CHAPTER 67:46:10
\r\n\r\n\r\nCHRONIC RENAL DISEASE PROGRAM
\r\n\r\n\r\n\r\nSection
\r\n\r\n67:46:10:01 Definitions.
\r\n\r\n67:46:10:02 Application to establish initial\r\neligibility -- Refusal to comply.
\r\n\r\n67:46:10:03 Application to establish continuing\r\neligibility.
\r\n\r\n67:46:10:04 Eligibility requirements.
\r\n\r\n67:46:10:05 Income considered.
\r\n\r\n67:46:10:06 Exclusions from resources.
\r\n\r\n67:46:10:07 Eligibility determination.
\r\n\r\n67:46:10:08 Program limitations.
\r\n\r\n67:46:10:09 Scope of services and benefits.
\r\n\r\n67:46:10:10 Basis of payment.
\r\n\r\n67:46:10:11 Payment limit.
\r\n\r\n67:46:10:12 Claim submission limit.
\r\n\r\n67:46:10:13 Date of eligibility.
\r\n\r\n67:46:10:14 Provider limitations.
\r\n\r\n67:46:10:15 Medical eligibility.
\r\n\r\n67:46:10:16 Acceptance for treatment.
\r\n\r\n67:46:10:17 Repealed.
\r\n\r\n67:46:10:18 Copayment.
\r\n\r\n\r\n\r\n67:46:10:01. Definitions. Terms\r\nused in this chapter mean:
\r\n\r\n\r\n\r\n
(1) "Chronic renal failure,"\r\na phase of renal functional impairment which can no longer be favorably\r\ninfluenced by conservative management and which requires long-term, continuing\r\ndialysis or transplantation to maintain life and health;
\r\n\r\n\r\n\r\n
(2) "Income," any money or\r\nin-kind payments before deductions as established in § 67:46:10:05;
\r\n\r\n\r\n\r\n
(3) "Program," the South\r\nDakota chronic renal disease program administered by the Department of Social\r\nServices;
\r\n\r\n\r\n\r\n
(4) "Resident," a person\r\nresiding in South Dakota with an intent to remain or absent from the state for\r\nmedical purposes but with an intent to return;
\r\n\r\n\r\n\r\n
(5) "Resource," real or\r\npersonal property and income owned by the applicant or persons legally responsible\r\nfor the applicant; and
\r\n\r\n\r\n\r\n
(6) "Third party payer," any\r\nindividual; firm; partnership; corporation; company; association; governmental\r\nagency, including Medicaid or veterans administration; local fund drive\r\ncontributions; or any other entity responsible for or otherwise assuming an\r\nobligation to provide the payment of all or part of the cost of the medical\r\ncare and treatment of a person suffering from chronic renal failure.
\r\n\r\n\r\n\r\n
Source: 2 SDR 88, effective July 1, 1976; 7\r\nSDR 66, 7 SDR 89, effective July 1, 1981; 7 SDR 121, effective July 2, 1981;\r\ntransferred from § 67:16:23:01, effective August 23, 1992; 21 SDR 86,\r\neffective December 29, 1994; 22 SDR 2, effective July 17, 1995; 41 SDR 93,\r\neffective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6A-12.
\r\n\r\nLaw Implemented: SDCL 28-6A-2.
\r\n\r\n\r\n\r\n
67:46:10:02. Application to establish initial eligibility --\r\nRefusal to comply. An individual suffering from chronic renal failure may\r\ncomplete and submit to the department a signed application for assistance under\r\nthe program after the individual has been on dialysis for one month or has\r\nreceived a transplant within the last 12 months. The applicant's refusal to\r\ncomplete, date, and sign the application for assistance is a basis for\r\nrejecting the application.
\r\n\r\n\r\nSource:\r\n2 SDR 88, effective July 1, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 7\r\nSDR 121, effective July 2, 1981; transferred from § 67:16:23:02, effective\r\nAugust 23, 1992; 21 SDR 86, effective December 29, 1994; 30 SDR 193, effective\r\nJune 13, 2004.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-12.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\nCross-Reference:\r\nEligibility requirements, § 67:46:10:04.
\r\n\r\n\r\n67:46:10:03. Application to establish continuing eligibility.\r\nA recipient of services under this chapter must submit a new, signed\r\napplication upon request of the department or at least annually. If the\r\nrecipient fails to complete, sign, date, and return the application within 10\r\ndays after the date the department mails the request, the recipient becomes\r\nineligible beginning the first day of the following month.
\r\n\r\n\r\nSource:\r\n7 SDR 121, effective July 2, 1981; transferred from § 67:16:23:02.01,\r\neffective August 23, 1992; 21 SDR 86, effective December 29, 1944.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-12.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\n67:46:10:04. Eligibility requirements. An individual is\r\neligible for benefits under this chapter if all of the following requirements\r\nare met:
\r\n\r\n\r\n(1) The individual is a\r\nresident of South Dakota;
\r\n\r\n\r\n(2) The individual is\r\neither a citizen of the United States or an alien eligible under the provisions\r\nof § 67:46:01:10;
\r\n\r\n\r\n(3) The individual is\r\nunable to pay the total cost of lifesaving care and treatment for the renal\r\nfailure;
\r\n\r\n\r\n(4) The individual has not\r\ndeprived himself or herself, directly or indirectly, of any property or assets\r\nfor the purpose of qualifying for assistance;
\r\n\r\n\r\n(5) The individual does not\r\nhave a third-party payer. For purposes of this rule, Medicare and Indian Health\r\nServices are not considered third-party payers. In addition, the department is\r\nnot considered a third-party payer if the individual is determined to be a\r\nqualified Medicare beneficiary, a special low-income Medicare beneficiary, or a\r\nMedicare beneficiary who has income of at least 120 percent but less than 135\r\npercent of the federal poverty level, and the individual's Medicaid benefits\r\nare limited to payment of the individual's part A or B premiums, deductibles,\r\nor coinsurance;
\r\n\r\n\r\n(6) The individual is a\r\nproper candidate for care and treatment as determined by §§ 67:46:10:02,\r\n67:46:10:15, and 67:46:10:16 and is willing to receive it;
\r\n\r\n\r\n(7) The individual's\r\nincome, considered according to § 67:46:10:05, is less\r\nthan 150 percent of the federal poverty level established in § 67:11:01:03;\r\nand
\r\n\r\n\r\n(8) Excluding items listed\r\nin § 67:46:10:06,\r\nthe equity value of resources is less than $4,000 for a single individual and\r\n$6,000 for an individual with a spouse.
\r\n\r\n\r\nSource:\r\n2 SDR 88, effective July 1, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 7\r\nSDR 121, effective July 2, 1981; transferred from § 67:16:23:03, effective\r\nAugust 23, 1992; 21 SDR 86, effective December 29, 1994; 21 SDR 162, effective\r\nMarch 23, 1995; 22 SDR 2, effective July 17, 1995; 30 SDR 193, effective June\r\n13, 2004.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-12.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\nCross-Reference:\r\nQualified Medicare beneficiaries, ch 67:46:11.
\r\n\r\n\r\n67:46:10:05. Income considered. When determining income\r\neligibility, the department considers the household's earned and unearned\r\nincome. For a salaried household member, earned income includes income in cash\r\nor in kind, before deductions, such as income taxes, social security taxes,\r\ninsurance premiums, or savings bonds, earned through the receipt of wages,\r\nsalary, commissions, or fees.
\r\n\r\n\r\nFor a self-employed household member,\r\nearned income is the taxable income declared on the most recent tax return plus\r\nall depreciation allowances claimed as a deduction on the return.
\r\n\r\n\r\nAll other income is considered\r\nunearned income and is considered when received.
\r\n\r\n\r\nSource:\r\n2 SDR 88, effective July 1, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 7\r\nSDR 121, effective July 2, 1981; transferred from § 67:16:23:04, effective\r\nAugust 23, 1992; 21 SDR 86, effective December 29, 1994; 22 SDR 2, effective\r\nJuly 17, 1995.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-12.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\n67:46:10:06. Exclusions from resources. All resources are\r\nconsidered available to the household unless excluded. The following resources\r\nare excluded:
\r\n\r\n\r\n(1) Personal residence and\r\nthe contiguous land;
\r\n\r\n(2) Personal property, such\r\nas household furniture, life insurance policies, items essential for daily\r\nliving, and automobiles;
\r\n\r\n(3) Income-producing\r\nproperty within the limits established in § 67:46:10:04; and
\r\n\r\n(4) Income-producing\r\npersonal property, such as equipment, inventory of a small business, or tools\r\nneeded to produce income during or following rehabilitation services.
\r\n\r\n\r\nSource:\r\n2 SDR 88, effective July 1, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 7\r\nSDR 121, effective July 2, 1981; 9 SDR 11, effective August 1, 1982;\r\ntransferred from § 67:16:23:05, effective August 23, 1992; 21 SDR 86,\r\neffective December 29, 1994; 22 SDR 2, effective July 17, 1995.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-12.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\n67:46:10:07. Eligibility determination. Applications\r\nshall be reviewed by the department and approval or rejection shall be made to\r\nthe applicant in writing within sixty days from the date of application.\r\nApproval for assistance, when granted, shall be for a period of one year or for\r\na period of one year after the date of a successful transplant, whichever\r\noccurs first.
\r\n\r\n\r\nSource:\r\n2 SDR 88, effective July 1, 1976; 6 SDR 66, effective January 10, 1980; 7 SDR\r\n66, 7 SDR 89, effective July 1, 1981; transferred from § 67:16:23:06,\r\neffective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-12.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\n67:46:10:08. Program limitations. All payments for\r\nassistance and services under the chronic renal disease program shall be made\r\nwithin the budget limitation of the program.
\r\n\r\n\r\nSource:\r\n2 SDR 88, effective July 1, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8\r\nSDR 58, effective November 29, 1981; transferred from § 67:16:23:07,\r\neffective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-2.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\n67:46:10:09. Scope of services and\r\nbenefits. Services and benefits payable under the program include:
\r\n\r\n\r\n\r\n
(1) Institutional dialysis;
\r\n\r\n(2) Home dialysis, including supplies,\r\nequipment, and special water softeners;
\r\n\r\n(3) Renal transplants;
\r\n\r\n(4) Hospitalization;
\r\n\r\n(5) Prescription drugs necessary for\r\ndialysis or transplants and not covered by other sources; and
\r\n\r\n(6) Travel expense reimbursements for\r\nthe recipient, in accordance with chapter 67:16:49.
\r\n\r\n\r\n\r\n
Source: 2 SDR 88, effective July 1, 1976; 6\r\nSDR 66, effective January 10, 1980; 7 SDR 23, effective September 18, 1980; 7\r\nSDR 66, 7 SDR 89, effective July 1, 1981; 7 SDR 121, effective July 2, 1981;\r\ntransferred from § 67:16:23:08, effective August 23, 1992; 21 SDR 86,\r\neffective December 29, 1994; 22 SDR 2, effective July 17, 1995; 30 SDR 193,\r\neffective June 13, 2004; 40 SDR 122, effective January 7, 2014; 43 SDR 31,\r\neffective September 12, 2016; 47 SDR 24, effective September 10, 2020.
\r\n\r\nGeneral Authority: SDCL 28-6A-12, 28-6-1.1.
\r\n\r\nLaw Implemented: SDCL 28-6A-2.
\r\n\r\n\r\n\r\n
67:46:10:10. Basis of payment. Payment for services under\r\nthe program shall be made to the provider. All payments for services provided\r\nshall be based on the criteria used to establish rates for services and\r\nbenefits in chapters 67:16:02, 67:16:03, 67:16:14, 67:46:10, and 67:16:25.
\r\n\r\n\r\nSource:\r\n2 SDR 88, effective July 1, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 7\r\nSDR 121, effective July 2, 1981; transferred from § 67:16:23:09, effective\r\nAugust 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-12.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\n67:46:10:11. Payment limit. Total payments made on behalf\r\nof an individual eligible under this chapter may not exceed $5,000 in a fiscal\r\nyear.
\r\n\r\n\r\nSource:\r\n2 SDR 88, effective July 1, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 7\r\nSDR 121, effective July 2, 1981; transferred from § 67:16:23:10, effective\r\nAugust 23, 1992; 21 SDR 86, effective December 29, 1994.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-12.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\n67:46:10:12. Claim submission limit.\r\nAll claims for services provided under this chapter must be submitted to the\r\ndepartment according to the provisions of § 67:16:35:04.
\r\n\r\n\r\n\r\n
Source: 9 SDR 28, effective September 5,\r\n1982; transferred from § 67:16:23:10.01, effective August 23, 1992; 40 SDR\r\n122, effective January 7, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6A-12.
\r\n\r\nLaw Implemented: SDCL 28-6A-2.
\r\n\r\n\r\n\r\n
67:46:10:13. Date of eligibility. Eligibility for\r\nbenefits under this chapter shall start with the first day of the month in\r\nwhich the application is signed.
\r\n\r\n\r\nSource:\r\n2 SDR 88, effective July 1, 1976; 6 SDR 66, effective January 10, 1980; 7 SDR\r\n66, 7 SDR 89, effective July 1, 1981; 7 SDR 121, effective July 2, 1981;\r\ntransferred from § 67:16:23:11, effective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-12.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\n67:46:10:14. Provider limitations. Payments to medical\r\nproviders under the program shall be limited to providers qualified for\r\nreimbursement from the Medicare program administered by the social security\r\nadministration.
\r\n\r\n\r\nSource:\r\n2 SDR 88, effective July 1, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981;\r\ntransferred from § 67:16:23:14, effective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-12.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\n67:46:10:15. Medical eligibility. Medical eligibility for\r\nbenefits under this chapter is limited to persons who meet both of the\r\nfollowing criteria:
\r\n\r\n\r\n(1) Presence of terminal\r\nirreversible renal failure of such severity that conservative management will\r\nnot support life. The person requires peritoneal dialysis, hemodialysis,\r\nor renal transplant in order to sustain life; and
\r\n\r\n\r\n(2) A sufficient degree of\r\nunderstanding and motivation to assure that the person will participate in\r\ncontinuing dialysis. The person is willing to adhere to dietary and intake\r\nrestrictions.
\r\n\r\n\r\nA report from the renal disease center\r\nor the applicant's or recipient's attending physician\r\nshall confirm that the requirements in this section are met before initial or\r\ncontinuing eligibility is determined.
\r\n\r\n\r\nSource:\r\n2 SDR 88, effective July 1, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 7\r\nSDR 121, effective July 2, 1981; transferred from § 67:16:23:15, effective\r\nAugust 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-12.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\n67:46:10:16. Acceptance for treatment. The person must be\r\naccepted for evaluation and treatment by a renal disease center which has been\r\ncertified as such by the Medicare program administered by the social security\r\nadministration.
\r\n\r\n\r\nSource:\r\n2 SDR 88, effective July 1, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981;\r\ntransferred from § 67:16:23:16, effective August 23, 1992.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-12.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\n67:46:10:17. Base income disregard.Repealed.
\r\n\r\n\r\nSource:\r\n7 SDR 121, effective July 2, 1981; 9 SDR 11, effective August 1, 1982;\r\ntransferred from § 67:16:23:18, effective August 23, 1992; repealed, 21\r\nSDR 86, effective December 29, 1994.
\r\n\r\n\r\n67:46:10:18. Copayment. A\r\nrecipient of benefits under this chapter must make a copayment\r\nto the provider. The amount of the copayment is five\r\npercent of the amount allowed in § 67:46:10:10.
\r\n\r\n\r\nSource:\r\n7 SDR 121, effective July 2, 1981; 9 SDR 11, effective August 1, 1982;\r\ntransferred from § 67:16:23:19, effective August 23, 1992; 21 SDR 86,\r\neffective December 29, 1994.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6A-12.
\r\n\r\nLaw\r\nImplemented: SDCL 28-6A-2.
\r\n\r\n\r\n