reglab/statecodes huggingface dataset:
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:01 - Assistance with child care costs › Section 67:47:01:25 - Department to investigate report - Notice of action - Review - Final determination

Current through Register Vol. 51, page 10, July 15, 2024
When the department receives a report which suggests that fraud or
	 abuse has occurred or is occurring, it shall immediately investigate to
	 determine the validity of the report. If the report is valid and will have an
	 adverse affect on either eligibility or the amount of the child care
	 assistance, the department shall send a notice of its intent to close the case,
	 to adjust the amount of assistance, or to withhold payment ten days before
	 taking such action.
If the report concerns a provider, the notice to the provider shall
	 specify the action taken, the reason, and the effective date. If the report
	 results in a change in the provider's eligibility, the department shall notify
	 any recipients using that particular provider.
If the report concerns a recipient, the notice to the recipient shall
	 specify the action taken, the reason, and the effective date. If the report
	 results in a change in the recipient's eligibility or the level of assistance,
	 the department shall notify the recipient's provider of the
	 change.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:01 - Assistance with child care costs › Section 67:47:01:25.01 - Overpayments - Hearings - Payments made pending hearing

Current through Register Vol. 51, page 10, July 15, 2024
If the department finds evidence that an overissuance has occurred as a
	 result of an error committed by the department or an inadvertent error on the
	 part of the client or the provider, the department shall notify the individual
	 in writing that the individual has the right to a fair hearing. The request for
	 a fair hearing must be made within 30 days after the individual receives the
	 notice of the intended action. A fair hearing is conducted according to chapter
	 67:17:02.
A parent or provider must follow the provisions of §
									67:10:10:07 in order to continue
	 receiving child care assistance pending the fair hearing. Payments made during
	 this time are considered overpayments and are subject to recoupment if the
	 final decision from the hearing upholds the department's decision to close the
	 case or reduce the benefit amount.
A provider may not request a fair hearing if the issue concerns a
	 client. A client may not request a fair hearing if the issue concerns a
	 provider.
If the department finds evidence that indicates an intentional program
	 violation has occurred, the department may initiate an administrative
	 disqualification hearing or may refer the matter to federal, state, or local
	 officials for further legal action. An administrative disqualification hearing
	 is held according to the provisions of SDCL chapter 1-26 and ARSD chapters
	 67:17:02 and 67:48:05.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-61.
Benefit paid in error as result of intentional program violation,
		§
											67:48:05:03.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:01 - Assistance with child care costs › Section 67:47:01:26 - Verification

Current through Register Vol. 51, page 10, July 15, 2024
The department may verify any of the information required to be
	 submitted under this chapter. If the department is unable to obtain the data
	 necessary to verify the information submitted, the applicant must obtain and
	 provide the needed information upon request.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:01 - Assistance with child care costs › Section 67:47:01:27 - Certain individuals ineligible to receive child care assistance

Current through Register Vol. 51, page 10, July 15, 2024
The following individuals are ineligible to receive child care
	 assistance:
(1) An individual who is
  performing volunteer services;
(2)
  An individual who is caring for the individual's own child;
(3) An individual providing registered or
  unregistered family child care who is requesting child care assistance for the
  individual's own children at another facility in order to increase the
  individual's own child care capacity; and
(4) An individual who is in an educational
  program beyond a bachelor's degree.
General Authority:
SDCL
		28-1-61(1).
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:01 - Assistance with child care costs › Section 67:47:01:28 - Continuance of child care assistance pending fair hearing decision

Current through Register Vol. 51, page 10, July 15, 2024
If a parent or provider requests a fair hearing and continued
	 assistance within ten days after the department mails the notice of adverse
	 action, the department shall continue to pay child care assistance without
	 reducing, terminating, suspending, or changing the manner or form of payment
	 until the fair hearing decision is made.
In no case may assistance be continued if the hearing examiner
	 determines at the hearing that the sole issue is one of state or federal law or
	 policy or a change in state or federal law and not one of incorrect payment
	 computation or unless a change affecting the recipient's payment occurs while
	 the hearing decision is pending.
Aid continued under this section is subject to recovery by the
	 department if, as a result of the fair hearing, the department's action is
	 sustained.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:01 - Assistance with child care costs › Section 67:47:01:29 - Department to maintain waiting list

Current through Register Vol. 51, page 10, July 15, 2024
If the department does not have sufficient funding to add an applicant
	 eligible for child care assistance to the program, the department shall place
	 the eligible applicant on a waiting list. An applicant must meet all
	 eligibility requirements in order to be placed on the waiting list. If a
	 waiting list is developed, the department shall assign a level of priority. The
	 first level of priority status consists of:
(1) recipients a temporary assistance to
  needy families program recipient;
(2) An applicant with children who have
  special needs;
(3) An applicant who
  meet meets the definition of homeless; and
(4) An applicant with children who will be
  receiving or need to receive protective services.
The second level of priority status consists of applicants whose
	 monthly gross income remains below 209 percent of the federal poverty
	 level.
Within the first level of priority, eligibility is prioritized by the
	 date the completed application is received. Within the second level of
	 priority, eligibility is prioritized by income in ascending order from the
	 lowest to the highest of the federal poverty level and by the date of
	 application. A change in an applicant's circumstances may warrant a change in
	 an applicant's level of priority on the waiting list. If an applicant on the
	 waiting list no longer meets eligibility requirements, the applicant shall be
	 removed from the waiting list.
General Authority:
SDCL
		28-1-61(1)(11).
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:02 - Child care assistance for temporary assistance to needy families program recipients › Section 67:47:02:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
As used in this chapter:
(1)
  "Child with special needs," means a child who is under age 18, or under age 19
  and a full-time student in a secondary school, and who is physically or
  mentally incapable of self-care; or a child who is under court supervision;
  and
(2) "Dependent child," means a
  child who has not attained 18 years of age or has not attained 19 years of age
  and is a full-time student in a secondary school and who has been deprived of
  support or care of a parent because of the parent's death, continued absence
  from the home, or physical or mental incapacity, or who is a child of
  unemployed parents who is living with the parents in a residence maintained by
  the parents as their home;
General Authority:
SDCL 28-1-61(11).
Law Implemented:
SDCL
		28-1-60.
Definition of Head Start Program,
		45 C.F.R. §
												1305.2.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:02 - Child care assistance for temporary assistance to needy families program recipients › Section 67:47:02:02 - Application for child care services

Current through Register Vol. 51, page 10, July 15, 2024
A temporary assistance to needy families program recipient desiring
	 child care assistance must submit a completed, written, and signed application
	 for assistance to the department within 90 days after the approved activity,
	 begins that resulted in the need for child care services,
An application is void if the department requests additional
	 information and the recipient fails to respond within 10 working days after the
	 request.
General Authority:
SDCL
		28-1-61(1).
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:02 - Child care assistance for temporary assistance to needy families program recipients › Section 67:47:02:03 - Certain temporary assistance to needy families program recipients eligible for child care assistance

Current through Register Vol. 51, page 10, July 15, 2024
A temporary assistance to needy families program recipient may be
	 eligible for child care assistance if the following conditions are met:
(1) The parent is participating in an
  approved activity under the provisions of chapter 67:10:06;
(2) The parent has a child who is under age
  13 or is a child with special needs; and
(3) The child is on temporary assistance to
  needy families or would be a dependent child if needy or is receiving
  supplemental security income or temporary assistance to needy families foster
  care and resides with the parent.
General Authority:
SDCL
		28-1-61(1).
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:02 - Child care assistance for temporary assistance to needy families program recipients › Section 67:47:02:04 - Limits

Current through Register Vol. 51, page 10, July 15, 2024
Child care services covered under this chapter are limited to those
	 times during which the parent is unavailable to care for the child because the
	 parent is participating in an approved activity under the provisions of chapter
	 67:10:06.
Child care services include the time the child is in care while the
	 parent travels to and from the approved activity or training site.
Child care services do not include those care services provided by the
	 dependent child's parent, caretaker relative, legal guardian, or a member of
	 the temporary assistance to needy families assistance unit.
General Authority:
SDCL
		28-1-61(1)(2).
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:02 - Child care assistance for temporary assistance to needy families program recipients › Section 67:47:02:09.02 - Maximum rates payable for family day care provider choosing to care for infants and toddlers and limit the number of children in care to six or less. Repealed

Current through Register Vol. 51, page 10, July 15, 2024
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:02 - Child care assistance for temporary assistance to needy families program recipients › Section 67:47:02:09.04 - Maximum child care service costs recognized by department - In-home, relative, and informal providers. Repealed

Current through Register Vol. 51, page 10, July 15, 2024
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:02 - Child care assistance for temporary assistance to needy families program recipients › Section 67:47:02:11 - Provider's portion of child care certificate - Completion of request for payment form required for payment - Provider to bill usual and customary charge. Repealed

Current through Register Vol. 51, page 10, July 15, 2024
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:02 - Child care assistance for temporary assistance to needy families program recipients › Section 67:47:02:21 - Applicable provisions of chapter 67:47:01

Current through Register Vol. 51, page 10, July 15, 2024
The following provisions of chapter 67:47:01 apply to TANF parents
	 eligible for child care assistance: §
									67:47:01:07; §§
									67:47:01:10.02 to 67:47:01:16,
	 inclusive; §§
									67:47:01:18 and
	 67:47:01:19; and §§
									67:47:01:22 to
	 67:47:01:25.01,
	 inclusive.
General Authority:
SDCL
		28-1-61(1)(2).
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:03 › Section 67:47:03:01

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-1-61(1)(11).
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:03 › Section 67:47:03:02

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-1-61(1).
Law Implemented:
SDCL
		28-1-60.
Written request required, §
											67:47:03:03.
Voluntarily quitting employment and failure to cooperate results in
		ineligibility, §
											67:47:03:17.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:03 › Section 67:47:03:03

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-1-61(1).
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:03 › Section 67:47:03:04

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-1-61(1)(2).
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:03 › Section 67:47:03:06

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-1-61(1)(2)(5).
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:03 › Section 67:47:03:07

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-1-61(1)(2).
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:47 - Child care services › Chapter 67:47:03 › Section 67:47:03:17

Current through Register Vol. 51, page 10, July 15, 2024
General Authority:
SDCL
		28-1-61(1).
Law Implemented:
SDCL
		28-1-60.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Terms used in this chapter mean:
(1) "Assets," when determining eligibility
  for medical services, the income and resources of those individuals required to
  be considered under article 67:46, including any income or resources which the
  individual or the individual's spouse, if applicable, is entitled to receive
  but does not because of some action or inaction on the part of any of the
  individuals listed in §
									67:46:05:32.01;
(2) "IPV," intentional program
  violation;
(3) "Long-term care,"
  continuing 24-hour service in a medical facility, a nursing facility, an
  intermediate care facility for individuals with intellectual disabilities, an
  assisted living facility, or an adult foster home; participation in a home and
  community-based service program under chapter 67:54:04 or 67:44:03;
  and
(4) "SSI," supplemental
  security income.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:02 - Establishing claim against individual - Medical benefits paid in error

Current through Register Vol. 51, page 10, July 15, 2024
If medical assistance is paid on behalf of an individual and the
	 department subsequently finds that the individual was ineligible for the
	 medical assistance benefits paid, the department considers that the medical
	 benefit was paid in error. A benefit paid in error constitutes a debt to and is
	 subject to recovery from the individual by the department according to the
	 provisions and limits of this chapter.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
f?
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:03 - Medical benefit not subject to recovery if error made by department

Current through Register Vol. 51, page 10, July 15, 2024
If a medical benefit is paid in error because of a mistake made by the
	 department, the medical benefit paid in error is not subject to recovery.
	 Instances of department error include items such as the following:
(1) The department failed to take prompt
  action on a change reported by the individual or the individual's authorized
  representative;
(2) The department
  incorrectly computed the individual's income, resources, or deductions;
  or
(3) The department continued to
  provide the individual with medical benefits during the time the department was
  redetermining the individual's eligibility.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:04 - Recovery for certain long-term care cases

Current through Register Vol. 51, page 10, July 15, 2024
A medical benefit paid in error on behalf of an individual who was
	 residing or is residing in a long-term care facility is subject to recovery
	 from the individual if the individual meets one of the following
	 conditions:
(1) The individual is not
  an SSI recipient and would have been ineligible for medical benefits if
  information concerning the individual's assets had been disclosed within the
  mandatory reporting period specified in §
									67:46:02:09; or
(2) The individual is not an SSI recipient
  and would have been ineligible for medical benefits if information concerning
  transferred assets had been disclosed within the mandatory reporting period
  specified in §
									67:46:02:09.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:05 - Medical benefit paid in error as result of intentional program violation

Current through Register Vol. 51, page 10, July 15, 2024
A medical benefit paid in error includes a payment made as a result of
	 an intentional program violation. An intentional program violation exists if an
	 administrative hearing or a court of appropriate jurisdiction finds that the
	 individual or the individual's authorized representative intentionally made a
	 false or misleading statement or misrepresented, concealed, or withheld facts
	 or intentionally acted to mislead, misrepresent, conceal withhold facts, or
	 propound a falsity for the purpose of establishing or maintaining eligibility
	 under article 67:46 or increasing or preventing a reduction in the amount of
	 medical benefits payable on behalf of the individual. The individual or the
	 individual's authorized representative may sign a waiver waiving the
	 individual's rights to an administrative hearing.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
Hearing waiver, §
											67:48:01:14.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:06 - Administrative hearing to determine whether intentional program violation occurred

Current through Register Vol. 51, page 10, July 15, 2024
If the individual suspected of having committed an IPV chooses not to
	 sign a waiver, the department shall hold an administrative hearing to determine
	 whether an IPV occurred. An IPV hearing is held according to the provisions of
	 SDCL chapter 1-26 and ARSD chapter 67:17:02, unless otherwise specified in this
	 chapter.
The hearing examiner shall base the determination of an intentional
	 program violation on clear and convincing evidence that demonstrates that the
	 individual committed and intended to commit an intentional program
	 violation.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:07 - Notice to individual suspected of committing an intentional program violation

Current through Register Vol. 51, page 10, July 15, 2024
If the department intends to proceed with an IPV hearing, the
	 department shall send a written notice to the individual suspected of having
	 committed the intentional program violation. A copy of the notice must also be
	 sent to the individual's authorized representative, if the department is aware
	 that one exists. The notice must contain the following information:
(1) A statement that a review of the case
  indicates that an intentional program violation has occurred;
(2) A summary of the evidence supporting the
  finding;
(3) Information on how and
  where the evidence may be examined;
(4) Information on the intentional program
  violation hearing that will be scheduled; and
(5) Instructions on how the individual may
  waive the right to an administrative hearing and information on the
  ramifications of signing the waiver.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
Notice to individual -- Waiver of right to intentional program
		violation hearing, §
											67:48:01:15.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:08 - Notice of intentional program violation hearing

Current through Register Vol. 51, page 10, July 15, 2024
If the individual chooses not to sign the IPV waiver, the department
	 shall schedule an IPV hearing. At least 30 days before the date of the hearing,
	 the department shall send written notice to the individual and the individual's
	 representative, if applicable, advising the individual that an intentional
	 program violation hearing has been scheduled. The notice must be sent by
	 certified mail with a return receipt requested. If the notice is returned as
	 undeliverable, the hearing may still be held. The notice must contain the
	 following information:
(1) The date,
  time, and place of the hearing;
(2)
  The charge against the individual;
(3) A summary of the evidence;
(4) Information on how and where the evidence
  may be examined;
(5) A warning that
  the decision will be based solely on information provided by the department if
  the individual or the individual's representative, if applicable, fails to
  appear at the hearing;
(6) A
  statement that the individual or the individual's representative, if
  applicable, has 10 days from the date of the scheduled hearing to present good
  cause for failing to appear in order to receive a new hearing;
(7) A statement that the hearing does not
  preclude the state or federal government from prosecuting the individual for
  the intentional program violation in a civil or criminal court action or from
  collecting any overpayment; and
(8)
  The name of the individual or organization that provides free legal
  representation.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:09 - Individual's rights - Intentional program violation hearing

Current through Register Vol. 51, page 10, July 15, 2024
If the department holds an IPV hearing, the department shall give the
	 individual or the individual's representative, if applicable, the opportunity
	 to:
(1) Examine the documents and
  records to be used at the hearing at a reasonable time before the date of the
  hearing as well as during the hearing;
(2) Present the case or have it presented by
  legal counsel or another person;
(3) Bring witnesses;
(4) Advance arguments;
(5) Question or refute any testimony or
  evidence, including an opportunity to confront and cross-examine adverse
  witnesses; and
(6) Submit evidence
  to establish pertinent facts and circumstances in the case.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:10 - Time frame for holding hearing and writing final decision

Current through Register Vol. 51, page 10, July 15, 2024
A hearing examiner shall conduct the hearing, arrive at a decision, and
	 notify the individual and the department of the final hearing decision within
	 90 days of the date the individual was notified in writing that the IPV hearing
	 was scheduled.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:11 - Postponement of intentional program violation hearing

Current through Register Vol. 51, page 10, July 15, 2024
The individual may request that the IPV hearing be postponed. The
	 request must be made at least 10 days before the date of the scheduled hearing.
	 The hearing may not be postponed for more than 30 days and the number of
	 postponements is limited to one. If the hearing is postponed, the department
	 shall extend the 90-day time limit established in §
									67:48:01:10 for as many days as
	 the hearing is postponed.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:12 - Hearing may be held in absence of accused individual - Department to conduct new hearing if good cause found for individual's absence

Current through Register Vol. 51, page 10, July 15, 2024
If the individual cannot be located or fails to appear at an IPV
	 hearing without good cause, the hearing examiner shall conduct the hearing
	 without the individual being represented. The hearing examiner shall consider
	 the evidence to determine whether an intentional program violation was
	 committed. If the individual is found to have committed an intentional program
	 violation but a hearing examiner later determines that the individual had good
	 cause for not appearing, the previous decision is no longer valid and the
	 department shall conduct a new hearing. The hearing examiner who originally
	 rules on the case may conduct the new hearing.
In instances where good cause for failure to appear is based on a
	 showing of nonreceipt of the hearing notice, the individual has 30 days after
	 the date of the written notice of the hearing decision to claim good cause. In
	 all other instances, the individual has 10 days from the date of the scheduled
	 hearing to present reasons for failing to appear. The hearing examiner shall
	 enter the good cause decision into the record.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:13 - Consolidation of hearings

Current through Register Vol. 51, page 10, July 15, 2024
The department may combine a fair hearing and an IPV hearing into a
	 single hearing if the factual issues arise out of the same or related
	 circumstances and the individual receives prior notice that the hearings will
	 be combined. If the hearings are combined, the department shall follow the time
	 frames for conducting an intentional program violation hearing. However, at the
	 individual's request, the department shall waive the 30-day advance notice
	 period required.
If the hearings are combined for the purpose of settling the amount of
	 the overpayment at the same time as determining whether or not an intentional
	 program violation has occurred, the individual loses the right to a subsequent
	 fair hearing on the amount of the claim.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:14 - Hearing waiver

Current through Register Vol. 51, page 10, July 15, 2024
An individual accused of committing an intentional program violation
	 may waive the right to an administrative hearing. If the individual waives this
	 right, the department may initiate a collection action against the individual
	 to recover the amount of the overpayment.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:01 - Collection of medical benefits paid in error › Section 67:48:01:15 - Notice to individual - Waiver of right to intentional program violation hearing

Current through Register Vol. 51, page 10, July 15, 2024
The department shall provide written notice to the individual suspected
	 of having committed an intentional program violation that the individual may
	 waive the right to an IPV hearing. The notice must include at least the
	 following information:
(1) The date
  the department must receive the signed waiver to avoid the holding of an
  intentional program violation hearing;
(2) A signature block for the accused
  individual or the individual's authorized representative, if applicable, to
  sign;
(3) A statement of the
  accused individual's right to remain silent concerning the charge and that
  anything said or signed by the individual concerning the charge may be used
  against the individual in a court of law; and
(4) An opportunity for the accused individual
  to specify whether or not the individual admits to the facts as presented by
  the department.
General Authority:
SDCL
		28-6-1(4).
Law Implemented:
SDCL
		28-6-1(4).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:02 - Liens and estate recoveries › Section 67:48:02:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Terms used in this chapter mean:
(1) "Contiguous property," all land adjacent
  to the home including land separated only by roads, rivers, streams, and
  similar features and not separated by intervening property owned by another
  person;
(2) "Estate," all real and
  personal property and other assets included within the individual's estate as
  defined in SDCL
  29A-1-201, and any other real and
  personal property or other assets in which the individual had any legal title
  or interest at the time of death, including such assets conveyed to a survivor,
  heir, or assign of the deceased individual through joint tenancy, tenancy in
  common, survivorship, life estate, living trust, or other arrangement,
  including any funds remaining in an individual's prepaid burial trust or
  prepaid burial account after the individual's reasonable burial expenses are
  paid; and
(3) "Real property," real
  property as defined in SDCL
  43-1-3.
General Authority:
SDCL
		28-6-23,
		28-6-24.
Law Implemented:
SDCL
		28-6-23,
		28-6-24.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:02 - Liens and estate recoveries › Section 67:48:02:02 - Individuals subject to liens and estate recoveries

Current through Register Vol. 51, page 10, July 15, 2024
Any payment of medical assistance by or through the department is a
	 debt due to the department if the individual is residing in any of the
	 following:
(1) A nursing
  home;
(2) An intermediate care
  facility for individuals with intellectual disabilities;
(3) An adult foster care home;
(4) An assisted living center;
(5) A hospital swingbed; or
(6) An institution for individuals with a
  mental disease.
General Authority:
SDCL
		28-6-23,
		28-6-24.
Law Implemented:
SDCL
		28-6-23,
		28-6-24.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:02 - Liens and estate recoveries › Section 67:48:02:03 - Lien filed for medical assistance

Current through Register Vol. 51, page 10, July 15, 2024
A lien created under the provisions of SDCL
	 28-6-24 may be filed against an
	 individual's home and other real property in which the individual has a legal
	 interest.
Real property includes home property, real property held in trust, and
	 other real property.
Home property is the shelter which the individual owns and which is
	 used by the individual as the individual's principal place of residence. Home
	 property includes the buildings and contiguous property.
Real property held in trust is that property to which the federal
	 government has the legal title but which is being held for the benefit of
	 citizens.
Other real property is any real property other than that having the
	 characteristics of home property or real property held in trust. Other real
	 property includes property owned by the individual but separated from the
	 individual's home property by property belonging to another.
The amount of the lien is the amount of the medical assistance provided
	 by the department on behalf of the individual after June 30, 1994. The lien is
	 limited to the cost of those services specified in SDCL
	 28-6-23.
General Authority:
SDCL
		28-6-23,
		28-6-24.
Law Implemented:
SDCL
		28-6-23,
		28-6-24.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:02 - Liens and estate recoveries › Section 67:48:02:04 - Lien on home prohibited under certain circumstances

Current through Register Vol. 51, page 10, July 15, 2024
The department may not place a lien on an individual's home if there is
	 a reasonable expectation, based on the individual's medical, nursing, and
	 social needs, that the individual will return home or if any of the following
	 persons are lawfully residing in the home:
(1) The individual's spouse;
(2) The individual's adult child if the adult
  child has resided in and used the home as his principal place of residence for
  a continuous period of at least two years immediately prior to the date the
  individual was admitted to any of the facilities listed in SDCL
  28-6-24 and can establish to the
  department that the adult child had been providing care which permitted the
  individual to reside at home rather than in an institution;
(3) The individual's child who is under age
  21 or is blind or disabled;
(4) The
  individual's sibling who has an equity interest in the home and who has resided
  in and used the home as his principal place of residence for a continuous
  period of at least one year immediately prior to the date the individual was
  admitted to any of the facilities listed in SDCL
  28-6-24.
A person is considered to be lawfully residing in the home if the
	 person is residing in the home with the permission of the owner or, if the
	 owner is under guardianship or conservatorship, with the permission of the
	 guardian or conservator.
General Authority:
SDCL
		28-6-23,
		28-6-24.
Law Implemented:
SDCL
		28-6-23,
		28-6-24.
Determination of disability, §
											67:46:03:18; Determination of
		blindness, §
											67:46:03:19.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:02 - Liens and estate recoveries › Section 67:48:02:05 - Recovery against an individual's estate

Current through Register Vol. 51, page 10, July 15, 2024
If the department provided any of the services specified in SDCL
	 28-6-23, and the individual has
	 since died, the department shall seek to recover from the individual's estate
	 the benefits paid on behalf of the individual.
If the individual had a long-term care partnership insurance policy
	 that paid for services, the department shall reduce the amount of recovery from
	 the individual's estate by the amount of the assets disregarded at the time
	 Medicaid eligibility was determined less the amount of disregarded assets
	 disposed of before the individual's death. The benefits paid by insurance must
	 be from a long-term care partnership policy approved by the Division of
	 Insurance. In no case may the amount of the reduction exceed the amount paid
	 under the long-term care partnership insurance policy.
The department may not seek recovery from the individual's estate if
	 the individual's spouse is still living or if the individual has a surviving
	 child who is under age 21 or is blind or disabled.
General Authority:
SDCL
		28-6-23.
Law Implemented:
SDCL
		28-6-23.
Determination of disability, §
											67:46:03:18.
Determination of blindness, §
											67:46:03:19.
Long-term care insurance, ch
		20:06:21.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:02 - Liens and estate recoveries › Section 67:48:02:06 - Recovery when individual would have been ineligible for assistance

Current through Register Vol. 51, page 10, July 15, 2024
If the department finds that the individual owned property or other
	 assets which would have made the individual ineligible for medical assistance,
	 the department shall seek to recover the amount of benefits paid and the
	 prohibitions for the placement of liens and the recovery from estates contained
	 in §§
									67:48:02:04 and
	 67:48:02:05 do not
	 apply.
General Authority:
SDCL
		28-6-23,
		28-6-24.
Law Implemented:
SDCL
		28-6-23,
		28-6-24.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:02 - Liens and estate recoveries › Section 67:48:02:07 - Fair hearing

Current through Register Vol. 51, page 10, July 15, 2024
A surviving spouse who is dissatisfied with the determination made
	 under §
									67:48:02:08 may request a fair
	 hearing.
If a fair hearing is requested because of the imposition of a lien, the
	 only issue which may be raised at the hearing is whether the requirements for
	 the imposition of the lien have been met. Fair hearings are conducted under the
	 provisions of chapter 67:17:02.
General Authority:
SDCL
		28-6-23,
		28-6-24.
Law Implemented:
SDCL
		1-26-16,
		28-6-23,
		28-6-24.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:02 - Liens and estate recoveries › Section 67:48:02:08 - Recovery against estate of surviving spouse - Petition to limit financial responsibility - Determination of value of estate

Current through Register Vol. 51, page 10, July 15, 2024
For purposes of SDCL
	 28-6-23.1, the surviving spouse
	 must petition the department on a form available from the department. The
	 surviving spouse or the surviving spouse's authorized representative or legal
	 guardian must complete, sign, and return the form to the department.
If a medical recipient's death occurred after June 30, 1994, but before
	 July 1, 1997, the department shall consider a petition to limit the financial
	 responsibility of the estate of a surviving spouse if the petition is submitted
	 and received by the department by January 1, 1998.
The department shall use the completed form and §§
									67:46:05:08 and
	 67:46:05:36 to determine the
	 amount of the surviving spouse's resources which are available for
	 recovery.
For purposes of this rule, the fair market value of property is
	 determined by using 100 percent of the county's tax valuation for the
	 property.
General Authority:
SDCL
		28-6-23.
Law Implemented:
SDCL
		28-6-23.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:03 - Recoveries from providers › Section 67:48:03:02 - Provider to reimburse department for services paid by both the department and another payment source - Time limit for reimbursing department

Current through Register Vol. 51, page 10, July 15, 2024
If the department pays a provider for services provided on behalf of a
	 Medicaid recipient and the provider has received or subsequently receives
	 payment for the same service from a source other than the Medicaid recipient or
	 the county, the provider must reimburse the department. The provider must
	 reimburse the department within 45 days after receiving payment from the other
	 source. If the payment is for a service provided within the last 12 months, the
	 provider's reimbursement must be accomplished by submitting an adjustment/void
	 claim form to the department. Failure to reimburse the department within the
	 time limit shall result in an action against the provider to recover the
	 payment.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Claims, ch 67:16:35.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:04 - Recoveries from policyholders › Section 67:48:04:02 - Policyholder to reimburse department for services paid by both Medicaid and insurance - Time limit for reimbursing department

Current through Register Vol. 51, page 10, July 15, 2024
A policyholder must reimburse the department if the policyholder
	 receives reimbursement from the policyholder's insurance company for medical
	 services paid by the department on behalf of an individual who is
	 Medicaid-eligible and covered under the policyholder's insurance. The
	 policyholder must reimburse the department within 45 days after receiving the
	 payment from the insurance company. Failure to reimburse the department within
	 the time limit shall result in an action against the policyholder to recover
	 the payment.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:04 - Recoveries from policyholders › Section 67:48:04:03 - Limit on attorney fees

Current through Register Vol. 51, page 10, July 15, 2024
For purposes of SDCL
	 28-6-7.1, attorney fees payable by
	 the department are limited to the following:
(1) If the department has agreed to the terms
  of a settlement which the individual's attorney has negotiated, 25 percent of
  the settlement that relates to the Medicaid expenditures recovered;
(2) If the amount of the award is determined
  through a third-party mediation, an administrative hearing, or by a circuit
  court, 33 1/3 percent of the award that relates to the Medicaid expenditures
  recovered;
(3) If the amount of the
  award determined under subdivision (2) is appealed to and successful in a
  higher court, 40 percent of the award that relates to the Medicaid expenditures
  recovered;
(4) If the third-party
  mediation, administrative hearing, or court action referred to in subdivision
  (2) or (3) of this section is for the purpose of either reducing the amount of
  the award payable to the department or increasing the attorney fees payable by
  the department, 25 percent of the original award that relates to the Medicaid
  expenditures recovered; or
(5) If
  the award includes a workers' compensation claim, the limits established in
  SDCL 62-7-36.
When the attorney acting on behalf of the individual receives the
	 award, the attorney shall immediately deduct the applicable fee from the
	 Medicaid expenditures recovered and send the remainder to the department. The
	 attorney must deduct the fee in one lump sum and may not deduct amounts that
	 represent taxes on the attorney fees.
Nothing in this section prohibits the department from negotiating with
	 the individual's attorney for a rate lower than the fees specified in this
	 section.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-7.1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:48 - Recoveries and investigations › Chapter 67:48:05 - Recoveries - Child care services › Section 67:48:05:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Terms used in this chapter mean:
(1) "Child care assistance" or "child care
  services," payments made by the department to a child care provider for caring
  for the child of an individual who qualifies to receive assistance with the
  payment of child care costs under the provisions of chapters 67:47:01 to
  67:47:03, inclusive; or payments made by the department to a child care
  provider under the terms of a grant obtained under the provisions of chapter
  67:47:04;
(2) "IPV," intentional
  program violation; and
(3)
  "Provider," a child care provider who receives child care assistance payments
  or grant funds from the department under the provisions of article
  67:47.
General Authority:
SDCL
		28-1-61.
Law Implemented:
SDCL
		28-1-61.