<html> <head> <title>Rule 67:16:47:04.04 Certification team -- Responsibilities.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:47:04.04"> <META NAME="Description" Content="Administrative Rules 67:16:47:04.04 Certification team -- Responsibilities."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 14 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} @font-face {font-family:Times; panose-1:0 0 0 0 0 0 0 0 0 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:Times;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><a name="_GoBack"></a><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:47:04.04.&nbsp;&nbsp;Certification team -- Responsibilities.</b> In order to meet the covered service conditions of subdivision 67:16:47:04(3), the certification team, based on medical documentation, must certify the existence of the following:</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;The individual requires intensive professional assistance and therapy for behavioral or emotional problems in the highly structured, self-contained environment of a residential treatment center, an intensive residential treatment center, or a psychiatric residential treatment facility;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;The services are medically necessary;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;The outpatient resources available in the community do not meet the individual's treatment needs;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp;The proper treatment for the individual's mental illness requires services on an inpatient basis under the direction of a physician;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (5)&nbsp;&nbsp;The individual has a diagnosis of one of the diagnoses listed in &#167;&nbsp;67:16:47:04.05 and is experiencing problems related to the diagnosis in one of the categories listed in &#167;&nbsp;67:16:47:04.06; has a history of a psychiatric diagnosis and is posing an imminent danger to self or others; or, in the absence of an identified psychiatric diagnosis, is exhibiting symptoms and behavior of such severity that it places the individual or others at risk and warrants residential treatment under the direction of a physician; and</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (6)&nbsp;&nbsp;The services can reasonably be expected to improve the individual's condition or prevent further regression so that the services will no longer be needed.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 34 SDR 180, effective December 26, 2007; 42 SDR 51, effective October 13, 2015.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&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'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=26-6-14">26-6-14</A>, <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'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-References:</b></span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Covered services must be medically necessary, &#167;&nbsp;67:16:01:06.02.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt'>&nbsp;</span></p> </div> </body> </html>