S.D. Admin. R. 50:05:01:21

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

Section 50:05:01:21 - Fee schedule

The following fee schedule applies to all residents of the home:

(1) A resident residing in any of the home's residential living units shall pay the home a monthly maintenance fee equal to 50 percent of the resident's gross monthly income, including any aide and attendance or housebound reimbursement received from the United States Department of Veterans Affairs;

(2) A resident residing in one of the home's nursing care units shall pay based on ability and eligibility for Medicaid governed by South Dakota Medicaid laws and rules;

(3) Each married couple residing in any one of the home's couples units shall pay the home a monthly maintenance fee equal to 55 percent of the couple's gross combined monthly income. If one member of the couple is transferred to the nursing care unit then the member shall pay based on ability and eligibility for Medicaid governed by South Dakota Medicaid laws and rules. The spouse not placed in nursing care shall pay 50 percent of that spouse's gross monthly income. The percentages specified in this subdivision are calculated on all income, including any aide and attendance or housebound reimbursement received from the United States Department of Veterans Affairs and any spousal or dependent allowance set by the Department of Social Services;

(4) The home's superintendent shall adjust the monthly maintenance fees as necessary to permit a single resident residing in a residential living unit (domiciliary) of the home to retain a minimum of $175 of the resident's monthly income. A single resident residing in the nursing care unit who is receiving any type of veteran's benefits may retain $150. This includes $60 from Medicaid and $90 from veterans benefits. Veterans and non-veterans who receive no veteran's benefits will retain $60 which is a benefit of Medicaid. Married couples residing in any of the domiciliary couple's units of the home may retain a minimum of $225 of their combined monthly income;

(5) Other adjustments to maintenance fees include the following:

(a) For residents living in the residential living system (domiciliary), the home's superintendent shall deduct Medicare Part B and D premiums, which are medical insurance premiums automatically deducted from the resident's Social Security monthly benefit, from gross income before calculating maintenance rent. This deduction does not apply to supplemental insurances;

(b) The home's superintendent may make an adjustment to a domiciliary resident's monetary assets total, not to exceed $5,000, for the purchase of a burial plan for the resident, upon evidence of this authorized allowable expense; or, an allowance may be made on a resident's gross income for monthly payments to an irrevocable trust to a funeral home for the purpose of a burial plan for the resident, not to exceed $50 per month and a maximum total of $1,500;

(c) If the home receives a reimbursement from a domiciliary resident's health/prescription medication insurance, and if the resident is paying the premiums for this insurance, the superintendent shall apply an adjustment to the resident's monthly maintenance rent based on half the actual reimbursement received for the previous month, less costs of administration;

(d) Because rent is paid in arrears, all new residents in the domiciliary shall pay an additional 10% of their current maintenance fee each month until they have pre-paid an amount equivalent to their calculated nursing care unit maintenance monthly fee;

(6) Monthly maintenance fees of a resident may not exceed the actual cost of providing the resident's home maintenance, as determined by the secretary of the Department of Veterans Affairs, less any payment made to the home by the United States Department of Veterans Affairs toward the cost of the resident's maintenance;

(7) The secretary of the Department of Veterans Affairs may set a lesser monthly maintenance fee for a resident if the secretary determines that the lesser fee is necessary to avoid an undue hardship because of the resident's unusual financial circumstances.

S.D. Admin. R. 50:05:01:21

SL 1975, ch 16, § 1; 1 SDR 17, effective 8/18/1974; transferred from § 67:50:12:20, effective 7/1/1977; 7 SDR 92, effective 4/9/1981; 9 SDR 94, effective 1/24/1983; 11 SDR 19, effective 8/8/1984; transferred from § 17:40:01:20, effective 7/1/1989; 33 SDR 63, effective 10/11/2006; 34 SDR 146, effective 12/3/2007; 38 SDR 58, effective 10/19/2011.

General Authority: SDCL 33A-4-4.

Law Implemented: SDCL 33A-4-12 to 33A-4-14.