  recipient has been accepted for assistance in a nursing home in a different
  state and that fact has been established by the department;
(6) A decision is made by the medical review
  team indicating a change in the level of care required by the
  recipient;
(7) The recipient has
  been admitted to an institution where the recipient is ineligible for further
  services; and
(8) SSI eligibility
  terminates.
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 67:46:08 - Long-term care notice requirements › Section 67:46:08:04 - Right to a conference

Current through Register Vol. 51, page 10, July 15, 2024
A recipient of long-term care whose assistance is being rejected,
	 terminated, suspended, held, or reduced may request a conference or a hearing.
	 The conference may not interfere with any time schedule established for
	 requesting a fair hearing.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Fair hearings, ch
		67:17:02.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:08 - Long-term care notice requirements › Section 67:46:08:05 - Notice of right to request waiver of period of ineligibility - Assets transferred at less than fair market value - Ineligibility due to home equity limit

Current through Register Vol. 51, page 10, July 15, 2024
The department shall notify an individual if it intends to impose a
	 period of ineligibility because an individual has transferred an asset for less
	 than fair market value or is ineligible for long-term care assistance due to
	 the home equity limit established in §
									67:46:05:15. The notice shall
	 specify the date of the intended action, information about how the individual
	 can request a waiver of the period of ineligibility, and information on how to
	 request a fair hearing.
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1.
Ineligibility if assets transferred, §
											67:46:05:09.02.
Period of ineligibility waived under certain circumstances, §
											67:46:05:10.
Availability of hardship waivers,
		42 U.S.C. §
												1396 p(c)(2)(D).
Fair hearings, ch
		67:17:02.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:09 - Disabled children › Section 67:46:09:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Terms used in this chapter mean:
(1) "Active treatment," a continuous program
  of specialized training, treatment, health services, and related services
  provided to help an individual achieve the highest functioning level possible,
  but not services required to maintain generally independent individuals who are
  able to function with little supervision or in the absence of the continuous
  active treatment program;
(2)
  "Activities of daily living" or "ADL," physical functions which allow a person
  to live independently, including bathing, dressing, eating, toileting, and
  mobility according to an age appropriate assessment;
(3) "Developmental milestones," significant
  behavior that marks and delineates normal sequences of human
  development;
(4) "Disabled child
  program," a program for certain medically fragile and severely disabled
  children whose medical care needs would otherwise require the level of care
  provided in a medical institution;
(5) "ICF-IID," an intermediate care facility
  for individuals with intellectual disabilities as defined in §
									67:54:03:01;
(6) "Medical institution," a hospital as
  defined under §
									67:16:03:01; a facility licensed
  by the department of health under SDCL 34-12 as a specialized hospital with
  services limited to rehabilitation; a nursing facility as defined in §
									67:45:01:01; or an intermediate
  care facility for individuals with intellectual disabilities;
(7) "Professional nursing services," nursing
  services which are provided by a professional nurse under the provisions of
  SDCL chapter 36-9 and §§
									20:48:04:01,
  20:48:04:01.07, 20:48:04:01.11,
  20:48:04:01.12; and
(8) "Team," a
  group which determines eligibility for the disabled child program under the
  provisions of this chapter and consists of a nurse and may include a
  representative of the department and may include a physician.
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 67:46:09 - Disabled children › Section 67:46:09:02 - Application required - Time for determining eligibility - Notice

Current through Register Vol. 51, page 10, July 15, 2024
A parent, legal guardian, or authorized representative must complete,
	 date, and sign an application for assistance pursuant to this chapter. An
	 application lacking the information needed to determine eligibility or any of
	 the required signatures is cause for a denial of eligibility.
After the department receives the completed application, the department
	 shall request the medical documentation necessary to determine medical
	 eligibility from the child's physician.
Within 90 days after the date of the application, the department shall
	 determine eligibility and shall send written notice of the eligibility
	 determination to the individual who signed the application. This deadline
	 applies except in unusual circumstances, including a failure or delay on the
	 part of an examining physician to provide necessary information, an inability
	 to obtain a supplemental security disability determination, or an emergency
	 beyond the department's control. The department shall fully document in the
	 case record the cause of any delay. The department's deadline 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.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:09 - Disabled children › Section 67:46:09:03 - Prerequisites for eligibility

Current through Register Vol. 51, page 10, July 15, 2024
A parent, legal guardian, or authorized representative must apply for
	 supplemental security income (SSI) on behalf of the child and the social
	 security administration must issue its notice of eligibility determination
	 before the department determines a child's eligibility for assistance pursuant
	 to this chapter.
The social security administration's disability determination is
	 binding on eligibility or continued eligibility for services. If supplemental
	 security income is denied because the social security administration determined
	 that the child was not disabled, the child is not eligible for
	 assistance.
If supplemental security income is denied because of parental income or
	 resources, an application may be made under this chapter.
An individual must take advantage of all income and resources to which
	 the individual is entitled, including social security, SSI, income and
	 resources available under the terms of a trust, veterans' benefits, insurance
	 policies, and contractual agreements. Failure or refusal by the individual to
	 take the necessary action to take advantage of the income and resources makes
	 the individual ineligible for benefits.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.