<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0 { margin-top: 0; margin-bottom: 0; margin-left: 0; margin-right: 0; text-indent: 0.00in; text-align: justify; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; } span.s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC3 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC4 { color: black; background: white; font-family: Times; font-size: 8pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } p.s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0-000003 { margin-top: 0; margin-bottom: 0; margin-left: 0; margin-right: 0; text-indent: 0.00in; text-align: justify; background: white; font-family: 'Times New Roman', 'serif'; font-size: 11pt; line-height: 108%; } span.s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000004 { color: black; background: white; font-size: 11pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0-000005 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:44:03:16"><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0-000000">67:44:03:16</span></a><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0-000001">.  </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0-000001">Exceptions process</span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0-000001">.</span><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0"> </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">The total amount the department will authorize for all HOPE waiver services</span><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC3"> for a participant is based on assessed need as identified in the individual support plan, with a maximum threshold equal to the average cost of nursing facility care. Services over this threshold are subject to an exceptions review process initiated and conducted by the department</span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC3">.</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002"> </span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">To qualify for an exception, a participant must meet all of the following criteria</span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">:</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002"> </span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    </span><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">(1)  </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">The participant is not severely impaired based on the most recent assessment conducted by the department</span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">;</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002"> </span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    (2)  </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">The participant has an assessed need for extensive or total assistance</span><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC4">, </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">in at least two of the following activities of daily living</span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">:</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002"> </span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">        (a)  Locomotion;</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">        (b)  Toilet transfer;</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">        (c)  Toilet use;</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">        (d)  Bed mobility; or</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">        (e)  Eating;</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002"> </span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    (3)  </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">Without additional waiver services, nursing facility care is required to assure the participant's health, safety, and welfare</span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">;</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002"> </span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    (4)  </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">The participant's needs cannot be met without exceeding one hundred percent of the cost of nursing facility care</span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">;</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002"> </span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    (5)  </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">The participant has demonstrated compliance with the individual support plan</span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">;</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002"> </span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    (6)  </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">The participant has demonstrated compliance with medical advice from the participant's physician, if applicable</span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">;</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002"> </span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    (7)  </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">The participant has demonstrated that support offered through the HOPE waiver program provides opportunities for increased community integration that would not otherwise be available if residing in a nursing facility; and</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002"> </span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    (8)  </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">The participant does not experience seclusion from the greater community and the living arrangement does not promote isolation</span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">.</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002"> </span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC3">A participant who does not meet all exceptions criteria is limited to services that do not exceed the average cost of nursing facility care</span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC3">.</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0-000003"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000004"> </span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC3">    </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">The exceptions request may not exceed one hundred and fifty percent of the average cost of nursing facility care. A participant approved for services above the one hundred and fifty percent limit prior to the effective date of this rule is not subject to this limit unless there is a significant change in health status or case closure</span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">.</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002"> </span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0-000001">Source:</span><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0"> </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">51 SDR 36</span><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">, effective </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">September 30, 2024</span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">.</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0-000001">General Authority:</span><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=1-36A-26"><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0-000005">1-36A-26</span></a><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">.</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">    </span><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0-000001">Law Implemented:</span><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=1-36A-25"><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0-000005">1-36A-25</span></a><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">, </span><a href="https://sdlegislature.gov/Statutes?Statute=1-36A-26"><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0-000005">1-36A-26</span></a><span class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cC0">.</span></p><p dir="ltr" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4cP0"><span xml:space="preserve" class="s77e50dbb-c3d9-468c-940e-c3d70c9b2e4c000002"> </span></p></div></body></html>