CHAPTER 67:46:02
\r\n\r\n\r\nAPPLICATION FOR LONG-TERM CARE
\r\n\r\n\r\n\r\nSection
\r\n\r\n67:46:02:01 Definitions.
\r\n\r\n67:46:02:02 Signed application\r\nrequired.
\r\n\r\n67:46:02:03 Determining\r\neligibility.
\r\n\r\n67:46:02:04 Prompt determinations.
\r\n\r\n67:46:02:05 Application of time standard.
\r\n\r\n67:46:02:06 Case\r\nrecord to contain facts.
\r\n\r\n67:46:02:07 Informing\r\napplicant.
\r\n\r\n67:46:02:08 Review of continuing eligibility.
\r\n\r\n67:46:02:09 Reporting\r\nchange of circumstances.
\r\n\r\n67:46:02:10 Prompt action for continuing\r\neligibility.
\r\n\r\n\r\n\r\n67:46:02:01. Definitions. Terms\r\nused in this chapter mean:
\r\n\r\n\r\n\r\n
(1) "Long-term care,"\r\ncontinuing 24-hour service in a medical, nursing, or intermediate care\r\nfacility, assisted living facility, or adult foster home; participation in the\r\nhome and community-based service programs under chapters 67:44:03 and 67:54:04;\r\nand
\r\n\r\n\r\n\r\n
(2) "Application," the action\r\nby which an individual completes the department's application form for\r\nlong-term care assistance or medical assistance. An application is not an\r\ninquiry, which is simply a request for information about eligibility\r\nrequirements for long-term care assistance or medical assistance. An inquiry\r\nmay be followed by an application.
\r\n\r\n\r\n\r\n
Source: 2 SDR 74, effective May 13, 1976; 7\r\nSDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982;\r\n10 SDR 79, effective February 1, 1984; transferred from § 67:16:17:01,\r\neffective August 23, 1992; 20 SDR 92, effective December 21, 1993; 41 SDR 93,\r\neffective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
\r\n\r\n\r\n\r\n
67:46:02:02. Signed application required. The applicant\r\nshall personally sign an application, and the department shall verify the\r\napplication in accordance with § 67:46:02:03. If the applicant is\r\nincompetent, incapacitated, or deceased, an authorized representative may sign\r\nthe application on the applicant's behalf. The applicant may be assisted by an\r\nindividual of the applicant's choice or someone acting in a legal capacity for\r\nthe applicant in the various aspects of the application or in contacts with the\r\ndepartment.
\r\n\r\n\r\nSource:\r\n2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8\r\nSDR 170, effective June 21, 1982; transferred from § 67:16:17:02,\r\neffective August 23, 1992.
\r\n\r\n\r\n\r\n\r\n\r\n\r\n67:46:02:03. Determining eligibility. Initial and\r\ncontinuing eligibility for long-term care assistance shall be determined by the\r\ndepartment on the basis of statements submitted by the applicant or recipient\r\nof long-term care assistance about the facts that are within the applicant's or\r\nrecipient's knowledge and competence. Verification through contacts is required\r\nfor selected items, including family composition, resources, and income.
\r\n\r\n\r\nSource:\r\n2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981;\r\ntransferred from § 67:16:17:03, effective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6-1.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6-1.
\r\n\r\n\r\n67:46:02:04. Prompt determinations. The notification of\r\napproval or denial of long-term care assistance shall be mailed to the\r\napplicant within 45 days after the date of application.
\r\n\r\n\r\nSource:\r\n2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8\r\nSDR 170, effective June 21, 1982; transferred from § 67:16:17:04,\r\neffective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6-1.
\r\n\r\n\r\n\r\n\r\n67:46:02:05. Application of time standard. The time\r\nstandard set by § 67:46:02:04 applies except in unusual circumstances,\r\nincluding a failure or delay on the part of an examining physician to provide\r\nnecessary information or an emergency beyond the department's control causing a\r\ndelay in a decision by the department. Case records must be fully documented to\r\nshow the cause of the delay in all instances when delay occurs. The\r\ndepartment's time standard for acting on applications or continuing eligibility\r\nmay not be used as a waiting period before granting or denying benefits.
\r\n\r\n\r\nSource:\r\n2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8\r\nSDR 170, effective June 21, 1982; transferred from §67:16:17:05,\r\neffective August 23, 1992; 20 SDR 92, effective December 21, 1993.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6-1.
\r\n\r\n\r\n\r\n\r\n67:46:02:06. Case record to contain\r\nfacts. If the applicant voluntarily withdraws an application, the\r\ndepartment shall send a notice to the applicant to confirm the withdrawal and\r\nshall enter the action in the case record. If the applicant dies or cannot be\r\nlocated, the department shall file the application without action and enter a\r\nnotation in the case record. In all other cases, the applicant's or recipient's\r\ncase record shall contain supportive facts for each decision relating to\r\napproval or denial of eligibility.
\r\n\r\n\r\n\r\n
Source: 2 SDR 74, effective May 13, 1976; 7\r\nSDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982;\r\ntransferred from § 67:16:17:06, effective August 23, 1992; 41 SDR 93,\r\neffective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
\r\n\r\n\r\n\r\n
67:46:02:07. Informing applicant. Applicants shall be\r\ninformed about eligibility requirements and conditions, coverage, scope of\r\nprogram, related services available, the rights and responsibilities of the\r\napplicant or recipient, and the department's time standard in acting on\r\napplications. This information shall be given in writing or orally as\r\nappropriate.
\r\n\r\n\r\nSource:\r\n2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981;\r\ntransferred from § 67:16:17:07, effective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6-1.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6-1.
\r\n\r\n\r\n67:46:02:08. Review of continuing\r\neligibility. The department shall redetermine continuing eligibility for\r\nlong-term care and medical assistance at least once every 12 months.
\r\n\r\n\r\n\r\n
Source: 2 SDR 74, effective May 13, 1976; 7\r\nSDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982;\r\ntransferred from § 67:16:17:09, effective August 23, 1992; 20 SDR 92,\r\neffective December 21, 1993; 41 SDR 93, effective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
\r\n\r\n\r\n\r\n
Cross-Reference: Periodic redeterminations\r\nof Medicaid eligibility, 42 C.F.R. 435.916 (March 23, 2012).
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67:46:02:09. Reporting change of circumstances. Any\r\nchange in circumstances affecting an individual's eligibility shall be reported\r\nby the recipient to the department within 30 days of the date the change\r\noccurred.
\r\n\r\n\r\nSource:\r\n2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981;\r\ntransferred from § 67:16:17:10, effective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6-1.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6-1.
\r\n\r\n\r\n67:46:02:10. Prompt action for continuing eligibility.\r\nUpon receipt of information which affects continued eligibility for long-term\r\ncare assistance, a redetermination of eligibility\r\nshall be made within 30 days. The recipient may be assisted by an individual of\r\nthe recipient's choice in the various aspects of the redetermination\r\nof eligibility.
\r\n\r\n\r\nSource:\r\n2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8\r\nSDR 170, effective June 21, 1982; transferred from § 67:16:17:11, effective\r\nAugust 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6-1.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6-1.
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