CHAPTER 67:46:06
\r\n\r\n\r\nBUDGETING FOR\r\nLONG-TERM CARE
\r\n\r\n\r\n\r\nSection
\r\n\r\n67:46:06:01 Scope of chapter.
\r\n\r\n67:46:06:02 Definitions.
\r\n\r\n67:46:06:03 Income for determining\r\nlong-term care assistance.
\r\n\r\n67:46:06:04 Supplemental payment to\r\nlong-term care facility.
\r\n\r\n67:46:06:05 Deduction for personal\r\nneeds.
\r\n\r\n67:46:06:06 Deduction for premiums.
\r\n\r\n67:46:06:07 Deduction for dependents\r\n-- No community spouse.
\r\n\r\n67:46:06:08 Repealed.
\r\n\r\n67:46:06:09 Treatment of income for\r\nless than a full month's residence.
\r\n\r\n67:46:06:10 Basis of payment for\r\nprogram benefits.
\r\n\r\n67:46:06:11 Payment made to facility\r\nor representative payee.
\r\n\r\n67:46:06:12 Deduction for home\r\nmaintenance.
\r\n\r\n\r\n\r\n67:46:06:01. Scope of chapter. Rules contained in this\r\nchapter are applied after financial eligibility is established according to\r\nchapter 67:46:04 and are used to determine the amount of long-term care\r\nassistance an individual is eligible to receive from the department.
\r\n\r\n\r\nSource:\r\n9 SDR 133, effective April 27, 1983; transferred from § 67:16:21:00,\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\n67:46:06:02. Definitions. Terms\r\nused in this chapter have the same meaning as those defined in\r\n§ 67:46:04:02.
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Source: 2 SDR 74, effective May 13, 1976; 5\r\nSDR 109, effective July 1, 1979; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 9\r\nSDR 133, effective April 27, 1983; transferred from § 67:16:21:01, effective August 23, 1992; 34 SDR\r\n322, effective July 1, 2008; 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.
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67:46:06:03. Income for determining\r\nlong-term care assistance. For purposes of determining the amount of\r\nlong-term care assistance, income is considered according to subdivisions\r\n67:46:04:03(1) to (5), inclusive; §§ 67:46:04:04, 67:46:04:06 and\r\n67:46:04:08 to 67:46:04:10, inclusive.
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Source: 2 SDR 74, effective May 13, 1976; 4\r\nSDR 10, effective August 28, 1977; 7 SDR 66, 7 SDR 89, effective July 1, 1981;\r\n8 SDR 170, effective June 21, 1982; 9 SDR 133, effective April 27, 1983;\r\ntransferred from § 67:16:21:02,\r\neffective August 23, 1992; 20 SDR 170, effective April 21, 1994; 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.
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67:46:06:04. Supplemental payment to\r\nlong-term care facility. The department shall pay a participating home and\r\ncommunity based waiver provider or nursing facility for amounts not covered by\r\nan eligible individual's own income, insurance, a responsible third party or\r\nother state or federal assistance programs.
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Source: 8 SDR 170, effective June 21, 1982;\r\n9 SDR 133, effective April 27, 1983; transferred from § 67:16:21:02.01,\r\neffective August 23, 1992; 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.
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Cross-Reference: Basis of payment for\r\nprogram benefits, § 67:46:06:10.
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67:46:06:05. Deduction for personal needs. An applicant or recipient residing in a nursing or intermediate care facility is allowed:
(1) A deduction of one hundred dollars per month to cover personal needs;
(2) If earning income, an additional deduction for personal needs up to a maximum of the first seventy-five dollars of gross earned income per month; and
(3) If paying court-ordered child or spousal support, an additional deduction for personal needs up to the amount of child or spousal support actually paid out, not to exceed the court-ordered amount.
Source: 2 SDR 74, effective May 13, 1976; 5 SDR 109, effective July 1, 1979; 7 SDR 76, effective February 11, 1981; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982; 9 SDR 133, effective April 27, 1983; 15 SDR 2, effective July 17, 1988; transferred from § 67:16:21:03, effective August 23, 1992; 19 SDR 141, effective March 25, 1993; 30 SDR 193, effective June 13, 2004; SL 2004, ch 186, § 1, effective July 1, 2004; 41 SDR 93, effective December 3, 2014; 51 SDR 3, effective June 30, 2024.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1(6).
67:46:06:06. Deduction for premiums. If an applicant's or\r\nrecipient's income is used to pay the applicant's or recipient's health\r\ninsurance premiums, the department allows a deduction from the income for the\r\namount paid. The premium may be for participation in the Medicare program or\r\nfor private health insurance, or both. For the purpose of deducting premiums\r\nfrom income, private health insurance is restricted to those policies which\r\ninsure payment for medical services rendered and medical expenses incurred. It does not include a policy which insures an\r\nincome supplement while an individual is disabled. The policy must directly\r\nassist in the payment of medical expenses. If a person is receiving benefits\r\nfrom an income supplement insurance policy for a disability and the policy is\r\nnot includable under the criteria in this section, the premium payment made is\r\ndeductible from income when the payment is necessary to continue benefits.
\r\n\r\n\r\nSource:\r\n2 SDR 74, effective May 13, 1976; 4 SDR 10, effective August 28, 1977; 7 SDR\r\n23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8\r\nSDR 170, effective June 21, 1982; 9 SDR 133, effective April 27, 1983;\r\ntransferred from § 67:16:21:04, effective August 23, 1992; 19 SDR 141,\r\neffective March 25, 1993.
\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\n67:46:06:07. Deduction for\r\ndependents -- No community spouse. If a recipient does not have a community\r\nspouse, as defined in SDCL 28-6-16, but the recipient's home is maintained for a dependent relative, a deduction from the recipient's income necessary to maintain a minimum income level for such a dependent is allowed based on family size. The deduction is determined by taking 100 percent of the need standard\r\nfor independent living set in § 67:12:06:04.01.
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The need standard for the family size, minus any\r\nother income the dependent relative may have, is then deducted from the\r\nrecipient's income. When determining the amount of the dependent's income,\r\n§§ 67:46:04:01 to 67:46:04:09, inclusive, apply.
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For purposes of this rule, a dependent relative is\r\na son, daughter, granddaughter, grandson, stepson, stepdaughter, mother, father,\r\nstepmother, stepfather, half sister, half brother, niece, nephew, grandmother,\r\ngrandfather, aunt, uncle, sister, brother, stepbrother, stepsister, first\r\ncousin, relatives of the preceding generation denoted by the prefixes of grand,\r\ngreat, or great-great; first cousin once removed; and great-great-great\r\ngrandparent, and spouses of any of the relatives specified, even though the\r\nmarriage is terminated by death or divorce, who is not currently receiving SSI.
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Source: 2 SDR 74, effective May 13, 1976; 4\r\nSDR 10, effective August 28, 1977; 5 SDR 109, effective July 1, 1979; 7 SDR 23,\r\neffective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR\r\n170, effective June 21, 1982; 9 SDR 133, effective April 27, 1983; 13 SDR 8,\r\neffective August 3, 1986; 15 SDR 2, effective July 17, 1988; 16 SDR 203,\r\neffective May 27, 1990; transferred from § 67:16:21:07,\r\neffective August 23, 1992; 20 SDR 92, effective December 21, 1993; 21 SDR 162,\r\neffective March 23, 1995; 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.
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Cross-References: In-kind shelter\r\nconsidered unearned income -- Dependent living arrangement, § 67:12:06:12;\r\nInstitutionalized, aged, blind, or disabled individuals; determination of\r\ncountable income, 42 C.F.R. § 435.733.
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67:46:06:08. Supplemental security\r\nincome. Repealed.
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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; 9\r\nSDR 133, effective April 27, 1983; transferred from § 67:16:21:09, effective August 23, 1992; repealed,\r\n41 SDR 93, effective December 3, 2014.
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67:46:06:09. Treatment of income for less than a full month's\r\nresidence. Whenever the residence period in a long-term care facility is\r\nless than a full month, the recipient's income shall not be applied toward the\r\ncost of care unless the recipient died or transferred to another long-term care\r\nfacility. In the event of death or\r\ntransfer, the income shall be used as a credit toward the cost of care.
\r\n\r\n\r\nSource:\r\n8 SDR 170, effective June 21, 1982; transferred from § 67:16:21:11,\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\n67:46:06:10. Basis of payment for program benefits.\r\nPayment for program benefits shall be based on the difference between the\r\nindividual's available income and the monthly rate for the provider of the\r\nindividual's choice, in accordance with the provisions of this chapter and the\r\nprovisions of chapter 67:46:07, if applicable.
\r\n\r\n\r\nSource:\r\n8 SDR 170, effective June 21, 1982; 16 SDR 203, effective May 27, 1990;\r\ntransferred from § 67:16:21:12, 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\n67:46:06:11. Payment made to\r\nfacility or representative payee. For an individual residing in a nursing\r\nor intermediate care facility, the department issues long-term care assistance\r\npayments directly to the facility. For an individual residing in assisted\r\nliving and not receiving HCBS or HCBWS, or for an individual residing in adult\r\nfoster care, the department issues assistance payments to the individual with\r\nthe facility as the representative payee. For an individual receiving HCBS or\r\nHCBWS, the department issues payments directly to the provider of the services.\r\n
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Source: 8 SDR 170, effective June 21, 1982;\r\n9 SDR 133, effective April 27, 1983; transferred from § 67:16:21:13,\r\neffective August 23, 1992; 20 SDR 92, effective December 21, 1993; 20 SDR 170, effective\r\nApril 21, 1994; 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.
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Cross-References: Definition of HCBS,\r\n§ 67:54:04:01; Definition of HCBWS, § 67:44:03:01.
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Source:\r\n43
General\r\nAuthority: SDCL 28-6-1.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6-1.
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