67:62:15:05  Categorical determinations for Level I. The department shall make a categorical determination in one of the following situations:

          (1)  A terminal illness diagnosis, determined by a physician or hospice involvement that includes a life expectancy of 6 months or less;

          (2)  A severe physical illness that has resulted in coma or ventilator dependence;

          (3)  The age of an individual is 75 years or older; or

          (4)  A primary diagnosis of dementia, including Alzheimer's disease or a related disorder or a non-primary diagnosis of dementia without a primary diagnosis that is a serious mental illness.

          For any of these situations, the department shall complete a Level I screening form. A copy of the form shall be sent to the appropriate facility. A categorical determination may warrant Medicaid certified swing bed or nursing facility services but does not warrant mental health services or specialized services.

          Source: 43 SDR 80, effective December 5, 2016.

          General Authority: SDCL 1-36-25.

          Law Implemented: SDCL 1-36-25(4).