<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.s1f6487f5-968b-403a-bca3-50954459b727P0 { margin-top: 0; margin-bottom: 0; margin-left: 0; margin-right: 0; text-indent: 0.00in; text-align: justify; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; } span.s1f6487f5-968b-403a-bca3-50954459b727C0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s1f6487f5-968b-403a-bca3-50954459b727C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s1f6487f5-968b-403a-bca3-50954459b727C0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s1f6487f5-968b-403a-bca3-50954459b727000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s1f6487f5-968b-403a-bca3-50954459b727C0-000003 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:09"><span class="s1f6487f5-968b-403a-bca3-50954459b727C0-000000">67:16:41:09</span></a><span class="s1f6487f5-968b-403a-bca3-50954459b727C0-000001">.  Covered mental health services -- Limits -- Payments.</span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> Payment for mental health services is the lesser of the provider's usual and customary charge or the fee listed on the department's fee schedule website. If no fee is listed, payment is 40 percent of the provider's usual and customary charge.</span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727000002"> </span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    Mental health services and associated rates of payment are subject to review and amendment under § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:28"><span class="s1f6487f5-968b-403a-bca3-50954459b727C0-000003">67:16:01:28</span></a><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">.</span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727000002"> </span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    Payment for psychiatric therapeutic procedures is limited to those recipients who have </span><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">received</span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> a primary diagnosis of a mental </span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">health </span><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">disorder</span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> or a provisional diagnosis of a mental health disorder during the 30-day time period that the mental health provider has to complete the diagnostic assessment</span><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">.</span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727000002"> </span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    Time units are for face-to-face </span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">or telehealth </span><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">session times with the recipient</span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> or a collateral contact</span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> and do not include time used for traveling, reporting, charting, or other administrative functions outside the scope of </span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">the </span><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">covered procedure codes.</span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727000002"> </span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    </span><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">T</span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">he maximum allowable coverage for </span><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">psychotherapy</span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> services may not exceed 40 hours of therapy in a 12-month period</span><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">, unless prior authorization has been received from the department</span><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">.</span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> For purposes of this limit, procedure codes without an associated time are considered to be one hour.</span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727000002"> </span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    </span><span class="s1f6487f5-968b-403a-bca3-50954459b727C0-000001">Source:</span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> 22 SDR 6, effective July 26, 1995; 25 SDR 104, effective February 17, 1999; 35 SDR 49, effective September 10, 2008; 37 SDR 53, effective September 23, 2010; 42 SDR 51, effective October 13, 2015; 45 SDR 82, effective December 10, 2018</span><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">; 48 SDR 39, effective October 3, 2021; 49 SDR 21, effective September 12, 2022.</span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    </span><span class="s1f6487f5-968b-403a-bca3-50954459b727C0-000001">General Authority:</span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s1f6487f5-968b-403a-bca3-50954459b727C0-000003">28-6-1</span></a><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">.</span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    </span><span class="s1f6487f5-968b-403a-bca3-50954459b727C0-000001">Law Implemented:</span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s1f6487f5-968b-403a-bca3-50954459b727C0-000003">28-6-1</span></a><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">(1)(2)(4)</span><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">, </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s1f6487f5-968b-403a-bca3-50954459b727C0-000003">28-6-1</span></a><span class="s1f6487f5-968b-403a-bca3-50954459b727C0">.1.</span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727000002"> </span></p></div></body></html>