67:16:41:11.  Prior authorization. A mental health provider must have prior authorization from the department before providing any treatment listed in § 67:16:41:09 which will exceed the limits established in this chapter. Authorization is based on documentation submitted to the department by the mental health provider. The documentation must include the provider's written treatment plan, the diagnosis, and the planned treatment. Failure to obtain approval from the department before providing the service is cause for the department to determine that the service is a noncovered service.

          The department may verbally authorize treatment; however, the department must verify a verbal authorization in writing before the services are paid.

          Treatment which exceeds the established limits is subject to peer reviews according to § 67:16:41:15.

          Source: 22 SDR 6, effective July 26, 1995; 37 SDR 53, effective September 23, 2010.

          General Authority: SDCL 28-6-1.

          Law Implemented: SDCL 28-6-1.