67:62:15:03.  Level II review exemptions. An individual is exempt from a Level II review if:

    (1)  The diagnosis of mental illness is unsubstantiated;

    (2)  The individual is readmitted to a Medicaid certified swing bed or nursing facility from a hospital to which the individual was transferred for the purpose of receiving care;

    (3)  The individual is transferred from one Medicaid certified swing bed or nursing facility to another, and a preadmission screening and resident review has previously been completed;

    (4)  The physician identifies the need for convalescent care following hospitalization for a duration of less than one hundred days;

    (5)  The physician orders a respite stay of thirty days or less;

    (6)  The individual has a diagnosis of situational depression that:

        (a)  Is of short duration;

        (b)  Is in direct relation to an occurrence in an individual's life; and

        (c)  Does not appear to be a chronic disability;

    (7)  The individual is using psychotropic medication in the absence of a major mental illness diagnosis; or

    (8)  The individual has a diagnosis of an anxiety disorder that is not identified as severe and does not appear to be leading to a chronic disability.

    The department shall complete a Level I screening form to notify appropriate parties of the determination of the exemption.

    Source: 43 SDR 80, effective December 5, 2016; 50 SDR 63, effective November 27, 2023.

    General Authority: SDCL 1-36-25.

    Law Implemented: SDCL 1-36-25.