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. (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. (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.

   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).

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.