67:16:41:10.  Noncovered services. The department does not cover and the provider may not submit a claim for:

    (1)  Mental health services not defined in § 67:16:41:01;

    (2)  Mental health treatment provided without the recipient physically present in a face-to-face session with the mental health provider, except for telehealth treatment and collateral contact;

    (3)  Treatment for a mental health disorder not included in the diagnosis codes set forth in § 67:16:41:05;

    (4)  Mental health treatment provided before a diagnostic assessment is completed, except treatment provided with a provisional diagnosis of a mental health disorder during the thirty-day time period the mental health provider has to complete the diagnostic assessment;

    (5)  Mental health treatment provided after thirty days from the date of intake, if a treatment plan has not been completed;

    (6)  Mental health treatment provided if a required treatment plan review has not been completed;

    (7)  Court appearance, staffing sessions, or treatment team appearances;

    (8)  Mental health services provided to a recipient incarcerated in a correctional facility;

    (9)  Mental health services provided to a recipient in an institution for mental diseases or an intermediate care facility for individuals with intellectual disabilities;

    (10)  Mental health treatment that does not demonstrate a reasonably timed continuum of progress toward the specific goals stated in the treatment plan, as determined by the peer review entity;

    (11)  Mental health treatment that is not listed in the treatment plan or documented in the recipient's clinical record, even though the service is allowable under this chapter;

    (12)  Mental health treatment provided to a recipient who is:

        (a)  Incapable of cognitive functioning due to age or mental incapacity; or

        (b)  Unable to receive any benefit from the service;

    (13)  Mental health services performed without relationship to evaluations or psychotherapy for a specific condition, symptom, or complaint;

    (14)  Time spent preparing reports, treatment plans, or clinical records outside the scope of covered procedure codes;

    (15)  A service designed to assist a recipient regulate a bodily function controlled by the autonomic nervous system, by using an instrument to monitor the function and signal the changes in the function;

    (16)  Alcohol or drug rehabilitation therapy;

    (17)  Missed or canceled appointments;

    (18)  Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family members or another responsible person;

    (19)  Medical hypnotherapy;

    (20)   Field trips and other off-site activities;

    (21)  Consultations or meetings between an employer and employee;

    (22)  Review of work product by the treating mental health provider;

    (23)  Telephone consultations with or on behalf of the recipient, except for collateral contact;

    (24)  Educational, vocational, socialization, or recreational services, or components of services, including:

        (a)  Activity group therapy;

        (b)  Assertiveness training;

        (c)  Bioenergetics therapy;

        (d)  Consciousness training;

        (e)  Dance therapy;

        (f)  Day care;

        (g)  Educational activities;

        (h)  Family counseling;

        (i)  Growth groups or psychotherapy for nonspecific conditions of distress;

        (j)  Guided imagery;

        (k)  Marital counseling;

        (l)  Marriage enrichment;

        (m)  Milieu therapy;

        (n)  Music therapy;

        (o)  Obesity control therapy;

        (p)  Occupational therapy;

        (q)  Parental counseling or bonding;

        (r)  Peer relations therapy;

        (s)  Play observation;

        (t)  Primal scream therapy;

        (u)  Recorded psychotherapy;

        (v)  Recreational therapy;

        (w)  Religious counseling;

        (x)  Rolfing or structural integration;

        (y)  Sensitivity training;

        (z)  Sex therapy;

        (aa)  Sleep observation;

        (bb)  Tape therapy;

        (cc)  Training disability service;

        (dd)  Vocational counseling; and

        (ee)  Z-therapy; and

    (25)  Mental health treatment delivered in excess of the frequency prescribed in the treatment plan.

    Source: 22 SDR 6, effective July 26, 1995; 26 SDR 168, effective July 1, 2000; 37 SDR 53, effective September 23, 2010; 40 SDR 122, effective January 8, 2014; 45 SDR 82, effective December 10, 2018; 46 SDR 50, effective October 10, 2019; 48 SDR 39, effective October 3, 2021; 49 SDR 21, effective September 12, 2022; 50 SDR 63, effective November 27, 2023.

    General Authority: SDCL 28-6-1.

    Law Implemented: SDCL 28-6-1.

    Cross-References:

    Treatment plan, § 67:61:07:06.

    Treatment plan, § 67:62:08:07.

    Treatment plan review -- Six month review, § 67:62:08:08.