Rule 67:46:06:01 Scope of chapter.

CHAPTER 67:46:06

BUDGETING FOR LONG-TERM CARE

Section

67:46:06:01 Scope of chapter.

67:46:06:02 Definitions.

67:46:06:03 Income for determining long-term care assistance.

67:46:06:04 Supplemental payment to long-term care facility.

67:46:06:05 Deduction for personal needs.

67:46:06:06 Deduction for premiums.

67:46:06:07 Deduction for dependents -- No community spouse.

67:46:06:08 Repealed.

67:46:06:09 Treatment of income for less than a full month's residence.

67:46:06:10 Basis of payment for program benefits.

67:46:06:11 Payment made to facility or representative payee.

67:46:06:12 Deduction for home maintenance.

67:46:06:01. Scope of chapter. Rules contained in this chapter are applied after financial eligibility is established according to chapter 67:46:04 and are used to determine the amount of long-term care assistance an individual is eligible to receive from the department.

Source: 9 SDR 133, effective April 27, 1983; transferred from § 67:16:21:00, effective August 23, 1992.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:06:02. Definitions. Terms used in this chapter have the same meaning as those defined in § 67:46:04:02.

Source: 2 SDR 74, effective May 13, 1976; 5 SDR 109, effective July 1, 1979; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 9 SDR 133, effective April 27, 1983; transferred from § 67:16:21:01, effective August 23, 1992; 34 SDR 322, effective July 1, 2008; 41 SDR 93, effective December 3, 2014.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:06:03. Income for determining long-term care assistance. For purposes of determining the amount of long-term care assistance, income is considered according to subdivisions 67:46:04:03(1) to (5), inclusive; §§ 67:46:04:04, 67:46:04:06 and 67:46:04:08 to 67:46:04:10, inclusive.

Source: 2 SDR 74, effective May 13, 1976; 4 SDR 10, effective August 28, 1977; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982; 9 SDR 133, effective April 27, 1983; transferred from § 67:16:21:02, effective August 23, 1992; 20 SDR 170, effective April 21, 1994; 41 SDR 93, effective December, 3, 2014.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:06:04. Supplemental payment to long-term care facility. The department shall pay a participating home and community based waiver provider or nursing facility for amounts not covered by an eligible individual's own income, insurance, a responsible third party or other state or federal assistance programs.

Source: 8 SDR 170, effective June 21, 1982; 9 SDR 133, effective April 27, 1983; transferred from § 67:16:21:02.01, effective August 23, 1992; 41 SDR 93, effective December 3, 2014.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Cross-Reference: Basis of payment for program benefits, § 67:46:06:10.

    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 recipient's income is used to pay the applicant's or recipient's health insurance premiums, the department allows a deduction from the income for the amount paid. The premium may be for participation in the Medicare program or for private health insurance, or both. For the purpose of deducting premiums from income, private health insurance is restricted to those policies which insure payment for medical services rendered and medical expenses incurred. It does not include a policy which insures an income supplement while an individual is disabled. The policy must directly assist in the payment of medical expenses. If a person is receiving benefits from an income supplement insurance policy for a disability and the policy is not includable under the criteria in this section, the premium payment made is deductible from income when the payment is necessary to continue benefits.

Source: 2 SDR 74, effective May 13, 1976; 4 SDR 10, effective August 28, 1977; 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982; 9 SDR 133, effective April 27, 1983; transferred from § 67:16:21:04, effective August 23, 1992; 19 SDR 141, effective March 25, 1993.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:06:07. Deduction for dependents -- No community spouse. If a recipient does not have a community spouse, 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 for independent living set in § 67:12:06:04.01.

The need standard for the family size, minus any other income the dependent relative may have, is then deducted from the recipient's income. When determining the amount of the dependent's income, §§ 67:46:04:01 to 67:46:04:09, inclusive, apply.

For purposes of this rule, a dependent relative is a son, daughter, granddaughter, grandson, stepson, stepdaughter, mother, father, stepmother, stepfather, half sister, half brother, niece, nephew, grandmother, grandfather, aunt, uncle, sister, brother, stepbrother, stepsister, first cousin, relatives of the preceding generation denoted by the prefixes of grand, great, or great-great; first cousin once removed; and great-great-great grandparent, and spouses of any of the relatives specified, even though the marriage is terminated by death or divorce, who is not currently receiving SSI.

Source: 2 SDR 74, effective May 13, 1976; 4 SDR 10, effective August 28, 1977; 5 SDR 109, effective July 1, 1979; 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982; 9 SDR 133, effective April 27, 1983; 13 SDR 8, effective August 3, 1986; 15 SDR 2, effective July 17, 1988; 16 SDR 203, effective May 27, 1990; transferred from § 67:16:21:07, effective August 23, 1992; 20 SDR 92, effective December 21, 1993; 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.

Cross-References: In-kind shelter considered unearned income -- Dependent living arrangement, § 67:12:06:12; Institutionalized, aged, blind, or disabled individuals; determination of countable income, 42 C.F.R. § 435.733.

67:46:06:08. Supplemental security income. 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; 9 SDR 133, effective April 27, 1983; transferred from § 67:16:21:09, effective August 23, 1992; repealed, 41 SDR 93, effective December 3, 2014.

67:46:06:09. Treatment of income for less than a full month's residence. Whenever the residence period in a long-term care facility is less than a full month, the recipient's income shall not be applied toward the cost of care unless the recipient died or transferred to another long-term care facility. In the event of death or transfer, the income shall be used as a credit toward the cost of care.

Source: 8 SDR 170, effective June 21, 1982; transferred from § 67:16:21:11, effective August 23, 1992.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:06:10. Basis of payment for program benefits. Payment for program benefits shall be based on the difference between the individual's available income and the monthly rate for the provider of the individual's choice, in accordance with the provisions of this chapter and the provisions of chapter 67:46:07, if applicable.

Source: 8 SDR 170, effective June 21, 1982; 16 SDR 203, effective May 27, 1990; transferred from § 67:16:21:12, effective August 23, 1992.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:06:11. Payment made to facility or representative payee. For an individual residing in a nursing or intermediate care facility, the department issues long-term care assistance payments directly to the facility. For an individual residing in assisted living and not receiving HCBS or HCBWS, or for an individual residing in adult foster care, the department issues assistance payments to the individual with the facility as the representative payee. For an individual receiving HCBS or HCBWS, the department issues payments directly to the provider of the services.

Source: 8 SDR 170, effective June 21, 1982; 9 SDR 133, effective April 27, 1983; transferred from § 67:16:21:13, effective August 23, 1992; 20 SDR 92, effective December 21, 1993; 20 SDR 170, effective April 21, 1994; 41 SDR 93, effective December 3, 2014.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Cross-References: Definition of HCBS, § 67:54:04:01; Definition of HCBWS, § 67:44:03:01.

67 : 46 : 06 : 12 . Deduction for home maintenance. An applicant or recipient residing in a nursing or intermediate care facility is allowed a deduction in the amount of the SSI benefit standard minus $60 for the maintenance of the home of the individual or couple for not longer than 6 months if a physician has certified that the individual, or one member of the institutionalized couple, is likely to return to the home within that period.

Source: 43 SDR 31 , effective September 12, 2016 .

General Authority: SDCL 28 - 6 - 1.

Law Implemented: SDCL 28-6-1.