Rule 67:46:02 APPLICATION FOR LONG-TERM CARE

CHAPTER 67:46:02

APPLICATION FOR LONG-TERM CARE

Section

67:46:02:01 Definitions.

67:46:02:02 Signed application required.

67:46:02:03 Determining eligibility.

67:46:02:04 Prompt determinations.

67:46:02:05 Application of time standard.

67:46:02:06 Case record to contain facts.

67:46:02:07 Informing applicant.

67:46:02:08 Review of continuing eligibility.

67:46:02:09 Reporting change of circumstances.

67:46:02:10 Prompt action for continuing eligibility.

67:46:02:01. Definitions. Terms used in this chapter mean:

(1) "Long-term care," continuing 24-hour service in a medical, nursing, or intermediate care facility, assisted living facility, or adult foster home; participation in the home and community-based service programs under chapters 67:44:03 and 67:54:04; and

(2) "Application," the action by which an individual completes the department's application form for long-term care assistance or medical assistance. An application is not an inquiry, which is simply a request for information about eligibility requirements for long-term care assistance or medical assistance. An inquiry may be followed by an application.

Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982; 10 SDR 79, effective February 1, 1984; transferred from § 67:16:17:01, effective August 23, 1992; 20 SDR 92, effective December 21, 1993; 41 SDR 93, effective December 3, 2014.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:02:02. Signed application required. The applicant shall personally sign an application, and the department shall verify the application in accordance with § 67:46:02:03. If the applicant is incompetent, incapacitated, or deceased, an authorized representative may sign the application on the applicant's behalf. The applicant may be assisted by an individual of the applicant's choice or someone acting in a legal capacity for the applicant in the various aspects of the application or in contacts with the department.

Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982; transferred from § 67:16:17:02, effective August 23, 1992.

General Authority: SDCL 28-6-1 , 28-6-5.

Law Implemented: SDCL 28-6-1 , 28-6-5.

67:46:02:03. Determining eligibility. Initial and continuing eligibility for long-term care assistance shall be determined by the department on the basis of statements submitted by the applicant or recipient of long-term care assistance about the facts that are within the applicant's or recipient's knowledge and competence. Verification through contacts is required for selected items, including family composition, resources, and income.

Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; transferred from § 67:16:17:03, effective August 23, 1992.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:02:04. Prompt determinations. The notification of approval or denial of long-term care assistance shall be mailed to the applicant within 45 days after the date of application.

Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982; transferred from § 67:16:17:04, effective August 23, 1992.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1 , 28-6-5.

67:46:02:05. Application of time standard. The time standard set by § 67:46:02:04 applies except in unusual circumstances, including a failure or delay on the part of an examining physician to provide necessary information or an emergency beyond the department's control causing a delay in a decision by the department. Case records must be fully documented to show the cause of the delay in all instances when delay occurs. The department's time standard for acting on applications or continuing eligibility may not be used as a waiting period before granting or denying benefits.

Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982; transferred from §67:16:17:05, effective August 23, 1992; 20 SDR 92, effective December 21, 1993.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1 , 28-6-5.

67:46:02:06. Case record to contain facts. If the applicant voluntarily withdraws an application, the department shall send a notice to the applicant to confirm the withdrawal and shall enter the action in the case record. If the applicant dies or cannot be located, the department shall file the application without action and enter a notation in the case record. In all other cases, the applicant's or recipient's case record shall contain supportive facts for each decision relating to approval or denial of eligibility.

Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982; transferred from § 67:16:17:06, effective August 23, 1992; 41 SDR 93, effective December 3, 2014.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:02:07. Informing applicant. Applicants shall be informed about eligibility requirements and conditions, coverage, scope of program, related services available, the rights and responsibilities of the applicant or recipient, and the department's time standard in acting on applications. This information shall be given in writing or orally as appropriate.

Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; transferred from § 67:16:17:07, effective August 23, 1992.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:02:08. Review of continuing eligibility. The department shall redetermine continuing eligibility for long-term care and medical assistance at least once every 12 months.

Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982; transferred from § 67:16:17:09, effective August 23, 1992; 20 SDR 92, effective December 21, 1993; 41 SDR 93, effective December 3, 2014.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Cross-Reference: Periodic redeterminations of Medicaid eligibility, 42 C.F.R. 435.916 (March 23, 2012).

67:46:02:09. Reporting change of circumstances. Any change in circumstances affecting an individual's eligibility shall be reported by the recipient to the department within 30 days of the date the change occurred.

Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; transferred from § 67:16:17:10, effective August 23, 1992.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:02:10. Prompt action for continuing eligibility. Upon receipt of information which affects continued eligibility for long-term care assistance, a redetermination of eligibility shall be made within 30 days. The recipient may be assisted by an individual of the recipient's choice in the various aspects of the redetermination of eligibility.

Source: 2 SDR 74, effective May 13, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982; transferred from § 67:16:17:11, effective August 23, 1992.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.