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 67:54:05 - Nursing facility for individuals with a mental disease › Section 67:54:05:04 - Determination of need for nursing facility care

Current through Register Vol. 51, page 10, July 15, 2024
The utilization control team shall establish an individual's need for
	 nursing facility care by reviewing the individual's medical, nursing, social,
	 and mental health needs. The individual must require professional nursing
	 services in addition to the provision of or assistance with personal care
	 activities or medications.
The utilization control team shall, at least annually, redetermine
	 whether or not the individual continues to need nursing facility care for a
	 mental disease.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:05 - Nursing facility for individuals with a mental disease › Section 67:54:05:05 - Determination of need for specialized psychiatric services

Current through Register Vol. 51, page 10, July 15, 2024
The utilization control team shall determine the individual's need for
	 specialized psychiatric services. The determination must be based on the
	 following criteria:
(1) A
  comprehensive history and physical examination of the person, including a
  complete medical history, a review of all body systems, and a specific
  evaluation of the person's neurological system in the areas of motor function,
  sensory functioning, gait, deep tendon reflexes, cranial nerves, and abnormal
  reflexes and, in the case of abnormal findings which are the basis for the
  determination of the need for nursing facility placement, additional
  evaluations conducted by appropriate specialists;
(2) A comprehensive drug history including
  current or immediate past use of medications that could mask symptoms or mimic
  mental illness;
(3) A psychosocial
  evaluation of the person, including current living arrangements and medical and
  support systems;
(4) A
  comprehensive psychiatric evaluation including a complete psychiatric history;
  evaluation of intellectual and memory functioning; orientation; description of
  current attitudes and affect; overt behaviors; suicidal or homicidal ideation;
  paranoia, degree of reality testing, presence and content of delusions, and
  hallucinations; and
(5) A
  functional assessment of the individual's ability to engage in activities of
  daily living and the level of support that would be needed to assist the
  individual to perform these activities while living in the community. The
  assessment shall indicate whether this level of support can be provided to the
  individual in an alternative community setting or whether the level of support
  needed is such that nursing facility placement is required. The functional
  assessment must address self-monitoring of health status, self-administering
  and scheduling of medical treatment, including medication compliance,
  self-monitoring of nutritional status, handling money, dressing appropriately,
  and grooming.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:05 - Nursing facility for individuals with a mental disease › Section 67:54:05:06 - Services not covered in nursing facility for individual with mental disease

Current through Register Vol. 51, page 10, July 15, 2024
The following services are not covered in a nursing facility for an
	 individual with a mental disease:
(1)
  Rehabilitation treatment for alcoholism or drug addiction;
(2) Counseling for alcoholism or drug
  addition;
(3) Detoxification for
  alcoholism or drug addiction;
(4)
  Alcohol or drug abuse prevention programs; and
(5) Initial psychiatric evaluation.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:05 - Nursing facility for individuals with a mental disease › Section 67:54:05:07 - Utilization review

Current through Register Vol. 51, page 10, July 15, 2024
Services provided under this chapter are subject to utilization review
	 on the following four levels:
(1) At
  the time of the admission;
(2)
  During claims processing;
(3) At
  the annual redetermination review; and
(4) After payment.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:05 - Nursing facility for individuals with a mental disease › Section 67:54:05:08 - Payment limits

Current through Register Vol. 51, page 10, July 15, 2024
Payment to a facility is made for resident days only. Resident days
	 include the day of admission but exclude the day of discharge.
No payment may be made to a facility owned by the state for reserving a
	 bed during a resident's absence.
No payment may be made to a facility until the psychiatric evaluation
	 required in §
									67:54:05:03 has been
	 completed.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:05 - Nursing facility for individuals with a mental disease › Section 67:54:05:09 - 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
  enrollment;
(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 67:54:05 - Nursing facility for individuals with a mental disease › Section 67:54:05:10 - Claim requirements

Current through Register Vol. 51, page 10, July 15, 2024
Each month the Department of Social Services shall send a two-part
	 claim form (nursing home request for payment) to the provider. The first part
	 contains a list of the recipients who were present at the provider's facility
	 during the last billing period. The provider must complete the second part by
	 correcting any errors or changes in the list in the first part and adding
	 information on the new residents.
The provider or the provider's authorized agent must sign and date the
	 form even if there are no changes or additions and return the form to the
	 Department of Social Services. The completed form must contain each recipient's
	 full name, recipient's identification number, date of service, credit amount,
	 level of care, and status. The provider must use one of the following codes to
	 indicate the individual's status:
(1)
  0 - reserved bed days;
(2) 1 -
  transferred to a hospital;
(3) 2 -
  transferred to another nursing facility;
(4) 4 - reserved bed days - individual
  died;
(5) 5 - discharged to home
  for self-care;
(6) 6 - discharged
  to home under home health agency care;
(7) 7 - left against advice;
(8) 8 - died;
(9) 9 - individual on therapeutic leave;
  or
(10) Blank - individual remains
  in care.
If the claim is being submitted to adjust or void a previously
	 submitted claim, the provider must include the reference number of the claim
	 being adjusted or voided.
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 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:01 - Definitions

Current through Register Vol. 51, page 10, July 15, 2024
Terms used in this chapter mean:
(1) "Ancillary services," services or
  equipment that supplement the direct care services provided under this
  chapter;
(2) "Assistive daily
  living services," services of a personal attendant, case management and
  consumer preparation services, and ancillary services performed on behalf of
  and at the request of an individual with quadriplegia to allow the individual
  to remain in the individual's own home;
(3) "Case management," services designed to
  monitor and assist a consumer gain access to services contained in the case
  service plan;
(4) "Client" or
  "consumer," an individual with quadriplegia who is receiving assistance under
  the provisions of this chapter;
(5)
  "Consumer preparation," services designed to train the consumer in areas such
  as medical self-care, activities of daily living, time management, and
  management of a personal attendant;
(6) "Emergency response device," a device
  that links an individual living at home to an individual who will respond in
  the event of an emergency;
(7)
  "Independently direct and manage," the ability to recruit, screen, interview,
  select, schedule, train, supervise, arrange for emergency coverage, determine
  the attendant's competency to perform the needed services, direct the attendant
  to do the task, resolve conflict, and, if necessary, terminate the attendant if
  the conflict cannot be resolved, all with only a minimal amount of assistance
  or direction from or collaboration with the provider agency;
(8) "Personal attendant," an individual who
  completes tasks on behalf of an individual with quadriplegia or assists an
  individual with quadriplegia in the completion of a task when the individual
  with quadriplegia is unable to do the task or to do the task would take an
  exceptionally long time to complete alone;
(9) "Private duty nursing," temporary nursing
  services prescribed by a physician and provided by a nurse who holds a current
  license under the provisions of SDCL chapter 36-9;
(10) "Unit," a 15-minute measurement of time
  or fraction thereof; and
(11)
  "Utilization review team" or "URT," a team employed by the Department of Human
  Services that consists of a registered nurse, a physician, and an employee of
  the Department of Human Services.
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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:02 - Eligibility - Individual

Current through Register Vol. 51, page 10, July 15, 2024
An individual must meet the following requirements to be eligible to
	 receive services under this chapter:
(1) Must be receiving personal attendant,
  case management, consumer preparation, or ancillary services;
(2) Must be at least 18 years old;
(3) Must have quadriplegia due to or
  resulting from ataxia, cerebral palsy, rheumatoid arthritis, muscular
  dystrophy, multiple sclerosis, traumatic brain injury, a congenital condition,
  an accident or injury to the spinal cord, or another neuromuscular or cerebral
  condition or disease other than traumatic brain injury; or the individual has
  four limbs absent due to disease, trauma, or congenital conditions;
(4) Must require a nursing facility level of
  care;
(5) Must have a service plan
  prepared under the provisions of §
									67:54:06:05 that requires one or
  more of the services provided under this chapter;
(6) Must be a recipient of SSI or must
  qualify for Medicaid as determined by the Department of Social Services under
  article 67:46 except for residing in a long-term care facility;
(7) If receiving personal attendant services,
  must be able to independently direct and manage the needed personal attendant
  services;
(8) Must be medically
  stable and free from life-threatening conditions as determined by the
  individual's personal physician.
General Authority:
SDCL
		28-6-1(6).
Law Implemented:
SDCL
		28-6-1(6).
Medical review team -- Level of care, ch 67:45:01.
Agency to assign case manager -- Preparation of assessment and case
		service plan, §
											67:54:06:05.
Ineligibility when income exceeds 300 percent of the maximum SSI
		standard, §
											67:46:04:14.
Eligibility starting date, §
											67:46:01:03.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:03 - Individual to select provider agency

Current through Register Vol. 51, page 10, July 15, 2024
The Department of Human Services shall provide an individual desiring
	 assistive daily living services with a list of provider agencies. The
	 individual must select a service provider agency from the list and must apply
	 directly to the selected agency for services.
For purposes of service delivery, each provider agency must maintain
	 the following directories:
(1)
  Attendants who meet the requirements of §
									67:54:06:08, are available to
  provide services, and have requested to have their names placed into the
  directory;
(2) Home health agencies
  available in the consumer's area that have an agreement with the Department of
  Social Services to provide private duty nursing services under the provisions
  of chapter 67:16:05;
(3) Companies
  that have an agreement with the Department of Social Services to supply an
  emergency response device that meets the consumer's needs.
The consumer must independently select a personal attendant from the
	 agency's list of available attendants. If the agency has no attendants
	 available to provide the needed services, the consumer may need to
	 independently recruit, interview, and select a personal attendant. The consumer
	 must submit the name of the selected attendant to the provider agency for
	 review and approval.
The provider agency must reimburse the consumer for the consumer's
	 actual out-of-pocket expenses incurred while recruiting, interviewing, and
	 selecting a personal attendant who is placed on the provider agency's attendant
	 list. The consumer must have approval from the provider agency before incurring
	 the expenditure.
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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:04 - Eligibility - Provider agency

Current through Register Vol. 51, page 10, July 15, 2024
To be eligible to receive reimbursements for services provided under
	 this chapter, a provider agency must meet the following requirements:
(1) Must have experience in delivering
  services to individuals with severe disabilities;
(2) Must have a process for gathering
  consumer input;
(3) Must have a
  contract with the Department of Human Services to provide assistive daily
  living services;
(4) Must be a
  Medicaid provider and have a signed provider agreement with the Department of
  Social Services;
(5) Must have
  available the following array of services:
(a)
  Personal attendant services;
(b)
  Case management services;
(c)
  Consumer preparation services; and
(d) Ancillary services;
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:05 - Provider agency to assign case manager - Preparation of assessment and case service plan

Current through Register Vol. 51, page 10, July 15, 2024
Within 10 days after the individual requests services from a provider
	 agency, the agency must assign a case manager. The case manager must assess the
	 individual's cognitive, mental, and physical functioning capabilities within 45
	 days to determine whether the individual is appropriate for assistive daily
	 living services.
If determined appropriate, the case manager together with the client
	 shall prepare the assessment and service plan. At a minimum, the service plan
	 must contain the types of services to be furnished; the amount, frequency, and
	 duration of each service; and the type of provider to furnish each service. The
	 case service plan must be reviewed and approved by the client's personal
	 physician. As evidence of approval, the client's physician must sign and date
	 the client assessment and service plan. The case manager must forward copies of
	 the completed client assessment and service plan to the Department of Human
	 Services.
The case manager is responsible for ongoing monitoring of the services
	 included in the client's assessment and service plan. Additionally, case
	 managers must initiate and oversee the process of assessment and reassessment
	 of the client's level of care. The case manager must prepare a new assessment
	 and service plan at least annually.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:06 - Qualifications of case manager

Current through Register Vol. 51, page 10, July 15, 2024
A provider agency's case manager must meet the following
	 qualifications:
(1) Must be employed
  by a provider agency;
(2) Must have
  a minimum of one year experience working with individuals having severe
  disabilities, with experience working with individuals with quadriplegia
  preferred;
(3) Must be trained by
  the provider agency in case management; and
(4) Must be able to provide the services
  listed in §
									67:54:06:07.
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 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:07 - Covered services - Case management

Current through Register Vol. 51, page 10, July 15, 2024
Covered case management services include the following:
(1) Determining the consumer's level of
  functioning, including an assessment of the consumer's knowledge of service
  needs, appropriate procedures and practices needed to address those needs, the
  ability to effectively communicate those needs, and the ability to effectively
  and independently direct and manage the services of a personal attendant on a
  daily basis;
(2) Determining
  whether the consumer is in need of personal attendant, consumer preparation, or
  ancillary services;
(3) Identifying
  resources currently being utilized to meet the consumer's identified needs and
  locate and facilitate the use of community resources needed to meet the
  identified needs;
(4) Informing the
  consumer about how the provider agency documents the consumer's competency to
  independently direct and manage a personal attendant;
(5) Working directly with the consumer to
  develop and implement an individual service plan;
(6) Estimating the cost of the planned
  services;
(7) Monitoring the
  provision of services and reviewing the consumer's service plan following the
  initial six-month period and at least once every 12 months thereafter unless
  more frequent contact is indicated or if requested by the consumer. The case
  manager must monitor the consumer's assessment and service plan for continuity
  of services, changes in the consumer's functioning, appropriateness of care,
  and quality of the services provided; and
(8) Monitoring the service costs to assure
  continued cost effectiveness is maintained.
General Authority:
SDCL
		28-6-1(1).
Law Implemented:
SDCL
		28-6-1(1).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:08 - Qualifications of personal attendant

Current through Register Vol. 51, page 10, July 15, 2024
A personal attendant must have completed a basic nurse aide or home
	 health aide training course, as evidenced by a certificate of completion signed
	 by the director of the training program, provided the trainee also received
	 training in disability awareness and in the philosophy of consumer direction; a
	 personal attendant training program supervised by a registered nurse at an
	 approved agency, as evidenced by a certificate of completion signed by the
	 director of the training program; or a personal attendant competency assessment
	 as evidenced by a certificate of competency signed by a licensed nurse, a
	 physician, or the consumer.
The provider agency must maintain a copy of the signed certificate in
	 the personal attendant's personnel file. If the personal attendant is certified
	 through a personal attendant competency assessment and provides services for
	 more than one individual, there must be a separate certification for each
	 individual served. In addition, the personal attendant must meet the following
	 qualifications:
(1) Must be employed
  by a provider agency that has a contract with the Department of Human Services
  to provide assistive daily living services;
(2) Must produce proof of having a social
  security number;
(3) Must be able
  to read, write, and communicate;
(4) During the last three years, may not have
  on record a conviction for an offense that would directly affect the
  individual's fitness to be a personal attendant. For purposes of this
  subdivision, the provider agency must develop and use a system for screening
  each applicant and for including the consumer in the screening
  process;
(5) May not have an
  infectious or contagious disease or condition which results in a medical
  condition that is prolonged or potentially life-threatening;
(6) Must be capable of performing the needed
  services;
(7) Must be capable of
  maintaining confidentiality; and
(8) Must have demonstrated competency to
  perform the duties contained in §
									67:54:06:09.
A consumer's spouse, parent, or adult child may receive reimbursement
	 for providing personal attendant services if the requirements of this chapter
	 are met.
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 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:09 - Covered services - Personal attendant

Current through Register Vol. 51, page 10, July 15, 2024
Covered services of a personal attendant are those services listed in
	 the case service plan which include services such as the following:
(1) Practicing infection control
  methods;
(2) Handling and disposing
  of body fluids;
(3) Bathing
  techniques including bed, tub, and shower;
(4) Caring for hair, including
  shaving;
(5) Maintaining oral
  hygiene, including brushing teeth and cleaning dentures;
(6) Dressing and undressing a
  consumer;
(7) Assisting with
  toileting;
(8) Caring for a
  consumer who is incontinent;
(9)
  Feeding or assisting a consumer with eating, unless there is another person in
  the home who is able to perform the task;
(10) Planning and preparing meals including
  shopping for and purchasing food, unless there is another person in the home
  who is able to perform the task;
(11) Performing routine eye care;
(12) Taking a consumer's
  temperature;
(13) Caring of nails
  and feet;
(14) Applying an ace wrap
  and anti-embolic stockings;
(15)
  Assisting the consumer apply or remove a prosthesis or orthotic;
(16) Assisting a consumer with
  self-administration of medications;
(17) Changing dressings on noninfected
  sores;
(18) Caring for skin
  including giving back rubs;
(19)
  Turning and positioning the consumer in bed;
(20) Transferring the consumer;
(21) Maintaining the consumer's home in a
  clean and safe condition, unless there is another person in the home who is
  able to perform the task;
(22)
  Making a wrinkle-free bed, unless there is another person in the home who is
  able to perform the task;
(23)
  Laundering and mending clothes, unless there is another person in the home who
  is able to perform the task;
(24)
  Assisting the consumer with paying bills, balancing a checkbook, and managing a
  home budget, unless there is another person in the home who is able to perform
  the task;
(25) Performing range of
  motion exercises designed for the specific consumer;
(26) Performing routine ostomy
  care;
(27) Assisting with a bladder
  and bowel program;
(28) Assisting
  the consumer into and out of a vehicle;
(29) Providing ventilator management if the
  personal attendant is a family member. A consumer who was receiving ventilator
  management by someone other than a family member before the effective date of
  this rule change is not affected by this change;
(30) Performing tracheostomy care if the
  personal attendant is a family member. A consumer who was receiving
  tracheostomy care by someone other than a family member before the effective
  date of this rule change is not affected by this change;
(31) Providing chest physiotherapy;
(32) Providing nebulizer therapy;
  and
(33) Applying topical
  medications.
General Authority:
SDCL
		28-6-1(1).
Law Implemented:
SDCL
		28-6-1(1).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:09.01 - Services not covered

Current through Register Vol. 51, page 10, July 15, 2024
The following services are not covered under the provisions of this
	 chapter, and a provider agency may not submit a bill if it provides any of
	 these services on behalf of an eligible individual:
(1) Washing outside windows;
(2) Moving large furniture;
(3) Shoveling snow;
(4) Performing garden or yard work;
(5) Cleaning up before or after company or
  visitors;
(6) Washing
  walls;
(7) Caring for pets or
  livestock;
(8) Painting;
(9) Visiting, except while performing
  approved services;
(10) Shampooing
  carpets; or
(11) Other tasks not
  necessary to maintain a client in the client's home.
General Authority:
SDCL
		28-6-1(1).
Law Implemented:
SDCL
		28-6-1(1).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:10 - Qualifications and duties of consumer preparation specialist

Current through Register Vol. 51, page 10, July 15, 2024
A provider agency's consumer preparation specialist must meet the
	 following qualifications:
(1) Must be
  employed by a provider agency;
(2)
  Must have a minimum of one year experience working with individuals having
  severe disabilities with experience working with individuals with quadriplegia
  preferred;
(3) Must be trained by
  the provider agency in consumer preparation; and
(4) Must be able to provide the services
  listed in §
									67:54:06:11.
Consumer preparation services are provided by staff from a provider
	 agency. The services are contained in the consumer's service plan and are
	 agreed to by the consumer and the consumer's case manager.
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 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:11 - Covered services - Consumer preparation specialist

Current through Register Vol. 51, page 10, July 15, 2024
Covered consumer preparation specialist services include the
	 following:
(1) Instructing clients in
  the methods of identifying personal needs and effectively communicating those
  needs to the personal attendant;
(2) Instructing the client in personal health
  maintenance tasks;
(3) Instructing
  the client in managing a personal attendant, including interviewing, selecting,
  training, supervising, and scheduling the attendant;
(4) Instructing the client on the appropriate
  personal and professional relationships to be maintained by the client and the
  client's personal attendant.
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 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:11.01 - Ancillary services

Current through Register Vol. 51, page 10, July 15, 2024
Ancillary services provided under this chapter are limited to emergency
	 response devices and private duty nursing services. The need for ancillary
	 services must be determined by the client's case manager under the provisions
	 of §§
									67:54:06:05 and
	 67:54:06:07.
General Authority:
SDCL
		28-6-1(1).
Law Implemented:
SDCL
		28-6-1(1).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:11.02 - Ancillary services - Private duty nursing - Limits

Current through Register Vol. 51, page 10, July 15, 2024
Private duty nursing services are limited to nursing services provided
	 under the direction of the consumer's physician that cannot be provided by the
	 consumer's personal attendant because the needed services are beyond the
	 attendant's scope of practice as allowed under SDCL
	 36-9-28.
General Authority:
SDCL
		28-6-1(1).
Law Implemented:
SDCL
		28-6-1(1).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:12 - Department of Human Services to determine level of care

Current through Register Vol. 51, page 10, July 15, 2024
Within 30 days after receiving the completed client assessment and
	 service plan, the Department of Human Services' utilization review team must
	 review the documents to determine whether placement into the program and the
	 services required are appropriate. Within the same 30-day period, the URT must
	 also determine whether the individual requires a nursing facility level of
	 care. The determination of the need for care is based on information submitted
	 by the client's personal physician and the provider agency which documents the
	 client's medical status and the need for services.
The URT must redetermine the individual's level of care at least
	 annually.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:13 - Payment, procedure codes, and limits for covered services

Current through Register Vol. 51, page 10, July 15, 2024
Payment for assistive daily living services is limited to the following
	 procedure codes:
PROCEDURE
CODE
PROCEDURE
T1019
Services of a personal attendant
T1016
Case management
S5115
Consumer preparation
S5160
Emergency response device
T1000
Private duty nursing
A provider may bill for no more than three units of services of a
	 personal attendant if the actual service time is less than 45 minutes and the
	 personal attendant did not provide services for another consumer immediately
	 preceding or subsequent to the services provided to the consumer on whose
	 behalf the services are being billed.
The Department of Human Services shall establish the rate of payment in
	 the provider agency's contract.
General Authority:
SDCL
		28-6-1(2).
Law Implemented:
SDCL
		28-6-1(2).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:14 - Basis of payment

Current through Register Vol. 51, page 10, July 15, 2024
Payment for assistive daily living services is based on the difference
	 between the consumer's income, minus allowable deductions, and the consumer's
	 monthly care costs.
If the consumer meets the requirements of subdivision 67:54:04:03(1),
	 none of the consumer's income is credited to the monthly care costs.
If the consumer meets the requirements of subdivision 67:54:04:03(2),
	 the department applies the following criteria to determine the amount of
	 assistance a consumer is eligible to receive from the department to meet the
	 consumer's monthly care costs:
(1)
  Apply the provisions of chapter 67:46:06, with the exception of §
									67:46:06:05;
(2) If the consumer is married, apply the
  provisions of chapter 67:46:07, with the exception of subdivision
  67:46:07:10(1);
(3) Allow a
  deduction equal to the SSI standard benefit amount plus $20 for the consumer's
  personal needs; and
(4) If the
  consumer is employed, allow a deduction of $400 from gross wages for work
  expenses.
The Department of Social Services shall pay its share of the costs
	 directly to the provider agency. The consumer is responsible for paying the
	 consumer's share directly to the provider agency.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
SSI standard benefit amount, §
											67:46:04:13(2).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:15 - Billing requirements

Current through Register Vol. 51, page 10, July 15, 2024
A claim submitted for services provided under this chapter must be
	 submitted at the provider's usual and customary charge and must contain the
	 applicable procedure codes and units being billed.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Eligibility starting date, §
											67:46:01:03.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:16 - 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 identification
  card;
(3) The 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
  payments from this charge;
(7) The
  units of service furnished, if more than one, for each procedure;
(8) The applicable procedure codes;
(9) The type of service; and
(10) The provider's name and medical
  assistance identification number.
A separate claim form must be used for each client.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Note:
The HFCA 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 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:17 - Cost of service not to exceed cost of institutional care

Current through Register Vol. 51, page 10, July 15, 2024
The cost of services provided under this chapter may not exceed the
	 cost of caring for the client in an institutional setting. The cost of caring
	 for the client in an institutional setting is equal to the monthly statewide
	 average nursing home rate for individuals classified in the special care case
	 mix category payable under the provisions of chapter 67:16:04. If the assistive
	 daily living service costs exceed the monthly statewide average nursing home
	 rate for individuals classified in the special care case mix category, the
	 client is no longer eligible for services under this chapter.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:18 - Provider agency may terminate services

Current through Register Vol. 51, page 10, July 15, 2024
If a provider agency terminates services to a consumer, the termination
	 must be for cause. Specific reasons for terminating services include
	 circumstances such as the following:
(1) The consumer is refusing to take
  prescribed medication, which is adversely affecting the consumer's ability to
  independently direct and manage the needed services, is a threat to the health
  or safety of the provider, or is interfering with the delivery of the needed
  services;
(2) The consumer is
  sexually harassing, verbally abusive, threatening, or is combative towards the
  personal attendant, case manager, or any other person involved in the delivery
  of services;
(3) The consumer's
  living environment presents health and fire hazards or unsafe conditions for
  the person delivering services and attempts to alleviate the situation have
  been unsuccessful;
(4) The consumer
  is not in compliance with the assessment, service plan, or other agreement
  needed to deliver services;
(5) The
  consumer's cognitive ability is limited to the extent that the consumer is not
  oriented to person, place, or time;
(6) The consumer's condition has improved and
  no longer meets program eligibility;
(7) The consumer refuses to allow the service
  provider on the premises;
(8) The
  consumer or others in the household are under the influence of alcohol or
  illegal drugs, which is a threat to the health or safety of the provider or is
  interfering with the delivery of needed services;
(9) The consumer is failing to pay the
  consumer's share of the payment as required in §
									67:54:06:14; or
(10) The consumer is no longer able to
  independently direct and manage the attendant.
General Authority:
SDCL
		28-6-1(1)(4).
Law Implemented:
SDCL
		28-6-1(1)(4).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:18.01 - Provider agency may terminate services - Notice - Exception

Current through Register Vol. 51, page 10, July 15, 2024
If a provider agency intends to terminate services to a consumer, the
	 provider agency must notify the consumer in writing at least ten working days
	 before the service is terminated. If a written notice is not an appropriate
	 format for the consumer, the provider agency must also provide the notice in a
	 format that is appropriate for the consumer involved.
The notice must contain the reason for the termination and an
	 explanation of the consumer's right to file a grievance with the provider
	 agency.
At the same time the provider agency sends notice to the consumer, it
	 must also send a copy of the notice to each of the consumer's service
	 providers, the Department of Social Services, and the Department of Human
	 Services.
If the provider agency's management staff determines that an abusive,
	 dangerous, or unsafe situation exists, the provider agency may immediately
	 terminate the services without serving the ten-day notice on the consumer.
	 However, the provider agency shall immediately notify the consumer in writing
	 of the reason for the termination and an explanation of the consumer's right to
	 file a grievance with the provider agency. If a written notice is not an
	 appropriate format for the consumer, the provider agency must also provide the
	 notice in a format that is appropriate for the consumer
	 involved.
General Authority:
SDCL
		28-6-1(4)(6).
Law Implemented:
SDCL
		28-6-1(4)(6).
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:19 - Notice of adverse action

Current through Register Vol. 51, page 10, July 15, 2024
The Department of Social Services shall send a written notice if any of
	 the following occurs:
(1) The
  Department of Social Services has determined that the individual is no longer
  eligible under the provisions of subdivision 67:54:06:02(6);
(2) The Department of Human Services has
  determined that the individual is not eligible for services because the
  individual does not meet the requirements of subdivision 67:54:06:02(1), (2),
  (3), (4), (5), (7), or (8); or
(3)
  The Department of Human Services has determined that services will be
  terminated because the individual no longer meets the requirements of
  subdivision 67:54:06:02(1), (3), (4), (5), (7), or (8).
The 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. The Department of
	 Social Services shall mail this notice at least ten days before the date of the
	 intended action.
If the consumer does not request a conference within the 15-day period
	 established in § 67:54:06:19.01, the notice of adverse action shall
	 constitute the final decision for purposes of a fair hearing.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.
Conference with staff from Department of Human Services or
		Department of Social Services, §
		67:54:06:19.01.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:19.01 - Conference with staff from Department of Human Services or Department of Social Services

Current through Register Vol. 51, page 10, July 15, 2024
An individual may request a conference if any of the following
	 occurs:
(1) The Department of Social
  Services determines that the individual no longer meets the requirements of
  subdivision 67:54:06:02(6). The individual must request a conference with the
  Department of Social Services;
(2)
  The Department of Human Services determines that the individual does not meet
  the requirements of subdivision 67:54:06:02(1), (2), (3), (4), (5), (7), or
  (8). The individual must request a conference with the Department of Human
  Services;
(3) The Department of
  Human Services determines that services will be terminated because the
  individual no longer meets the requirements of subdivision 67:54:06:02(1), (3),
  (4), (5), (7), or (8). The individual must request a conference with the
  Department of Human Services.
In any case, the request for a conference must be made within 15 days
	 after the date the notice of adverse action is sent. The conference may be held
	 by telephone or in person. Within five days after receiving the request, the
	 appropriate department shall make arrangements for the conference. At the end
	 of the conference, the department shall inform the individual of the
	 department's final decision. If a final decision cannot be made, the conference
	 may be extended until a decision is reached and written notice of the decision
	 delivered to the individual. Following receipt of the final decision, the
	 individual has 30 days to request a hearing.
General Authority:
SDCL
		28-6-1(4)(6).
Law Implemented:
SDCL
		28-6-1(4)(6).
Notice of adverse action, §
											67:54:06:19; Fair hearings, ch
		67:17:02.
South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:54 - Medical programs administered by Department of Human Services › Chapter 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:20 - Record retention

Current through Register Vol. 51, page 10, July 15, 2024
The provider agency 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 provider agency 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 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:21 - Access to records

Current through Register Vol. 51, page 10, July 15, 2024
Within ten days after the Department of Human Services or the
	 Department of Social Services notifies the provider agency, the provider agency
	 must allow the State of South Dakota and federal agencies access to and copies
	 of all information, data, reports, and records maintained by the agency 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 67:54:06 - Assistive daily living services for individuals with quadriplegia › Section 67:54:06:22 - Annual review

Current through Register Vol. 51, page 10, July 15, 2024
The URT must conduct an annual review of the consumer's record to
	 determine the appropriateness and adequacy of the services being provided and
	 to ensure that the services provided are consistent with the nature and
	 severity of the consumer's disability.
General Authority:
SDCL
		28-6-1.
Law Implemented:
SDCL
		28-6-1.