<html> <head> <title>Rule 67:54:04:18 Initial level of care.</title> <META NAME="Keywords" Content="Administrative Rules 67:54:04:18"> <META NAME="Description" Content="Administrative Rules 67:54:04:18 Initial level of care."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 14 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; text-align:justify; font-size:12.0pt; font-family:"Times New Roman","serif";} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US> <div class=WordSection1> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b><span style='font-weight:bold'>67:54:04:18.&nbsp;&nbsp;Initial level of care.</span></b> The following documentation is required to determine the initial level of care:</span></font></p> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;A completed ICAP that indicates a minimum of three substantial functional limitations;</span></font></p> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;A copy of the psychological evaluation;</span></font></p> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;An HCBS Waiver Choice and Rights Form signed by a CSP staff member and the individual, the individual's parent if the individual is under 18 years of age, or the individual's guardian; and</span></font></p> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp;A provisional plan of care that designates the specific waiver service that the individual will receive.</span></font></p> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b><span style='font-weight:bold'>Source:</span></b> 10 SDR 79, effective February 1, 1984; 15 SDR 154, effective April 9, 1989; 15 SDR 203, effective July 2, 1989; 18 SDR 67, effective October 13, 1991; transferred from &#167;&nbsp;67:16:27:15, effective August 23, 1992; 26 SDR 150, effective May 21, 2000; SL 2013, ch 128, &#167;&nbsp;14, effective July 1, 2013.</span></font></p> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b><span style='font-weight:bold'>General Authority:</span></b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A></span></font></p> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b><span style='font-weight:bold'>Law Implemented:</span></b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A></span></font></p> <p class=MsoNormal style='punctuation-wrap:simple;text-autospace:none; vertical-align:baseline'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </div> </body> </html>