67:16:41:02.  Mental health service requirements. To be covered under this chapter, mental health services are limited to services that are established in this chapter and meet the following requirements:

    (1)  There must be a diagnostic assessment prepared by a mental health provider in accordance with § 67:16:41:04;

    (2)  The diagnostic assessment must contain a primary mental health disorder diagnosis code set forth in § 67:16:41:05;

    (3)  There must be an individual trreatment plan that is prepared by a mental health provider and meets the requirements of §§ 67:16:41:06 and 67:16:41:07;

    (4)  The treatment must be provided directly to the recipient or via collateral contact;

    (5)  The treatment must be documented in the recipient's clinical record in accordance with § 67:16:41:08; and

    (6)  The treatment must be medically necessary in accordance with § 67:16:01:06.02.

    If the requirements set forth in this section are not met, the department may determine that the mental health services are noncovered.

    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 requirements set forth in this section are met and the mental health provider has made a provisional diagnosis of a mental health disorder.

    Source: 22 SDR 6, effective July 26, 1995; 45 SDR 82, effective December 10, 2018; 49 SDR 21, effective September 12, 2022.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1(1)(2).