<html> <head> <title>Rule 67:16:39:11 Exempt services.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:39:11"> <META NAME="Description" Content="Administrative Rules 67:16:39:11 Exempt services."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} @font-face {font-family:Tahoma; panose-1:2 11 6 4 3 5 4 4 2 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline;} p.MsoAcetate, li.MsoAcetate, div.MsoAcetate {mso-style-link:"Balloon Text Char"; margin:0in; margin-bottom:.0001pt; font-size:8.0pt; font-family:"Tahoma",serif; color:black;} span.BalloonTextChar {mso-style-name:"Balloon Text Char"; mso-style-link:"Balloon Text"; font-family:"Tahoma",serif;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink=purple> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:39:11.&nbsp;&nbsp;Exempt services.</b> The following medically necessary covered services are exempt from this chapter:</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;Family planning services;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;Emergency services as defined in chapter 67:16:01;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;Dental services listed in chapter 67:16:06;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp;Podiatric services listed in chapter 67:16:07;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (5)&nbsp;&nbsp;Optometric and optical services listed in chapter 67:16:08;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (6)&nbsp;&nbsp;Chiropractic services listed in chapter 67:16:09;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (7)&nbsp;&nbsp;Immunization, home-based therapy, dental, orthodontic, and chemical dependency treatment services listed in chapter 67:16:11;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (8)&nbsp;&nbsp;Mental health services for individuals who are diagnosed </span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>with a serious emotional disturbance,</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> as defined in &#167;&nbsp;6</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>7</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>:</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>6</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>2:1</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>1</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>:0</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>1,</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> or</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> a</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>serious mental illness,</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> as defined in &#167;&nbsp;6</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>7</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>:</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>6</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>2:12:0</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>1</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (9)&nbsp;&nbsp;Prescription drug services listed in chapter 67:16:14;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (10)&nbsp;&nbsp;Personal care services listed in chapter 67:16:24;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (11)&nbsp;&nbsp;Transportation services listed in chapter 67:16:25</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>; and</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (12)&nbsp;&nbsp;Four urgent care visits per year, per recipient</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 20 SDR 135, effective February 22, 1994; 30 SDR 115, effective February 4, 2004; 35 SDR 253, effective May 12, 2009</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>; 43 SDR 80, effective December 5, 2016</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>; 46 SDR 50, effective October 10, 2019.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A></span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)(4)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html>