S.D. Admin. R. 67:16:41:06

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

Section 67:16:41:06 - Treatment plan requirements

The mental health provider must develop a treatment plan for each recipient who is receiving medically-necessary, covered mental health treatment based on a primary diagnosis of a mental disorder. The plan must be relevant to the diagnosis, be developmentally appropriate, and relate to each covered mental health treatment to be delivered. Evidence of participation by the recipient or the recipient's legal guardian and evidence of meaningful involvement in formulating the plan must be documented in the file.

The treatment plan must:

(1) Be developed jointly by the recipient, or the recipient's legal guardian, and the mental health provider who will be providing the covered mental health treatment;

(2) Be understandable by the recipient and the recipient's legal guardian, if applicable;

(3) Include a list of other professionals known to be involved in the case;

(4) Contain written goals, objectives, or both, which are individualized, clear, specific, and measurable so that the recipient and the mental health provider can determine if progress has been made, and which specifically address the recipient's treatment goals;

(5) Be based on the findings of the diagnostic assessment and contain the recipient's mental disorder diagnosis code;

(6) List the specific therapies, interventions, and activities that match the recipient's readiness for change for identified issues, and which are prescribed for meeting the treatment goals;

(7) Include the specific treatment goals for improving the recipient's condition to a point of no longer needing mental health treatment; and

(8) Include a specific schedule of treatment services including the prescribed frequency and duration of each mental health service to be provided to meet the treatment plan goals.

The mental health provider must complete, sign, and date the treatment plan within thirty days of intake. The signature is a certification by the mental health provider that the treatment plan is accurate. The certification date is the effective date of the treatment plan. A copy of the treatment plan must be provided to the recipient and to the recipient's parent or guardian, if applicable.

Mental health treatment provided after the third session with the recipient, without a supporting treatment plan meeting the requirements of this section, is not covered.

S.D. Admin. R. 67:16:41:06

22 SDR 6, effective 7/26/1995; 37 SDR 53, effective 9/23/2010; 46 SDR 050, effective 10/10/2019; 48 SDR 39, effective 10/3/2021; 50 SDR 063, effective 11/27/2023

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Clinical record requirements, § 67:16:41:08.