reglab/statecodes huggingface dataset:
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:07 - Traumatic brain injury services › Section 67:54:07:02 - Eligibility for services

Current through Register Vol. 51, page 10, July 15, 2024
An individual is eligible for TBI services if the individual meets the
	 following requirements:
(1) The
  individual has medical documentation from a licensed physician which contains a
  diagnosis of TBI, information as to the client's current physical condition,
  and a statement that the individual is medically stable and does not require
  ongoing nursing services in order to participate in the program and that the
  disability is likely to continue indefinitely;
(2) The individual requires TBI services to
  develop the ability to live independently within the community;
(3) The Department of Social Services has
  confirmed that the individual is eligible for and receiving Medicaid;
(4) The TBI service provider has completed a
  preplacement assessment;
(5) The
  Department of Human Services has determined that TBI services are the most
  appropriate services needed to address the individual's needs; and
(6) The individual is not receiving
  HCBS.
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 67:54:07 - Traumatic brain injury services › Section 67:54:07:03 - Application for services

Current through Register Vol. 51, page 10, July 15, 2024
An individual desiring to obtain TBI services must apply to a TBI
	 service provider. A list of approved TBI service providers is available from
	 the Department of Human Services.
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 67:54:07 - Traumatic brain injury services › Section 67:54:07:04 - Department approval of client services - Notice

Current through Register Vol. 51, page 10, July 15, 2024
After an individual requests services from a TBI provider, the TBI
	 service provider must prepare a preplacement assessment and, within five
	 working days after completing the assessment, send a copy of the assessment
	 together with the medical documentation required in §
									67:54:07:02 to the Department of
	 Human Services for its review and approval. The Department of Human Services
	 shall determine eligibility for TBI services within seven working days after
	 receiving the documentation.
The Department of Human Services shall notify the individual and the
	 individual's parent, guardian, spouse, or authorized representative, as
	 appropriate, and the service provider of the eligibility determination within
	 seven working days. If the individual is determined ineligible, the notice
	 shall include the reason for the determination of ineligibility, the specific
	 regulations supporting the action, an explanation of the individual's right to
	 request a fair hearing, the procedure for requesting a fair hearing, the right
	 to be represented by others at the hearing, and the time within which a hearing
	 may be requested.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		1-26-16,
		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 67:54:07 - Traumatic brain injury services › Section 67:54:07:05 - TBI rehabilitation service plan

Current through Register Vol. 51, page 10, July 15, 2024
After the Department of Human Services has approved the individual as a
	 TBI client and the TBI service provider has accepted the individual as a TBI
	 client, the interdisciplinary team must prepare a TBI rehabilitation service
	 plan for the client. The plan must contain specific goals, objectives, and
	 services related to the needs identified in the client's preplacement
	 assessment.
The interdisciplinary team must consist of a licensed psychologist, the
	 client's case manager, a vocational rehabilitation counselor, if appropriate,
	 and other professional staff providing direct services to the client. When
	 developing the plan, the interdisciplinary team must include the client and the
	 client's parent, guardian, spouse, or authorized representative, if
	 appropriate. The plan must be approved by the interdisciplinary team; the
	 client; the client's parent, guardian, spouse, or authorized representative, if
	 appropriate; the client's physician; and the Department of Human Services.
	 Those approving the plan must sign the plan as an indication of their approval.
	 The interdisciplinary team must develop and approve a new service plan at least
	 once every six months.
The provider must review the plan at least monthly to ensure that the
	 services continue to be appropriate for the client and update it as needed. The
	 provider must document completion of the monthly reviews and must maintain
	 copies of the plan, plan amendments, and the documentation of the monthly
	 reviews in the client's record.
The provider must submit a copy of the individual's rehabilitation
	 service plan to the Department of Human Services within seven days after
	 completion.
Failure to meet the conditions of this section is cause to determine
	 that the service provided is a noncovered service.
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 67:54:07 - Traumatic brain injury services › Section 67:54:07:06 - Covered services

Current through Register Vol. 51, page 10, July 15, 2024
Services payable under this chapter are limited to cognitive training
	 and case management 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 67:54:07 - Traumatic brain injury services › Section 67:54:07:07 - Termination of services

Current through Register Vol. 51, page 10, July 15, 2024
The provider may terminate services provided under this chapter if any
	 of the following occurs:
(1) The
  client can no longer benefit from the services provided;
(2) The client is physically threatening
  towards provider staff or others involved in the delivery of services,
  including other clients;
(3) The
  client no longer meets the criteria contained in §
									67:54:07:02;
(4) The client's living environment presents
  health and fire hazards or unsafe conditions for the person delivering
  services;
(5) The client refuses to
  comply with the assessment and service plan, fails to make progress toward
  achieving the goals identified in the plan, or fails to take needed
  medications;
(6) The client's
  cognitive ability is limited to the extent that the client is not oriented to
  person, place, or time;
(7) The
  client is under the influence of illegal drugs or alcohol; or
(8) The client has an uncontrolled infectious
  disease.
The provider must have approval from the Department of Human Services
	 before terminating the 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 67:54:07 - Traumatic brain injury services › Section 67:54:07:08 - Notice of adverse action

Current through Register Vol. 51, page 10, July 15, 2024
If the client is no longer eligible for Medicaid, the Department of
	 Social Services will send a written notice to the recipient. This notice shall
	 inform the recipient that he or she is no longer eligible.
If services are going to be terminated or reduced, the Department of
	 Human Services shall send a written notice to the client and the client's
	 parent, guardian, spouse, or authorized representative, as appropriate. This
	 notice shall state the specific regulations supporting the action taken and
	 explain the individual's right to request a conference and to be represented by
	 others at the conference, the 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.
In either case, the notices must be mailed at least ten days before the
	 date of the intended action.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		1-26-16,
		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 67:54:07 - Traumatic brain injury services › Section 67:54:07:09 - Participating provider

Current through Register Vol. 51, page 10, July 15, 2024
To participate in the delivery of TBI services, a provider must meet
	 the following requirements:
(1) Must
  be certified by the Department of Human Services as a community support
  provider. If the provider is located in another state, the provider must be
  licensed or certified by the applicable licensing agency from the other state
  either as an intermediate care facility for individuals with intellectual
  disabilities or as a home- or community-based service provider;
(2) Must provide TBI services;
(3) Must have a signed provider agreement
  with the Department of Human Services; and
(4) Must have a signed Medicaid provider
  agreement with the Department of Social Services.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Community facility standards, art 46:11; Provider requirements, ch
		67:16:33.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:07 - Traumatic brain injury services › Section 67:54:07:10 - Provider agreement with Department of Human Services

Current through Register Vol. 51, page 10, July 15, 2024
A provider agreement between the Department of Human Services and the
	 TBI service provider shall specify the provider's service limits and the rate
	 of reimbursement. The agreement shall cover a one-year period and, if both
	 parties agree, may be revised during the year. Revisions made during the year
	 must be in writing.
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 67:54:07 - Traumatic brain injury services › Section 67:54:07:11 - Required cost reports

Current through Register Vol. 51, page 10, July 15, 2024
Each year the TBI service provider must complete and submit a cost
	 report to the Department of Human Services by November 15. The cost report must
	 be on the cost reporting form available from the Department of Human Services.
	 The reporting period must cover the 12-month period of July 1 through June
	 30.
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 67:54:07 - Traumatic brain injury services › Section 67:54:07:12 - Record retention

Current through Register Vol. 51, page 10, July 15, 2024
The TBI service provider must maintain or supervise the maintenance of
	 records necessary for the program's operation including records relating to
	 applications, determinations of eligibility, the provision of services,
	 administrative costs, and statistical, fiscal, and other records necessary for
	 reporting and accountability. The TBI service provider must retain the records
	 for a minimum of six years after final payment has been made. If an audit is
	 pending, records needed for the audit must be maintained until the audit is
	 complete.
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 67:54:07 - Traumatic brain injury services › Section 67:54:07:13 - Access to records

Current through Register Vol. 51, page 10, July 15, 2024
The TBI service provider must allow the agencies of this state and
	 federal agencies access to and copies of all information, data, reports, and
	 records maintained by the provider and relating to the services
	 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 67:54:07 - Traumatic brain injury services › Section 67:54:07:14 - Basis of payment - Payment limits

Current through Register Vol. 51, page 10, July 15, 2024
The Department of Human Services shall establish the rate of payment by
	 June 1 each year. The rate of payment is based on reasonable and allowable
	 costs reported on the cost report.
If the services provided in a 24-hour period are up to but do not
	 exceed five hours, payment is limited to one unit of service for the 24-hour
	 period. If the services provided in a 24-hour period are five hours or more,
	 payment is limited to two units of service for the 24-hour
	 period.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Required cost reports, §
											67:54:07:11.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:07 - Traumatic brain injury services › Section 67:54:07:15 - Billing requirements

Current through Register Vol. 51, page 10, July 15, 2024
Claims must be submitted at the provider's usual and customary charge
	 and must contain the Procedure Code W5100.
Claims must be submitted to the Department of Human Services. The
	 Department of Human Services shall review the claims and forward the approved
	 claims to the Department of Social Services for processing.
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 67:54:07 - Traumatic brain injury services › Section 67:54:07:16 - Claim requirements

Current through Register Vol. 51, page 10, July 15, 2024
A claim for services provided under this chapter must be submitted on a
	 form which contains the following information:
(1) The recipient's full name;
(2) The recipient's medical assistance
  identification number from the recipient's medical assistance identification
  card;
(3) Third-party liability
  information required under chapter 67:16:26;
(4) Date of service;
(5) Place of service;
(6) The provider's usual and customary
  charge. The provider may not subtract other third-party payments from this
  charge;
(7) The procedure code
  specified in §
									67:54:07:15;
(8) The units of service furnished if more
  than one; and
(9) The provider's
  name and medical assistance identification number.
A separate claim form must be used for each recipient.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Note:
The HCFA 1500 form substantially meets the
		requirements of this rule and its content and appearance are acceptable to the
		department. These forms are available for direct purchase through the
		Superintendent of Documents, U. S. Government Printing Office, Washington D.C.
		20402. (202) 783-3238 - pricing desk.
Claims, ch 67:16:35.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:07 - Traumatic brain injury services › Section 67:54:07:17 - Utilization review

Current through Register Vol. 51, page 10, July 15, 2024
The utilization review team must conduct, at least annually, an on-site
	 review to determine whether the TBI program is an appropriate placement;
	 whether the services delivered are appropriate for the client, meet the
	 client's needs, and have assisted the client to live independently in the
	 community; whether the needed services have been provided in a timely and
	 efficient manner; and whether the provider has the staff and facilities to
	 carry out the services identified in the client's rehabilitation plan.
The utilization review team must submit its written report of the
	 review to the Department of Human Services and the service provider within 30
	 days after completing the review. The report must include the team's findings
	 and recommendations for corrective action. The service provider has 15 days
	 from receipt of this report to challenge in writing any of the team's findings
	 or recommendations. The Department of Human Services shall issue its final
	 report within 40 days following receipt of the initial report. The Department
	 of Human Services shall specify in the final report the time within which the
	 provider must institute any required corrective action.
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 67:54:07 - Traumatic brain injury services › Section 67:54:07:18 - 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, 67:16:35, and, if applicable, 67:16:39.
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 67:54:08 › Section 67:54:08:01

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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:08 › Section 67:54:08:02

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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:08 › Section 67:54:08:03

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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:08 › Section 67:54:08:04

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Treatment for chemical dependency for adolescents -- Out-of-state,
		§
											67:54:08:06.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:08 › Section 67:54:08:05

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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:08 › Section 67:54:08:06

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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:08 › Section 67:54:08:07

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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:08 › Section 67:54:08:08

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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:08 › Section 67:54:08:09

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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:08 › Section 67:54:08:10

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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:08 › Section 67:54:08:11

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Note:
The CMS 1500 form substantially meets the
		requirements of this rule and its content and appearance is acceptable. These
		forms are available for direct purchase through the Superintendent of
		Documents, U.S. Government Printing Office, Washington, D.C. 20402. (202)
		783-3238 - pricing desk.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:08 › Section 67:54:08:12

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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:08 › Section 67:54:08:13

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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:09 - Family support waiver services › Section 67:54:09:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Terms used in this chapter mean:
(1) "Activities of daily living," routine
  activities that an individual would normally do every day such as eating,
  bathing, dressing, toileting, and transferring;
(2) "Companion services," nonmedical services
  geared towards developing an individual's independent living skills;
(3) "Department," the Department of Social
  Services;
(4) "Division," the
  Division of Developmental Disabilities for the Department of Human
  Services;
(5) "Individual," a
  person not yet receiving services or supports under the provisions of this
  chapter;
(6) "Individual service
  plan" or "ISP," a single plan for the provision of services and supports to the
  participant that is directed by the participant, is out-come oriented, and is
  intended to specify all needed assessments, supports, and training;
(7) "Participant," a person receiving
  services or supports under the provisions of this chapter;
(8) "Personal care services," services that
  enable an individual to accomplish tasks that the individual would normally do
  if the individual did not have a disability;
(9) "SSI," supplemental security income;
  and
(10) "Unit," a 15-minute
  segment of time.
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 67:54:09 - Family support waiver services › Section 67:54:09:02 - Covered family support services

Current through Register Vol. 51, page 10, July 15, 2024
For a participant who meets the requirements of §§
									67:54:09:12 and
	 67:54:09:13, the following family
	 support services are covered under this chapter:
(1) Specialized medical and adaptive
  equipment and supplies;
(2) Service
  coordination;
(3) Respite care
  services;
(4) Nutritional
  supplements;
(5) Personal care
  services;
(6) Companion
  services;
(7) Environmental
  accessibility adaptations;
(8)
  Supported employment;
(9) Vehicle
  modifications; and
(10) Specialized
  therapies.
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 67:54:09 - Family support waiver services › Section 67:54:09:03 - Specialized medical and adaptive equipment and supplies

Current through Register Vol. 51, page 10, July 15, 2024
Specialized medical and adaptive equipment and supplies include
	 devices, controls, or appliances not covered under article 67:16. The equipment
	 and supplies shall be documented in the participant's ISP and shall help the
	 participant perform activities of daily living or assist the participant in
	 perceiving, controlling, or communicating with the environment in which the
	 participant lives.
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 67:54:09 - Family support waiver services › Section 67:54:09:04 - Service coordination

Current through Register Vol. 51, page 10, July 15, 2024
Service coordination includes the following:
(1) Coordination of services that will assist
  the participant to gain access to needed medical, social, and other needed
  services;
(2) Ongoing monitoring of
  the services; and
(3) Initiating
  and overseeing the assessment and reassessment of the participant's level 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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:09 - Family support waiver services › Section 67:54:09:05 - Respite care services

Current through Register Vol. 51, page 10, July 15, 2024
Respite care services include care services needed on a short-term
	 basis because of the absence of the primary care giver or to provide temporary
	 relief to the primary care giver. Respite care may be provided either in the
	 participant's home or in a location outside the participant's
	 home.
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 67:54:09 - Family support waiver services › Section 67:54:09:06 - Nutritional supplements

Current through Register Vol. 51, page 10, July 15, 2024
Nutritional supplements include nutritional supplements prescribed by a
	 physician and not otherwise covered under article 67:16. The need for
	 nutritional supplements shall be documented in the participant's
	 ISP.
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 67:54:09 - Family support waiver services › Section 67:54:09:07 - Personal care services

Current through Register Vol. 51, page 10, July 15, 2024
Personal care services include the following:
(1) Assistance with basic living skills such
  as eating, drinking, toileting, dressing, and personal hygiene;
(2) Assistance with the preparation of meals,
  not to include the cost of the food itself; and
(3) Assistance with housekeeping chores such
  as making the bed, dusting, and vacuuming.
The need for personal care services shall be documented in the
	 participant's ISP.
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 67:54:09 - Family support waiver services › Section 67:54:09:08 - Companion services

Current through Register Vol. 51, page 10, July 15, 2024
Companion services include the following:
(1) Assistance with or supervision of
  laundry, shopping, or meal preparation, not to include the cost of the
  food;
(2) Assistance or supervision
  with the acquisition, retention, or improvement in self-help, socialization,
  and adaptive skills;
(3) Assistance
  with participation in community events to develop appropriate social skills to
  become integrated into the community.
The need for companion care shall be documented in the participant's
	 ISP.
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 67:54:09 - Family support waiver services › Section 67:54:09:09 - Environmental accessibility adaptations

Current through Register Vol. 51, page 10, July 15, 2024
Environmental accessibility adaptations include modifications to the
	 participant's home owned by the participant or the participant's family to
	 ensure the participant's health, safety, and welfare or that enable the
	 participant to function with greater independence in the home and without which
	 the participant would require institutionalization. Adaptations include items
	 such as the following:
(1) The
  installation of ramps or grab bars;
(2) Widening of doorways;
(3) Modifications to bathroom facilities;
  and
(4) Installation of specialized
  electric and plumbing systems necessary to accommodate necessary medical
  equipment and supplies.
Adaptations or improvements to the home that increase the total square
	 footage of the home or are not a direct medical or remedial benefit to the
	 participant, such as carpeting, roof repair, or central air conditioning, are
	 not covered. The division shall prior authorize any environmental accessibility
	 adaptation that exceeds the cost of $1,000.
The needed adaptations shall be documented in the participant's
	 ISP.
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 67:54:09 - Family support waiver services › Section 67:54:09:10 - Supported employment services

Current through Register Vol. 51, page 10, July 15, 2024
Supported employment services are employment services for an eligible
	 participant who, because of the participant's disability, needs intensive,
	 ongoing support to perform in a work setting or services directed towards
	 assisting the participant to obtain and retain paid employment in a community
	 setting in which individuals without disabilities are employed. Supported
	 employment services include the following:
(1) Supervision and training;
(2) Job search;
(3) Job placement;
(4) Situational evaluations and trial
  placements; and
(5) Long-term
  support to help a participant maintain a desired, integrated employment status.
Supervisory activities provided as a normal part of the business
	 setting, the production of goods or services, transportation, or compensation
	 for each participant served are not covered.
The needed supported employment services shall be documented in the
	 participant's ISP.
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 67:54:09 - Family support waiver services › Section 67:54:09:11 - Vehicle modification - Exclusions

Current through Register Vol. 51, page 10, July 15, 2024
Vehicle modification consists of adaptations or alterations to an
	 automobile that is the participant's primary means of transportation. The
	 adaptations shall be documented in the participant's ISP and shall ensure the
	 health, safety, and welfare of the participant. The following services are not
	 covered:
(1) Adaptations to a vehicle
  that are of general utility and do not directly benefit the
  participant;
(2) The purchase or
  lease of a vehicle; and
(3) Except
  for the upkeep and maintenance of covered adaptations and alterations, the
  regular upkeep and maintenance of a vehicle.
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 67:54:09 - Family support waiver services › Section 67:54:09:11.01 - Specialized therapy

Current through Register Vol. 51, page 10, July 15, 2024
Specialized therapy means:
(1)
  Art therapy used to:
(a) Increase awareness
  of self and others;
(b) Cope with
  symptoms, stress, or traumatic experiences; and
(c) Enhance cognitive abilities.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:09 - Family support waiver services › Section 67:54:09:12 - Eligibility for family support services

Current through Register Vol. 51, page 10, July 15, 2024
The department shall apply the provisions of chapters 67:16:01,
	 67:46:01 through 67:46:05, inclusive, 67:46:07, and 67:46:08 when determining
	 eligibility for services provided under this chapter. The individual shall be
	 receiving SSI or be aged, blind, or disabled and have income less than 300
	 percent of the SSI standard benefit amount. In addition, the following
	 requirements shall also be met:
(1)
  The division has determined that the individual meets developmental disability
  criteria pursuant to §
									67:54:03:03 or, if the individual
  is age birth through two years of age, the division has documentation from the
  Department of Education that indicates the child has been identified as needing
  prolonged assistance as defined in § 24:05:24.01:15;
(2) For individuals age four and above, the
  division has determined that the individual has substantial deficits as
  exhibited by completion of an Inventory for Client and Agency Planning (ICAP)
  pursuant to §
									67:54:03:04;
(3) The division has determined that the
  individual is in need of and eligible for placement in an intermediate care
  facility for individuals with intellectual disabilities based on the division's
  finding that the individual has a substantial functional limitation in three or
  more of the functional areas listed in §
									67:54:03:04; and
(4) The division has an ISP for the
  individual that has been prepared under the provisions of §
									67:54:09:15.
General Authority:
SDCL
		28-6-1(1)(2).
Law Implemented:
SDCL
		28-6-1(1)(2).
SSI standard benefit amount, subdivision
		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 67:54:09 - Family support waiver services › Section 67:54:09:13 - Service restrictions

Current through Register Vol. 51, page 10, July 15, 2024
An individual may not receive family support services if already
	 receiving services under chapter 67:54:04, 67:54:06, or 67:44:03. An individual
	 may not be a resident of any of the following facilities when the family
	 support services available under the provisions of this chapter are
	 provided:
(1) A hospital;
(2) A nursing facility; or
(3) An intermediate care facility for
  individuals with intellectual disabilities.
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 67:54:09 - Family support waiver services › Section 67:54:09:15 - Service coordinator to coordinate development of ISP

Current through Register Vol. 51, page 10, July 15, 2024
The participant's service coordinator shall coordinate the development
	 of a written ISP according to § 46:10:07:20. The plan shall contain a
	 description of the services to be furnished, the frequency of the service, and
	 the type of provider who will furnish the needed service.
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 67:54:09 - Family support waiver services › Section 67:54:09:16 - Provider requirements

Current through Register Vol. 51, page 10, July 15, 2024
A provider of services under this chapter must be certified by the
	 division under the applicable requirements contained in chapter 46:11:02 and
	 must have a signed provider agreement with 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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:09 - Family support waiver services › Section 67:54:09:17 - Rate of payment

Current through Register Vol. 51, page 10, July 15, 2024
The division shall establish and specify in the division's contract
	 with the provider the rate of payment for service coordination. The
	 participant's ISP shall document an established rate for respite, personal, and
	 companion care services. The remaining covered services are paid based on the
	 charges billed for the services provided not to exceed the limits identified in
	 the approved participant's ISP.
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 67:54:09 - Family support waiver services › Section 67:54:09:18 - Billing requirements

Current through Register Vol. 51, page 10, July 15, 2024
A claim submitted for payment under this chapter shall contain the
	 following Health Care Common Procedure Coding System procedure codes, as
	 applicable.
PROCEDURE CODE
DESCRIPTION
T1020
Companion care
S5165
Home modifications
B4222
Nutritional supplements
T1005
Respite care
T1016
Service coordination
T1019
Personal care
T2018
Supported employment
A9900
Specialized medical adaptive equipment and supplies
T2039
Vehicle modifications
G0154
Personal Care 2
G0176
Specialized Therapies
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Use of Health Care Common Procedure Coding System, §
											67:16:01:27.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:09 - Family support waiver services › Section 67:54:09:19 - Claim requirements

Current through Register Vol. 51, page 10, July 15, 2024
A claim for services provided under this chapter shall be submitted on
	 a form or in an electronic format that contains the following
	 information:
(1) The participant's
  full name;
(2) The participant's
  medical assistance identification number from the participant's medical
  identification card;
(3)
  Third-party liability information required under chapter 67:16:26;
(4) The date of service;
(5) The place of service;
(6) The provider's usual and customary
  charge. The provider may not subtract other third-party or cost-sharing from
  this charge;
(7) The units of
  service furnished, if more than one, for claims submitted for respite care,
  service coordination, personal care, companion care, or supported
  employment;
(8) The applicable
  procedure codes contained in §
									67:54:09:18 for the services
  provided;
(9) The applicable
  diagnosis codes adopted in §
									67:16:01:26;
(10) The provider's name and National
  Provider Identification (NPI) number; and
(11) The type of service provided.
A separate claim shall be submitted for each
	 participant.
General Authority:
SDCL
		28-6-1. Law Implemented: SDCL
		28-6-1.
Note:
The CMS 1500 form substantially meets the
		requirements of this rule and its content and appearance are acceptable to the
		department. These forms are available for direct purchase through the
		Superintendent of Documents, U.S. Government Printing Office, Washington, D.C.
		20402. (202) 783-3238 - pricing desk.
Claims, ch 67:16:35.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:09 - Family support waiver services › Section 67:54:09:20 - Record retention

Current through Register Vol. 51, page 10, July 15, 2024
The provider must maintain or supervise the maintenance of records
	 necessary to substantiate eligibility, the provision of services, the cost
	 involved, and other records necessary for reporting and accountability. The
	 provider must maintain the records for a minimum of six years after final
	 payment has been made on behalf of an individual. If an audit is pending, the
	 provider must maintain the records needed for the audit until the audit is
	 complete.
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 67:54:09 - Family support waiver services › Section 67:54:09:21 - Access to records

Current through Register Vol. 51, page 10, July 15, 2024
The provider must allow the State of South Dakota and federal agencies
	 access to and copies of all information, data, reports, and records maintained
	 by the provider that relate to the services 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 67:54:09 - Family support waiver services › Section 67:54:09:22 - 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 67:16:01 --
  General provisions;
(2) Chapter
  67:16:26 -- Third-party liability;
(3) Chapter 67:16:33 -- Provider
  requirements;
(4) Chapter 67:16:34
  -- Records; and
(5) 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 67:54:09 - Family support waiver services › Section 67:54:09:23 - 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 review and 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 67:54:09 - Family support waiver services › Section 67:54:09:24 - 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 67:55 - Crime victims' compensation › Chapter 67:55:01 - General provisions › Section 67:55:01:03 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Terms used in this article have the same meaning as those terms defined
	 in SDCL 23A-28B-1. In addition, the
	 following definitions apply:
(1)
  "Inmate," an individual as defined in §
									17:10:01:10.
General Authority:
SDCL
		23A-28B-33.
Law Implemented:
SDCL
		23A-28B-40.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:55 - Crime victims' compensation › Chapter 67:55:01 - General provisions › Section 67:55:01:04 - Application

Current through Register Vol. 51, page 10, July 15, 2024
A claimant seeking compensation under this article must submit a
	 completed application for compensation signed by the claimant. The application
	 form is available from the department or any law enforcement agency.
A claimant applying for an emergency award must indicate on the
	 application that it is to be considered as an emergency application and must
	 attach a written statement explaining the undue hardship that will result to
	 the claimant if an emergency award is not given.
A claimant seeking compensation under this chapter is limited to the
	 following individuals:
(1) The
  victim;
(2) A family member
  representing the victim;
(3) If the
  victim is a minor, the minor's guardian or conservator; or
(4) In the event of personal injury to or
  death of the victim, the individual responsible for maintenance of the victim
  or the administration of the victim's estate.
A third party such as an employer, an assignee, an insurance company,
	 or a service provider may not submit an application for compensation under this
	 chapter.
General Authority:
SDCL
		23A-28B-33.
Law Implemented:
SDCL
		23A-28B-11,
		23A-28B-12,
		23A-28B-15,
		23A-28B-40.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:55 - Crime victims' compensation › Chapter 67:55:01 - General provisions › Section 67:55:01:05 - Circumstances when compensation not allowed

Current through Register Vol. 51, page 10, July 15, 2024
In addition to the circumstances contained in SDCL
	 23A-28B-25, compensation is not
	 allowed for any of the following circumstances:
(1) Accidental discharge of a firearm or
  other weapon;
(2) Obscene telephone
  calls;
(3) Motor vehicle accidents,
  unless the offender's conduct constituted driving under the influence,
  vehicular battery, vehicular homicide, or reckless driving;
(4) Except for first-degree burglary,
  property crimes including second- and third-degree burglary, theft, or
  arson;
(5) Cost and fees incurred
  by the victim or claimant in connection with a civil action;
(6) Instances in which the individual had a
  property loss but did not suffer a personal injury;
(7) Expenses resulting from a crime when the
  claimant knew of the crime but failed to report it; or
(8) Expenses incurred as a result of crimes
  committed against a victim who is an inmate in a public institution.
General Authority:
SDCL
		23A-28B-33.
Law Implemented:
SDCL
		23A-28B-25,
		23A-28B-40.