S.D. Admin. R. 46:11:13:05

Current through Register Vol. 51, page 67, December 16, 2024

Section 46:11:13:05 - Categorical determinations for Level I

A categorical determination is made by the Department of Social Services. A categorical determination may warrant Medicaid certified swing bed or nursing facility services but does not warrant specialized services. A situation known as a categorical situation is one of the following:

(1) A terminal illness diagnosis, determined by a physician or hospice involvement that includes a life expectancy of six months or less;

(2) A severe physical illness which has resulted in a coma or ventilator dependence;

(3) The age of the individual is 75 years or older; or

(4) A primary diagnosis of dementia, including Alzheimer's disease or a related disorder; or a non-primary diagnosis of dementia without a primary diagnosis that is a serious mental illness.

For any of these situations, the Department of Social Services shall complete a Level I screening form. A copy of the form shall be sent to the division and any appropriate facility.

S.D. Admin. R. 46:11:13:05

40 SDR 102, effective 12/3/2013; 40 SDR 229, effective 6/30/2014.

General Authority: SDCL 27B-2-26(8).

Law Implemented: SDCL 27B-2-26.