CHAPTER 67:46:03
\r\n\r\n\r\nLONG-TERM CARE\r\nELIGIBILITY
\r\n\r\n\r\n\r\nSection
\r\n\r\n67:46:03:01 Responsibility\r\nfor information.
\r\n\r\n67:46:03:02 Aged,\r\nblind, or disabled.
\r\n\r\n67:46:03:03 Long-term\r\ncare residency requirement and beginning of eligibility.
\r\n\r\n67:46:03:04 Transferred.
\r\n\r\n67:46:03:05 Transferred.
\r\n\r\n67:46:03:06 Transferred.
\r\n\r\n67:46:03:07 Transferred.
\r\n\r\n67:46:03:08 Transferred.
\r\n\r\n67:46:03:09 Transferred.
\r\n\r\n67:46:03:10 Transferred.
\r\n\r\n67:46:03:11 Transferred.
\r\n\r\n67:46:03:12 Transferred.
\r\n\r\n67:46:03:13 Transferred.
\r\n\r\n67:46:03:14 Transferred.
\r\n\r\n67:46:03:15 Transferred.
\r\n\r\n67:46:03:16 Repealed.
\r\n\r\n67:46:03:17 Repealed.
\r\n\r\n67:46:03:18 Determination\r\nof disability.
\r\n\r\n67:46:03:19 Determination\r\nof blindness.
\r\n\r\n67:46:03:20 Cessation\r\nof determination of blindness.
\r\n\r\n67:46:03:21 Cessation\r\nof disability.
\r\n\r\n67:46:03:22 Release\r\nof medical information.
\r\n\r\n67:46:03:23 Payment\r\nfor examinations.
\r\n\r\n67:46:03:24 Repealed.
\r\n\r\n\r\n\r\n67:46:03:01. Responsibility\r\nfor information. The applicant or recipient of long-term care shall have\r\nthe primary responsibility of furnishing the department information necessary\r\nto determine eligibility or ineligibility for long-term care assistance. Failure\r\nof the applicant or recipient to furnish the necessary information may result\r\nin the rejection or termination of long-term care assistance.
\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 § 67:16:18:01,\r\neffective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6-1.
\r\n\r\n\r\n\r\n\r\n67:46:03:02. Aged, blind, or disabled. Long-term care\r\nassistance shall be provided to an eligible aged, blind, or disabled applicant\r\nor recipient meeting one of the following:
\r\n\r\n\r\n(1) The individual is at\r\nleast 65 years of age at the time of application;
\r\n\r\n\r\n(2) The individual has a\r\ncentral visual acuity of 20/200 or less in the better eye with the use of a\r\ncorrecting lens;
\r\n\r\n\r\n(3) The individual has\r\nlimited vision: the widest diameter of the visual field subtends an angle no\r\ngreater than 20 degrees;
\r\n\r\n\r\n(4) The individual is\r\nunable to engage in substantial gainful activity because of a physical or\r\nmental impairment which can be expected to result in death or which has lasted\r\nor can be expected to last for a continuous period of at least 12 months; or
\r\n\r\n\r\n(5) The individual is a\r\nchild under 18 years of age who is unable to engage in substantial gainful\r\nactivity because of a mental or physical impairment which can be expected to\r\nresult in death or which has lasted or can be expected to last for a continuous\r\nperiod of at least 12 months.
\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 § 67:16:18:02,\r\neffective 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\n67:46:03:03. Long-term care residency requirement and\r\nbeginning of eligibility. The department shall approve long-term care\r\nassistance or medical services for an eligible individual if the individual is\r\nparticipating in a home and community-based service program or resides in one\r\nof the following facilities:
\r\n\r\n\r\n(1) A licensed hospital,\r\nnursing facility, intermediate care facility, or assisted living facility that\r\nhas a Medicaid provider agreement with the department for the level of care and\r\nservices provided; or
\r\n\r\n\r\n(2) An adult foster care\r\nfacility licensed by the South Dakota Department of Health.
\r\n\r\n\r\nIf an eligible individual's income\r\nminus $20 is less than the SSI standard, long-term care assistance or medical\r\nassistance begins in the month the person enters the facility, subject to § 67:46:01:03.
\r\n\r\n\r\nIf an eligible individual's income\r\nminus $20 is greater than the SSI standard but does not exceed 300 percent of\r\nthe SSI standard, long-term care assistance or medical assistance begins the\r\nfirst day of a 30-consecutive-day period of institutionalization, subject to\r\n§ 67:46:01:03. The 30-consecutive-day period is met if the requirements of\r\nthis rule are met and the individual dies before the 30th\r\nconsecutive day.
\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; 10 SDR 79, effective February 1, 1984; 15 SDR\r\n2, effective July 17, 1988; transferred from § 67:16:18:03, effective\r\nAugust 23, 1992; 19 SDR 141, effective March 25, 1993; 20 SDR 92, effective\r\nDecember 21, 1993; 30 SDR 193, effective June 13, 2004.
\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\nCross-References:
\r\n\r\nHome and community-based services, ch 67:54:04.
\r\n\r\nHome and community-based waiver\r\nservices, ch 67:44:03.
\r\n\r\nSSI standard benefit amount,\r\nsubdivision 67:46:04:13(2).
\r\n\r\n\r\n67:46:03:04. Transferred to\r\n§ 67:46:01:17.
\r\n\r\n\r\n\r\n
67:46:03:05. Transferred to\r\n§ 67:46:01:18.
\r\n\r\n\r\n\r\n
67:46:03:06. Transferred to\r\n§ 67:46:01:19.
\r\n\r\n\r\n\r\n
67:46:03:07. Transferred to\r\n§ 67:46:01:20.
\r\n\r\n\r\n\r\n
67:46:03:08. Transferred to\r\n§ 67:46:01:21.
\r\n\r\n\r\n\r\n
67:46:03:09. Transferred to\r\n§ 67:46:01:22.
\r\n\r\n\r\n\r\n
67:46:03:10. Transferred to\r\n§ 67:46:01:23.
\r\n\r\n\r\n\r\n
67:46:03:11. Transferred to\r\n§ 67:46:01:24.
\r\n\r\n\r\n\r\n
67:46:03:12. Transferred to\r\n§ 67:46:01:25.
\r\n\r\n\r\n\r\n
67:46:03:13. Transferred to\r\n§ 67:46:01:26.
\r\n\r\n\r\n\r\n
67:46:03:14. Transferred to\r\n§ 67:46:01:27.
\r\n\r\n\r\n\r\n
67:46:03:15. Transferred to\r\n§ 67:46:01:28.
\r\n\r\n\r\n\r\n
67:46:03:16. Citizenship and alienage.Repealed.
\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 § 67:16:18:06,\r\neffective August 23, 1992; 20 SDR 92, effective December 21, 1993; 23 SDR 152,\r\neffective March 14, 1997; repealed, 24 SDR 24, effective August 31, 1997.
\r\n\r\n\r\n67:46:03:17. Social security numbers.Repealed.
\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; 12 SDR 6, effective July 28, 1985;\r\ntransferred from § 67:16:18:07, effective August 23, 1992; repealed, 24\r\nSDR 24, effective August 31, 1997.
\r\n\r\n\r\n67:46:03:18. Determination of\r\ndisability. The disability/incapacity consultation team shall determine\r\ndisability following the guidelines for the SSI program provided in 42 U.S.C.\r\n§§ 1382c(a)(3)(A) to 1382c(a)(3)(C), inclusive, as of July 1, 2014, based on\r\nmedical evidence supplemented by a social history. Medical evidence may be a\r\nphysician's report, a copy of the physician's records, or the findings of a\r\nphysical examination completed for this purpose. An individual who is receiving\r\nsocial security or SSI disability benefits meets the long-term care assistance\r\ndisability requirements.
\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\n18 SDR 67, effective October 13, 1991; transferred from § 67:16:18:08,\r\neffective August 23, 1992; 21 SDR 162, effective March 23, 1995; 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
67:46:03:19. Determination of blindness. Blindness,\r\naccording to § 67:46:03:02, shall be determined\r\nby an ophthalmologist designated by the department. Based on an ophthalmologist's or optometrist's report and evaluation,\r\nthe ophthalmologist shall determine whether the disability requires long-term\r\ncare. If the individual is receiving social security disability benefits or SSI\r\nbenefits based on blindness, the individual is considered to meet the blindness\r\nrequirements for long-term care assistance.
\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 § 67:16:18:09,\r\neffective 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\n67:46:03:20 Cessation of determination of blindness. An\r\nindividual shall be ineligible for long-term care assistance when either of the\r\nfollowing occurs:
\r\n\r\n\r\n(1) The individual has\r\napplied for and has been denied social security disability or SSI benefits\r\nbased on blindness; or
\r\n\r\n(2) The department has\r\ndetermined that the blindness does not require long-term care.
\r\n\r\n\r\nIf an individual is ineligible based\r\non subdivision (1), the department may not overrule the decision.
\r\n\r\n\r\nSource:\r\n8 SDR 170, effective June 21, 1982; transferred from § 67:16:18:09.01,\r\neffective 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\nCross-Reference:\r\nDetermination of blindness, § 67:46:03:19.
\r\n\r\n\r\n67:46:03:21. Cessation of disability. An individual is\r\nineligible for long-term care assistance when either of the following occurs:
\r\n\r\n\r\n(1) The\r\ndisability/incapacity consultation team, following §67:46:03:18,\r\ninclusive, determines that a disability ceases to exist; or
\r\n\r\n\r\n(2) The individual has been\r\ndenied social security or SSI disability benefits based on a disability.
\r\n\r\n\r\nIf an individual is ineligible based\r\non subdivision (2) of this section, the department may not overrule the\r\ndecision.
\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; 18 SDR 67, effective October 13, 1991;\r\ntransferred from § 67:16:18:10, effective August 23, 1992; 21 SDR 162,\r\neffective March 23, 1995.
\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\n67:46:03:22. Release of medical information. No medical\r\ninformation may be obtained unless the department secures the applicant's\r\nwritten consent. Refusal to sign an authorization for the release of this\r\ninformation shall make the applicant ineligible for long-term care assistance.
\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 § 67:16:18:11,\r\neffective 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\n67:46:03:23. Payment for examinations. Physical\r\nexaminations requested by the department for the purpose of determining an\r\napplicant's or recipient's eligibility and level of care shall be paid for by\r\nthe department in accordance with §§ 67:16:01:09 and 67:16:01:11. The\r\napplicant or recipient shall obtain written authorization for the examination\r\nfrom the department and shall present the authorization to the person\r\nconducting the examination.
\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 § 67:16:18:12,\r\neffective 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\n67:46:03:24. Absence of regulations\r\nregarding conditions of eligibility. Repealed.
\r\n\r\n\r\n\r\n
Source: 8 SDR 170, effective June 21, 1982;\r\ntransferred from § 67:16:18:15, effective August 23, 1992; repealed, 41\r\nSDR 93, effective December 3, 2014.
\r\n\r\n\r\n\r\n