ARSD 67:46:09:12
Based on the level of care determination, the actual itemized cost of all Medicaid covered services provided in the home may not exceed 100 percent of the Medicaid-allowable cost of care in a medical institution. Medicaid allowable cost is the amount payable when cost share, insurance, or Medicare deductible or coinsurance has been applied.
(5) Intermediate care facility for individuals with intellectual disabilities for a child who meets the requirements of § 67:46:09:10, $5,200 a month.
Cross-References: Add-on payment -- Ventilator, § 67:16:04:08.04; Documentation required for ventilator add-on payment, § 67:45:02:07.
The costs of all services that would be included in a medical institution's reimbursement shall be used to determine the monthly home care cost. When determining the monthly home care cost, the cost of purchased medical equipment shall be prorated on an annual basis.
When the cost of care in the home exceeds the cost of institutional care, the department shall issue a notice of intent to discontinue or deny further service. The department may reconsider its decision to discontinue or deny further service if, within 30 days from the date of the notice, the parent provides documentation to the department that future costs will decline and be within 100 percent of the cost.
The Medicaid allowable cost of care for the various medical institutions are as follows:
Source: 19 SDR 26, effective August 23, 1992; 20 SDR 144, effective March 10, 1994; 21 SDR 162, effective March 23, 1995; 40 SDR 122, effective January 8, 2014.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.