CHAPTER 67:61:18
MEDICALLY-MONITORED INTENSIVE INPATIENT
TREATMENT PROGRAM
Section
67:61:18:01 Eligibility criteria.
67:61:18:02 Medical evaluations and vital signs.
67:61:18:03 Availability of medical director.
67:61:18:04 Services provided.
67:61:18:05 Intensity of services.
67:61:18:06 Reimbursable services.
67:61:18:07 Nonreimbursable services.
67:61:18:01. Eligibility criteria. To be eligible for medically-monitored, inpatient treatment:
(1) The client must be experiencing moderate to severe withdrawal or is at risk of severe withdrawal based on previous withdrawal history; the client's continued substance use causes imminent risk to biomedical conditions; or the client's continued substance use causes imminent risk to emotional, behavioral, and cognitive conditions; and
(2) The client requires intensive monitoring and support to promote progress through the stages of change; the client is in immediate danger of continued severe substance use or relapse and such behaviors present significant risk of serious adverse consequences to the client or to others; or the client's recovery environment poses a threat to safety or engagement in treatment or both.
Source: 43 SDR 80, effective December 5, 2016; 50 SDR 63, effective November 27, 2023.
General Authority: SDCL 1-36-25, 34-20A-27.
Law Implemented: SDCL 34-20A-27.
67:61:18:02. Medical evaluations and vital signs. A medically-monitored, inpatient treatment program must meet the following requirements:
(1) At the time of admission, each client's blood pressure, pulse, and respiration must be evaluated by staff trained to perform these tests and recorded in the client's case record;
(2) Within eight hours after admission, each client must receive a medical evaluation conducted by a registered nurse or a licensed practical nurse. The results of this medical evaluation must be provided to the program physician. The program physician shall assess whether the client needs an immediate and more extensive examination before determining the appropriateness of the admission. The program physician's approval must be documented in the client's case record.
The medical evaluation requires:
(a) A second reading of the client's blood pressure, pulse, and respiration;
(b) An assessment of the client's mental and emotional status;
(c) The identification of bruises, lacerations, cuts, wounds, and other medical conditions;
(d) Documentation of current medication use and medications being carried by the client; and
(e) Documentation regarding any history of diabetes; seizure disorders, including epilepsy; delirium tremens; and any history of having undergone convulsive therapies; and
(3) Within seventy-two hours after admission, the program must have completed the client's blood count and urinalysis tests and provided the client with a complete physical examination by, or under the supervision of, a licensed physician, who shall also evaluate the results of the tests conducted.
Source: 43 SDR 80, effective December 5, 2016; 50 SDR 63, effective November 27, 2023.
General Authority: SDCL 34-20A-27.
Law Implemented: SDCL 34-20A-27(1)(4)(6).
67:61:18:03. Availability of medical director. An agency's medically-monitored, inpatient treatment program must have a written agreement with a licensed physician, physician assistant, or certified nurse practitioner to serve as the medical director, or employ a licensed physician who is primarily responsible for providing medical care to the clients to serve as the medical director. The medical director's responsibilities to the medically-monitored, inpatient treatment program are:
(1) Providing advice on health-related policies and issues;
(2) Providing emergency medical care to admitted clients;
(3) Supervising the performance of the medical examination and laboratory tests required upon the client's admission to the program; and
(4) Supervising the medical treatment provided to the clients.
Source: 43 SDR 80, effective December 5, 2016; 50 SDR 63, effective November 27, 2023.
General Authority: SDCL 1-36-25, 34-20A-27.
Law Implemented: SDCL 34-20A-27.
67:61:18:04. Services provided. The medically-monitored, inpatient treatment program must provide:
(1) An integrated assessment, pursuant to § 67:61:07:05;
(2) Individual, group, and family counseling providing:
(a) Education regarding alcohol and drug abuse and dependence, including the biomedical effects of drug and alcohol use and abuse and the importance of medical care and treatment in recovery; and
(b) Education regarding tuberculosis and the human immunodeficiency virus, how each is transmitted, and how to safeguard against transmission;
(3) Housing and dietary services;
(4) Education programing for adolescent clients;
(5) Recreation and leisure time activities for adolescent clients;
(6) Medical care, including tuberculosis and human immunodeficiency virus services, pursuant to 42 U.S.C. § 300x-24, in effect on December 13, 2016; and
(7) Discharge planning providing:
(a) Continued care planning and counseling;
(b) Referral to and coordination of care with other resources that will assist a client's recovery, including education, vocational, medical, legal, social, mental health, employment, and other related alcohol and drug services; and
(c) Referral to and coordination of medical services, including information detailing the availability of tuberculosis and human immunodeficiency virus services pursuant to 42 U.S.C. § 300x-24, in effect on December 13, 2016.
Source: 43 SDR 80, effective December 5, 2016; 50 SDR 63, effective November 27, 2023.
General Authority: SDCL 1-36-25, 34-20A-27.
Law Implemented: SDCL 34-20A-27.
67:61:18:05. Intensity of services. A medically-monitored, intensive inpatient treatment program for adults must provide daily, to each client, a combination of individual, group, or family counseling, which must total a minimum of twenty-one hours per week.
The program must provide a minimum of nine hours of additional services on specialized topics that address the specific needs of the client. The additional services must be identified on the client's treatment plan or continued stay review. These services must be provided by an individual trained in the specific topic presented.
A medically-monitored, intensive inpatient treatment program for adolescent clients must include at least fifteen hours per week of any combination of individual, group, or family counseling services.
Source: 43 SDR 80, effective December 5, 2016; 50 SDR 63, effective November 27, 2023.
General Authority: SDCL 1-36-25, 34-20A-27.
Law Implemented: SDCL 34-20A-27
67:61:18:06. Reimbursable services. Reimbursable medically-monitored, intensive inpatient treatment program services are limited to face-to-face contacts for the purpose of providing services, pursuant to § 67:61:18:04. Services are reimbursed through a per diem rate and are not eligible to be reimbursed through a fifteen-minute unit.
Documentation that the client was at the facility at the time of the daily census must be available to support billing.
Reimbursable services for eligible Medicaid clients are limited to services provided under chapter 67:16:48.
Source: 43 SDR 80, effective December 5, 2016; 50 SDR 63, effective November 27, 2023.
General Authority: SDCL 1-36-25, 34-20A-27.
Law Implemented: SDCL 34-20A-27.
67:61:18:07. Nonreimbursable services. The following are nonreimbursable under this chapter:
(1) Billing for a client that exceeds the accredited bed capacity established by the department;
(2) Driving under the influence and driving while intoxicated education courses;
(3) Services that are solely recreational in nature;
(4) Time spent preparing paperwork from client assessments or clinical documentation;
(5) Time spent traveling; and
(6) Community twelve-step programs.
Source: 43 SDR 80, effective December 5, 2016; 50 SDR 63, effective November 27, 2023.
General Authority: SDCL 1-36-25, 34-20A-27.
Law Implemented: SDCL 34-20A-27.
