Rule 67:46:08:01 Required timely and adequate notice.

CHAPTER 67:46:08

LONG-TERM CARE NOTICE REQUIREMENTS

Section

67:46:08:01 Required timely and adequate notice.

67:46:08:02 Adequate notice to applicants.

67:46:08:03 Suspension of timely notice and the application of adequate notice.

67:46:08:04 Repealed.

67:46:08:05 Notice of right to request waiver of period of ineligibility -- Assets transferred at less than fair market value -- Ineligibility due to home equity limit.

67:46:08:01. Required timely and adequate notice. Timely and adequate notice shall be mailed to each recipient detailing the reason for a proposed action which may result in termination or reduction of payment or inability to authorize payment. The notice shall inform the recipient of any changes in federal or state law requiring automatic grant adjustments for classes of recipients and of a change in the manner or form of payment to a protective, vendor, or two-party payment. This notice shall state the specific regulations supporting the action taken and explain the individual's right to and procedure for requesting a fair hearing, the right to be represented by others at the hearing, and the time in which a hearing may be requested. This timely notice shall be mailed ten days before the date of action, which is the date when the recipient would normally receive an assistance check or, in the case of a Medicaid recipient, ten days before the intended change would be effective. In cases of probable fraud, notice of a proposed action which may result in termination or reduction of payment or inability to authorize payment shall be considered timely if mailed at least five days before the action would become effective. This notice shall also explain the circumstances under which assistance may be continued if a hearing is requested. Timely and adequate notice is not required when the recipient of a one-person case has died.

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 § 67:16:22:01, effective August 23, 1992 ; 43 SDR 31, effective September 12, 2016 .

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:08:02. Adequate notice to applicants. A written notice to applicants for services under this article shall be sent at the time the decision is made approving or rejecting each application. This written notice shall include a statement of what action the agency intends to take, the reasons for the intended agency action, the specific regulations supporting such action, and an explanation of the individual's right to and procedure for requesting a fair hearing, the right to be represented by others at the hearing, and the time in which a hearing may be requested. This notice shall explain the individual's right under the Civil Rights Act of 1964. Nothing in this section shall be construed as indicating that the department will pay for legal fees for representing applicants at conferences or hearings held according to this section.

Source: 8 SDR 170, effective June 21, 1982; transferred from § 67:16:22:01.01, effective August 23, 1992 ; 43 SDR 31, effective September 12, 2016 .

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:08:03. Suspension of timely notice and the application of adequate notice. The department may dispense with timely notice as provided in § 67:46:08:01 and mail adequate notice to a recipient of long-term care assistance no later than the effective date of the intended change in any of the following situations:

(1) The department has factual information confirming the death of a recipient;

(2) The department receives a clear written statement signed by a recipient that the recipient no longer wishes assistance or that gives information which requires termination or reduction of assistance, and the recipient has indicated, in writing, that the recipient understands that this is the consequence of supplying such information;

(3) The change requires an adjustment to the budget and has no impact on the recipient's eligibility for benefits;

(4) The recipient's whereabouts are unknown and mail from the department directed to the recipient has been returned by the post office or facility indicating no known forwarding address;

(5) The recipient has been accepted for assistance in a nursing facility in a different state and that fact has been established by the department;

(6) A decision is made by the medical review team indicating a change in the level of care required by the recipient; and

(7) The recipient has been admitted to an institution where the recipient is ineligible for further services.

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 § 67:16:22:02, effective August 23, 1992; 41 SDR 93, effective December 3, 2014.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:08:04. Right to a conference. A recipient of long-term care whose assistance is being rejected, terminated, suspended, held, or reduced may request a conference or a hearing. The conference may not interfere with any time schedule established for requesting a fair hearing.

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 § 67:16:22:03, effective August 23, 1992.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Cross-Reference: Fair hearings, ch 67:17:02.

67:46:08:05. Notice of right to request waiver of period of ineligibility -- Assets transferred at less than fair market value -- Ineligibility due to home equity limit. The department shall notify an individual if it intends to impose a period of ineligibility because an individual has transferred an asset for less than fair market value or is ineligible for long-term care assistance due to the home equity limit established in § 67:46:05:15. The notice shall specify the date of the intended action, information about how the individual can request a waiver of the period of ineligibility, and information on how to request a fair hearing.

Source: 33 SDR 44, effective August 31, 2006; 35 SDR 166, effective December 24, 2008.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Cross-References:

Ineligibility if assets transferred, § 67:46:05:09.02.

Period of ineligibility waived under certain circumstances, § 67:46:05:10.

Availability of hardship waivers, 42 U.S.C. § 1396p(c )( 2)(D).

Fair hearings, ch 67:17:02.