S.D. Admin. R. 67:16:41:02

Current through Register Vol. 51, page 64, December 9, 2024

Section 67:16:41:02 - Mental health service requirements

To be covered under this chapter, mental health services are limited to services established in this chapter which meet all of the following requirements:

(1) The mental health provider has prepared a diagnostic assessment according to § 67:16:41:04;

(2) The diagnostic assessment contains a primary diagnosis of one of the mental disorders specified in § 67:16:41:05;

(3) The mental health provider has prepared an individual treatment plan which meets the requirements of §§ 67:16:41:06 and 67:16:41:07;

(4) The mental health provider provides treatment directly to the recipient or via collateral contact;

(5) The treatment is documented in the recipient's clinical record according to § 67:16:41:08; and

(6) The treatment is medically necessary according to § 67:16:01:06.02.

Failure to meet all of the above requirements is cause for the department to determine the mental health services to be noncovered services.

Mental health services may be provided to a recipient during the 30-day time period the mental health provider has to complete the diagnostic assessment, if the mental health provider has met the above requirements and has made a provisional diagnosis of a mental health disorder

S.D. Admin. R. 67:16:41:02

22 SDR 6, effective 7/26/1995; 45 SDR 082, effective 12/10/2018; 49 SDR 021, effective 9/12/2022

General Authority: SDCL 28-6-1(1)(2).

Law Implemented: SDCL 28-6-1.