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CHAPTER 67:46:03
LONG-TERM CARE ELIGIBILITY
Section
67:46:03:01 Responsibility for information.
67:46:03:02 Aged, blind, or disabled.
67:46:03:03 Long-term care residency requirement and beginning of eligibility.
67:46:03:04 Transferred.
67:46:03:05 Transferred.
67:46:03:06 Transferred.
67:46:03:07 Transferred.
67:46:03:08 Transferred.
67:46:03:09 Transferred.
67:46:03:10 Transferred.
67:46:03:11 Transferred.
67:46:03:12 Transferred.
67:46:03:13 Transferred.
67:46:03:14 Transferred.
67:46:03:15 Transferred.
67:46:03:16 Repealed.
67:46:03:17 Repealed.
67:46:03:18 Determination of disability.
67:46:03:19 Determination of blindness.
67:46:03:20 Cessation of determination of blindness.
67:46:03:21 Cessation of disability.
67:46:03:22 Release of medical information.
67:46:03:23 Payment for examinations.
67:46:03:24 Repealed.
67:46:03:01. Responsibility for information. The applicant or recipient of long-term care shall have the primary responsibility of furnishing the department information necessary to determine eligibility or ineligibility for long-term care assistance. Failure of the applicant or recipient to furnish the necessary information may result in the rejection or termination of long-term care assistance.
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 § 67:16:18:01, effective August 23, 1992.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1 , 28-6-5.
67:46:03:02. Aged, blind, or disabled. Long-term care assistance shall be provided to an eligible aged, blind, or disabled applicant or recipient meeting one of the following:
(1) The individual is at least 65 years of age at the time of application;
(2) The individual has a central visual acuity of 20/200 or less in the better eye with the use of a correcting lens;
(3) The individual has limited vision: the widest diameter of the visual field subtends an angle no greater than 20 degrees;
(4) The individual is unable to engage in substantial gainful activity because of a physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of at least 12 months; or
(5) The individual is a child under 18 years of age who is unable to engage in substantial gainful activity because of a mental or physical impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of at least 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 § 67:16:18:02, effective August 23, 1992.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
67:46:03:03. Long-term care residency requirement and beginning of eligibility. The department shall approve long-term care assistance or medical services for an eligible individual if the individual is participating in a home and community-based service program or resides in one of the following facilities:
(1) A licensed hospital, nursing facility, intermediate care facility, or assisted living facility that has a Medicaid provider agreement with the department for the level of care and services provided; or
(2) An adult foster care facility licensed by the South Dakota Department of Health.
If an eligible individual's income minus $20 is less than the SSI standard, long-term care assistance or medical assistance begins in the month the person enters the facility, subject to § 67:46:01:03.
If an eligible individual's income minus $20 is greater than the SSI standard but does not exceed 300 percent of the SSI standard, long-term care assistance or medical assistance begins the first day of a 30-consecutive-day period of institutionalization, subject to § 67:46:01:03. The 30-consecutive-day period is met if the requirements of this rule are met and the individual dies before the 30 th consecutive day.
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; 15 SDR 2, effective July 17, 1988; transferred from § 67:16:18:03, effective August 23, 1992; 19 SDR 141, effective March 25, 1993; 20 SDR 92, effective December 21, 1993; 30 SDR 193, effective June 13, 2004.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
Cross-References:
Home and community-based services, ch 67:54:04.
Home and community-based waiver services, ch 67:44:03.
SSI standard benefit amount, subdivision 67:46:04:13(2).
67:46:03:04. Transferred to § 67:46:01:17.
67:46:03:05. Transferred to § 67:46:01:18.
67:46:03:06. Transferred to § 67:46:01:19.
67:46:03:07. Transferred to § 67:46:01:20.
67:46:03:08. Transferred to § 67:46:01:21.
67:46:03:09. Transferred to § 67:46:01:22.
67:46:03:10. Transferred to § 67:46:01:23.
67:46:03:11. Transferred to § 67:46:01:24.
67:46:03:12. Transferred to § 67:46:01:25.
67:46:03:13. Transferred to § 67:46:01:26.
67:46:03:14. Transferred to § 67:46:01:27.
67:46:03:15. Transferred to § 67:46:01:28.
67:46:03:16. Citizenship and alienage. Repealed.
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 § 67:16:18:06, effective August 23, 1992; 20 SDR 92, effective December 21, 1993; 23 SDR 152, effective March 14, 1997; repealed, 24 SDR 24, effective August 31, 1997.
67:46:03:17. Social security numbers. Repealed.
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; 12 SDR 6, effective July 28, 1985; transferred from § 67:16:18:07, effective August 23, 1992; repealed, 24 SDR 24, effective August 31, 1997.
67:46:03:18. Determination of disability. The disability/incapacity consultation team shall determine disability following the guidelines for the SSI program provided in 42 U.S.C. §§ 1382c(a)(3)(A) to 1382c(a)(3)(C), inclusive, as of July 1, 2014, based on medical evidence supplemented by a social history. Medical evidence may be a physician's report, a copy of the physician's records, or the findings of a physical examination completed for this purpose. An individual who is receiving social security or SSI disability benefits meets the long-term care assistance disability requirements.
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; 18 SDR 67, effective October 13, 1991; transferred from § 67:16:18:08, effective August 23, 1992; 21 SDR 162, effective March 23, 1995; 41 SDR 93, effective December 3, 2014.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
67:46:03:19. Determination of blindness. Blindness, according to § 67:46:03:02, shall be determined by an ophthalmologist designated by the department. Based on an ophthalmologist's or optometrist's report and evaluation, the ophthalmologist shall determine whether the disability requires long-term care. If the individual is receiving social security disability benefits or SSI benefits based on blindness, the individual is considered to meet the blindness requirements for long-term care assistance.
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 § 67:16:18:09, effective August 23, 1992.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
67:46:03:20 Cessation of determination of blindness. An individual shall be ineligible for long-term care assistance when either of the following occurs:
(1) The individual has applied for and has been denied social security disability or SSI benefits based on blindness; or
(2) The department has determined that the blindness does not require long-term care.
If an individual is ineligible based on subdivision (1), the department may not overrule the decision.
Source: 8 SDR 170, effective June 21, 1982; transferred from § 67:16:18:09.01, effective August 23, 1992.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
Cross-Reference: Determination of blindness, § 67:46:03:19.
67:46:03:21. Cessation of disability. An individual is ineligible for long-term care assistance when either of the following occurs:
(1) The disability/incapacity consultation team, following §67:46:03:18, inclusive, determines that a disability ceases to exist; or
(2) The individual has been denied social security or SSI disability benefits based on a disability.
If an individual is ineligible based on subdivision (2) of this section, the department may not overrule the decision.
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; 18 SDR 67, effective October 13, 1991; transferred from § 67:16:18:10, effective August 23, 1992; 21 SDR 162, effective March 23, 1995.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
67:46:03:22. Release of medical information. No medical information may be obtained unless the department secures the applicant's written consent. Refusal to sign an authorization for the release of this information shall make the applicant ineligible for long-term care assistance.
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 § 67:16:18:11, effective August 23, 1992.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
67:46:03:23. Payment for examinations. Physical examinations requested by the department for the purpose of determining an applicant's or recipient's eligibility and level of care shall be paid for by the department in accordance with §§ 67:16:01:09 and 67:16:01:11. The applicant or recipient shall obtain written authorization for the examination from the department and shall present the authorization to the person conducting the examination.
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 § 67:16:18:12, effective August 23, 1992.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
67:46:03:24. Absence of regulations regarding conditions of eligibility. Repealed.
Source: 8 SDR 170, effective June 21, 1982; transferred from § 67:16:18:15, effective August 23, 1992; repealed, 41 SDR 93, effective December 3, 2014.