South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:54 - Medical programs administered by Department of Human Services
Chapter 67:54:04 - Home and community-based services
Section 67:54:04:18 - Initial level of care

(1) A completed ICAP that indicates a minimum of three substantial functional limitations;

(2) A copy of the psychological evaluation;

(3) An HCBS Waiver Choice and Rights Form signed by a CSP staff member and the individual, the individual's parent if the individual is under 18 years of age, or the individual's guardian; and

(4) A provisional plan of care that designates the specific waiver service that the individual will receive.