<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>p.s30a35534-f878-4e2f-beb6-ae2f74186b0aP0 { margin-top: 0; margin-bottom: 0; margin-left: 0; margin-right: 0; text-indent: 0.00in; text-align: center; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; } span.s30a35534-f878-4e2f-beb6-ae2f74186b0aC0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s30a35534-f878-4e2f-beb6-ae2f74186b0a000001 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } p.s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002 { 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.s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004 { 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="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0">CHAPTER </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000000">67:16:41</span></a></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0a000001"> </span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0">MENTAL HEALTH SERVICES BY INDEPENDENT PRACTITIONERS</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0a000001"> </span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0a000001"> </span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">Section</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:01"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:01</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Definitions.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:02"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:02</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Mental health service requirements.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:03"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:03</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Mental health provider.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:04"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:04</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Diagnostic assessment requirements.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:04.01"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:04.01</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">    Diagnostic assessment components.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:05"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:05</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Mental disorder diagnosis codes -- Limits.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:06"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:06</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Treatment plan requirements.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:07"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:07</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Treatment plan reviews.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:08"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:08</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Clinical record requirements.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:09"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:09</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Covered mental health services -- Limits -- Payments.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:10"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:10</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Noncovered services.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:11"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:11</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Prior authorization.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:12"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:12</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        </span><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">Repealed</span><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:13"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:13</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Claim requirements.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:14"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:14</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Billing requirements.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:15"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:15</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Utilization review.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:16"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:16</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Repealed.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:17"><span style="white-space: pre-wrap;" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000004">67:16:41:17</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aC0-000003">        Application of other chapters.</span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0a000001"> </span></p><p dir="ltr" class="s30a35534-f878-4e2f-beb6-ae2f74186b0aP0-000002"><span style="white-space: pre-wrap;" xml:space="preserve" class="s30a35534-f878-4e2f-beb6-ae2f74186b0a000001"> </span></p></div></body></html><br /><hr><br /><html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>p.s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0 { 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.s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003 { 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="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:01"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000000">67:16:41:01</span></a><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000001">.  Definitions.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">As</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> used in this chapter:</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (1)  "Certified social worker - </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">private, independent practice</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">an individual certified under SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=36-26-17"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">36-26-17</span></a><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (2)  "Certified social worker - </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">private, independent practice</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> candidate" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">an individual who is licensed as a certified social worker under SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=36-26-14"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">36-26-14</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> and is working toward</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">becoming a certified social worker - </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">private, independent practice</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> under an approved supervision agreement</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> as required</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">by</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">§</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> </span><a href="https://sdlegislature.gov/Rules?Rule=20:59:05:05"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">20:59:05:05</span></a><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (3)  </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">"Clinical nurse specialist" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">an individual who is licensed under SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=36-9-85"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">36-9-85</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> to perform the functions contained in SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=36-9-87"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">36-9-87</span></a><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (4)  "Collateral contact" means telephone or face-to-face contact with an individual, other than the recipient receiving treatment, to plan appropriate treatment, to assist others in responding therapeutically regarding the recipient's difficulty or illness, or to link the recipient, family, or both, to other necessary and therapeutic community support;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">5</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">)  "Diagnostic assessment" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">a written comprehensive evaluation of symptoms </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">that</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> indicate a diagnosis of a mental disorder and which meet the requirements of § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:04"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">67:16:41:04</span></a><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">6</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">)  "Family" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">a unit of two or more persons</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> related by blood or by past or present marriage. A family may also include other individuals living in the same household with the recipient, individuals who will reside in the home in the future, or individuals who reside elsewhere</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> if the individual's participation is necessary to accomplish treatment plan goals</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> and </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">the individual is</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> considered an essential and integral part of the family unit identified in the treatment plan;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">7</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">)  "Group" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">a unit of at least two</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> but no more than ten</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> individuals who, because of the commonality and the nature of their diagnoses, can derive mutual benefit from psychotherapy and </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">the therapy</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> can be demonstrated to be medically necessary for the individuals to jointly participate</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> in order to accomplish treatment plan goals through a group psychotherapy session;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">8</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">)  "Licensed professional counselor - mental health" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">an individual certified </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">under</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=36-32-65"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">36-32-</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">65</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> to </span><a href="https://sdlegislature.gov/Statutes?Statute=36-32-67"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">36-32-</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">67</span></a><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">, inclusive;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (9)  "Licensed professional counselor working toward a mental health designation" means an individual who is licensed as a licensed professional counselor under SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=36-32-64"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">36-32-64</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> and is working toward a mental health designation under the supervision required by SDCL subdivision </span><a href="https://sdlegislature.gov/Statutes?Statute=36-32-65"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">36-32-65</span></a><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">(4);</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (10)  "Licensed marriage and family therapist" means an individual licensed under SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=36-33-43"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">36-33-43</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> to </span><a href="https://sdlegislature.gov/Statutes?Statute=36-33-45"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">36-33-45</span></a><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">, inclusive;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">11</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">)  "Mental disorder" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">an organic disorder of the brain or a clinically significant disorder of thought, mood, perception, orientation, or behavior;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">12</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">)  "Mental health services" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">nonresidential psychiatric or psychological diagnostic and treatment that is goal-oriented and designed for the care and treatment of an individual having a primary diagnosis of a mental disorder;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">13</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">)  "Mental health treatment" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">goal-oriented therapy designed for the care and treatment of an individual having a primary diagnosis of a mental disorder;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (1</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">4</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">)  "Psychologist" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means, </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">for services provided in South Dakota, a person licensed under SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=36-27A-12"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">36-27A-12</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> or </span><a href="https://sdlegislature.gov/Statutes?Statute=36-27A-13"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">36-27A-13</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">; for services provided in another state, a person licensed as a psychologist in the state where the services are provided. For purposes of the medical assistance program, a person practicing under SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=36-27A-11"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">36-27A-11</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> is specifically excluded</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> from this definition</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (1</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">5</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">)  "Psychotherapy" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">the face-to-face </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">or telehealth </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">treatment of a recipient</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> through a psychological or psychiatric method. The treatment is a planned, structured program based on a primary diagnosis of mental disorder and is directed to influence and produce a response for a mental disorder and to accomplish measurable goals and objectives specified in the recipient's individual treatment plan;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (1</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">6</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">)  "Psychotherapy session" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">a planned and structured face-to-face </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">or telehealth </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">treatment episode between a mental health provider and one or more recipients;</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (17)  "Telehealth" means a method of delivering services, including interactive audio-visual or audio-only technology, in accordance with SDCL chapter </span><a href="https://sdlegislature.gov/Statutes?Statute=34-52"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">34-52</span></a><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">; and</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    (1</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">8</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">)  "Treatment plan" </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">means </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">a written, individual, and comprehensive plan </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">that</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> is based on the information and outcome of the recipient's diagnostic assessment and which is designed to improve the recipient's mental disorder.</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000001">Source:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> 22 SDR 6, effective July 26, 1995; 26 SDR 168, effective July 1, 2000; 37 SDR 53, effective September 23, 2010; 45 SDR 82, effective December 10, 2018</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">; 48 SDR 39, effective October 3, 2021</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">.</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000001">General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">(1)(2)(4)</span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">.</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">    </span><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000001">Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8C0">.</span></p><p dir="ltr" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s0784e63a-2eeb-448b-b29d-45b3c9da2dc8000002"> </span></p></div></body></html><br /><hr><br /><html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>p.s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0 { 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.s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000003 { 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="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:02"><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000000">67:16:41:02</span></a><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000001">.  Mental health service requirements.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> To be covered under this chapter, mental health services are limited to services </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">that are </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">established in this chapter </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">and</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> meet the following requirements:</span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8000002"> </span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">    (1)  The</span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">re must be a diagnostic assessment prepared by a</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> mental health provider </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">in accordance with</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:04"><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000003">67:16:41:04</span></a><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">;</span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">    (2)  The diagnostic assessment </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">must </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">contain a primary </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">mental health disorder </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">diagnosis </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">code set forth in</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:05"><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000003">67:16:41:05</span></a><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">;</span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">    (3)  The</span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">re must be an individual trreatment plan that is prepared by a</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> mental health provider </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">and</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> meets the requirements of §§ </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:06"><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000003">67:16:41:06</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> and </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:07"><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000003">67:16:41:07</span></a><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">;</span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">    (4)  The treatment </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">must be provided </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">directly to the recipient</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> or via collateral contact</span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">;</span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">    (5)  The treatment </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">must be</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> documented in the recipient's clinical record </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">in accordance with</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:08"><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000003">67:16:41:08</span></a><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">; and</span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">    (6)  The treatment </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">must be</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> medically necessary </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">in accordance with</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:06.02"><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000003">67:16:01:06.02</span></a><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">.</span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8000002"> </span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">    </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">If the</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> requirements </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">set forth in this section are not met, the department may determine that the mental health services are noncovered</span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">.</span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8000002"> </span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">    Mental health services may be provided to a recipient during the 30-day time period the mental health provider has to complete the diagnostic assessment, if the requirements set forth in this section are met and the mental health provider has made a provisional diagnosis of a mental health disorder.</span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8000002"> </span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">    </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000001">Source:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> 22 SDR 6, effective July 26, 1995; 45 SDR 82, effective December 10, 2018</span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">; 49 SDR 21, effective September 12, 2022</span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">.</span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">    </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000001">General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">.</span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">    </span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000001">Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">(1)(2)</span><span style="white-space: pre-wrap;" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8C0">.</span></p><p dir="ltr" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s8ce9a0b8-1cfe-4878-9a06-3da8f03defe8000002"> </span></p></div></body></html><br /><hr><br /><html> <head> <title>Rule 67:16:41:03 Mental health provider.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:41:03"> <META NAME="Description" Content="Administrative Rules 67:16:41:03 Mental health provider."> <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;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; text-align:justify; font-size:12.0pt; font-family:"Times New Roman",serif;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt;} @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 link=blue vlink=purple> <div class=WordSection1> <p class=MsoNormal>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:41:03.&nbsp;&nbsp;Mental health provider.</b> A mental health provider must be a psychologist, a licensed professional counselor - mental health, a licensed professional counselor working toward a mental health designation, a clinical nurse specialist, a certified social worker-PIP, a certified social worker - PIP candidate, or a licensed marriage and family therapist who has a signed provider agreement with the department to provide mental health services.</p> <p class=MsoNormal>&nbsp;</p> <p class=MsoNormal>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A mental health provider must have a National Provider Identification (NPI) number and may not provide services under another provider's medical assistance provider NPI number.</p> <p class=MsoNormal>&nbsp;</p> <p class=MsoNormal>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; An individual who does not meet the certification or licensure requirements of the applicable profession may not enroll as a mental health provider or participate in the delivery of mental health services.</p> <p class=MsoNormal>&nbsp;</p> <p class=MsoNormal>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 22 SDR 6, effective July 26, 1995; 26 SDR 168, effective July 1, 2000; 37 SDR 53, effective September 23, 2010; 40 SDR 122, effective January 7, 2014; 45 SDR 82, effective December 10, 2018.</p> <p class=MsoNormal>&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(1)(2)(4).</A></p> <p class=MsoNormal>&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(1)(2)(4).</A></p> <p class=MsoNormal>&nbsp;</p> <p class=MsoNormal>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-Reference:</b> Provider requirements, ch 67:16:33.</p> <p class=MsoNormal>&nbsp;</p> </div> </body> </html> <br /><hr><br /><html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>p.sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8P0 { 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.sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8000003 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0-000004 { 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="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:04"><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0-000000">67:16:41:04</span></a><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0-000001">.  Diagnostic assessment requirements.</span></p><p dir="ltr" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8000002"> </span></p><p dir="ltr" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">    A diagnostic assessment must be completed within 30 days of the recipient's first face-to-face or telehealth visit with a mental health provider. On-going assessment and identification of changes in the recipient's needs and strengths must occur throughout treatment and must be documented in progress notes or other clinical documentation. Three </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">face-to-face </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">or telehealth </span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">interview</span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">s</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0"> designed to assist in the formulation of a diagnostic assessment are covered. For children under 18 years of age, the mental</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0"> </span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">health staff shall obtain permission from the parent or legal guardian to meet with the child, and</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0"> </span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">at least one parent or legal guardian shall participate in the assessment. Psychiatric therapeutic procedures or psychiatric somatotherapy</span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0"> provided before the diagnostic assessment is completed</span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0"> are considered noncovered services.</span></p><p dir="ltr" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8000003"> </span></p><p dir="ltr" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">    </span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">The mental health provider must complete, sign, and date the diagnostic assessment before providing mental health treatment. The signature is a certification by the mental health provider that the findings of the diagnostic assessment are accurate. The certification date is the effective date of the diagnostic assessment.</span></p><p dir="ltr" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8000003"> </span></p><p dir="ltr" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">    </span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0-000001">Source:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0"> 22 SDR 6, effective July 26, 1995; 37 SDR 53, effective September 23, 2010</span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">; 46 SDR 50, effective October 10, 2019; 48 SDR 39, effective October 3, 2021</span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">.</span></p><p dir="ltr" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">    </span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0-000001">General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0-000004">28-6-1</span></a><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">(1)(2)</span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">.</span></p><p dir="ltr" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">    </span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0-000001">Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0-000004">28-6-1</span></a><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">.</span></p><p dir="ltr" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8000003"> </span></p><p dir="ltr" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">    </span><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0-000001">Cross-Reference:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0"> Clinical record requirements, § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:08"><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0-000004">67:16:41:08</span></a><span style="white-space: pre-wrap;" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8C0">.</span></p><p dir="ltr" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf1d5bbb2-5f93-451a-81c1-3763e7ab16b8000003"> </span></p></div></body></html><br /><hr><br /><html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>p.s46d3f22d-1eee-480b-8e68-f3885a95784aP0 { 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.s46d3f22d-1eee-480b-8e68-f3885a95784aC0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s46d3f22d-1eee-480b-8e68-f3885a95784a000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000003 { 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="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:04.01"><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000000">67</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000000">:</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000000">16</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000000">:</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000000">41</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000000">:</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000000">04.01</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000001">.  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000001">Diagnostic assessment components</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000001">.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0"> </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">A diagnostic assessment must include</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">:</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784a000002"> </span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">(1)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">A face-to-face or telehealth interview with the recipient</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (2)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Identification of the strengths of the recipient and the recipient's family, if appropriate; previous periods of success and the strengths that contributed to that success; and potential resources within the family, if applicable</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (3)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Presenting problems or issues that indicate a need for mental health services</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (4)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Identification of readiness for change for problem areas, including motivation and supports for making such changes</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (5)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Relevant family history, including family relationship dynamics and family psychiatric and substance abuse history</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (6)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Behavioral observations and an examination of the recipient's mental status, including a description of anomalies in the recipient's appearance, general behavior, motor activity, speech, alertness, mood, cognitive functioning, and attitude toward the symptoms</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (7)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Current substance use and relevant treatment history, including previous mental health and substance use disorder or gambling treatment and periods of success, psychiatric hospital admissions, psychotropic and other medications, relapse history or potential for relapse, physical illness, and hospitalization</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (8)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">A review of the records that pertain to the recipient's medical and social background and history, if available</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (9)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Contact with the recipient's relatives and significant others to the extent necessary to complete an accurate psychological evaluation for the purpose of writing the assessment report and developing the treatment plan</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (10)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Formulation of a diagnosis that is consistent with the findings of the evaluation of the recipient's condition, including documentation of co-occurring medical, developmental disability, mental health, substance use disorder or gambling issues, or a combination of these based on the diagnostic evaluation</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (11)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Educational history and needs, if applicable</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (12)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Legal issues, if applicable</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (13)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Living environment or housing, if applicable</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (14)  </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Safety needs and risks with regard to physical acting-out, health conditions, acute intoxication, or risk of withdrawal, if applicable</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">;</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (15)  Past or current indications of trauma, domestic violence, or both, if applicable; and</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    (16) </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Vocational and financial history and needs, if applicable</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">.</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784a000002"> </span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000001">Source:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0"> </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">48</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0"> SDR </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">39</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">, effective </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">October 3, 2021</span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">.</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000001">General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">(1)(2).</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    </span><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000001">Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">.</span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784a000002"> </span></p><p dir="ltr" class="s46d3f22d-1eee-480b-8e68-f3885a95784aP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000001">Cross-Reference: </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">Clinic record requirements, § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:08"><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0-000003">67:16:41:08</span></a><span style="white-space: pre-wrap;" class="s46d3f22d-1eee-480b-8e68-f3885a95784aC0">.</span></p></div></body></html><br /><hr><br /><html> <head> <title>Rule 67:16:41:05 Mental disorder diagnosis codes -- Limits.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:41:05"> <META NAME="Description" Content="Administrative Rules 67:16:41:05 Mental disorder diagnosis codes -- Limits."> <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;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:41:05.&nbsp;&nbsp;Mental disorder diagnosis codes -- Limits.</b> For purposes of this chapter, mental disorder diagnosis codes are limited to the diagnosis codes listed on the department's billing guidance website and contained in the ICD-10-CM adopted in &#167;&nbsp;67:16:01:26.</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> 22 SDR 6, effective July 26, 1995; 37 SDR 53, effective September 23, 2010; 42 SDR 51, effective October 13, 2015.</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></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> <br /><hr><br /><html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>p.s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0 { 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.s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s2bc6ab21-0667-4af2-8d99-9d98070ab0a4000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0-000003 { 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="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:06"><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0-000000">67:16:41:06</span></a><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0-000001">.  Treatment plan requirements.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> mental health provider </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">shall</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> develop a treatment plan for each recipient who is receiving medically</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">necessary</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> covered mental health treatment based on a primary diagnosis of a mental disorder. The plan must be relevant to the diagnosis, be developmentally appropriate, and relate to each covered mental health treatment to be delivered.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">The mental health provider shall document in the recipient's clinical file evidence</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> of participation by the recipient or the recipient's legal guardian and evidence of the recipient's meaningful involvement in formulating the plan.</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4000002"> </span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">The treatment plan must</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">:</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4000002"> </span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">(</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">1</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">)  Be developed jointly by the recipient, or</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> the recipient's</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> legal guardian, and the mental health provider who will be providing the covered mental health treatment;</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">        (2)  Be understandable by the recipient and the recipient's legal guardian, if applicable;</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    (</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">3</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">)  Include a list of other professionals known to be involved in the case;</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    (</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">4</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">)  Contain written</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> goals,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> objectives, or both, which are individualized, clear, specific,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">and measurable so that the recipient and the mental health provider can determine if progress has</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">been made</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> towards</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> the recipient's treatment goals;</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    (5</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">)  Be based on the findings of the diagnostic assessment and contain the recipient's mental disorder diagnosis code;</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    (</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">6</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">)  List the specific therapies</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">, interventions,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> and activities</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> that match the recipient's readiness for change for identified issues, and which are</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> prescribed for meeting the treatment goals;</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">(</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">7</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">)  Include the specific treatment goal</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">s</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> for improving the recipient's condition to a point of no longer needing mental health treatment; and</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    (</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">8</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">)  Include a specific schedule of treatment services including the prescribed frequency and duration of each mental health service to be provided to meet the treatment plan goal</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">s</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">.</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4000002"> </span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">The mental health provider must complete, sign, and date the treatment plan </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">within thirty days of intake</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">. The signature is a certification by the mental health provider that the treatment plan is accurate. The certification date is the effective date of the treatment plan.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> The provider shall give a copy of the treatment plan to the recipient and to the recipient's parent or guardian, if applicable.</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4000002"> </span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">Mental health treatment provided after thirty days of intake if a treatment plan has not been completed</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> is not covered.</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4000002"> </span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0-000001">Source:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> 22 SDR 6, effective July 26, 1995; 37 SDR 53, effective September 23, 2010; 46 SDR 50, effective October 10, 2019</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">; 48 SDR 39, effective October 3, 2021; 50 SDR 63, effective November 27, 2023</span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">.</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0-000001">General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">.</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0-000001">Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">.</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4000002"> </span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">    </span><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0-000001">Cross-Reference:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0"> Clinical record requirements, § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:08"><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0-000003">67:16:41:08</span></a><span style="white-space: pre-wrap;" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4C0">.</span></p><p dir="ltr" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s2bc6ab21-0667-4af2-8d99-9d98070ab0a4000002"> </span></p></div></body></html><br /><hr><br /><html> <head> <title>Rule 67:16:41:07 Treatment plan reviews.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:41:07"> <META NAME="Description" Content="Administrative Rules 67:16:41:07 Treatment plan reviews."> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Originator content="Microsoft Word 10"> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:41:07.&nbsp;&nbsp;Treatment plan reviews.</b> As long as mental health services continue, the mental health provider must review the recipient's treatment plan at least semiannually with the first review completed no later than six months from the effective date of the initial treatment plan. Each semiannual review must contain a written review of the progress made toward the established treatment goals, significant changes to the treatment goals, and a justification for continued mental health services. When there is a significant change in the recipient's treatment goals, the mental health provider must review the treatment plan and record the changes in the treatment plan.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; The mental health provider who conducted the review and prepared the written documentation must sign and date the documentation.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Covered mental health services provided without the required semiannual treatment plan review or without significant changes added into the treatment plan, as required in this section, are considered noncovered services.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 22 SDR 6, effective July 26, 1995.</font></p> <p><font size=3 face="Times New Roman">&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></font></p> <p><font size=3 face="Times New Roman">&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></font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-Reference:</b> Clinical record requirements, §&nbsp;67:16:41:08.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:41:08 Clinical record requirements.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:41:08"> <META NAME="Description" Content="Administrative Rules 67:16:41:08 Clinical record requirements."> <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;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt;} @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>67:16:41:08.&nbsp;&nbsp;Clinical record requirements.</b> The mental health provider must maintain the recipient's clinical record. In addition to the record requirements contained in chapter 67:16:34, the recipient's clinical record must contain the following information, including the related supporting clinical data:</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;Concise data on client history, including present illness and complaints, past psychological, social, and medical</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> history,</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> previous hospitalization and treatment, and a drug-use profile;</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; (2)&nbsp;&nbsp;A diagnostic assessment </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>t</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>h</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>at</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> meets the requirements of &#167;&nbsp;67:16:41:04;</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; (3)&nbsp;&nbsp;A treatment plan </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>t</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>h</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>at</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> meets the requirements of &#167;&nbsp;67:16:41:06;</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; (4)&nbsp;&nbsp;A chronological record of known psychotropic medications prescribed and dispensed;</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; (5)&nbsp;&nbsp;Documentation of treatment plan reviews required in &#167;&nbsp;67:16:41:07;</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; (6)&nbsp;&nbsp;The specific services provided together with the date and amount of time of delivery of each service provided;</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; (7)&nbsp;&nbsp;The signature or initials and credential of the mental health provider providing the service;</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; (8)&nbsp;&nbsp;The location of the setting in which the service was provided;</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; (9)&nbsp;&nbsp;The relationship of the service to the treatment plan objectives and goals;</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; (10)&nbsp;&nbsp;Progress or treatment notes, entered chronologically at each encounter of service, documenting and summarizing progress the recipient is making during a given period of time toward attaining the treatment objectives and goals; an assessment of the recipient's current symptoms; a report of procedures administered during the session; and a plan for the next treatment session; and</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; (11)&nbsp;&nbsp;When the treatment is complete</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>d</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> or discontinued, a discharge summary </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>t</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>h</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>at</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> relates to the treatment received and progress made in achieving the treatment goals. A discharge summary is not required when the recipient prematurely discontinues the treatment.</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; All entries within the required clinical record must be current, consistently organized, legible, signed or initialed, and dated by the mental health provider.</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> 22 SDR 6, effective July 26, 1995</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>; 46 SDR 50, effective October 10, 2019</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; <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)</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> <br /><hr><br /><html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>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 style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:09"><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0-000000">67:16:41:09</span></a><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0-000001">.  Covered mental health services -- Limits -- Payments.</span><span style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727000002"> </span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0-000003">67:16:01:28</span></a><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0">.</span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727000002"> </span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    Payment for psychiatric therapeutic procedures is limited to those recipients who have </span><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0">received</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> a primary diagnosis of a mental </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">health </span><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0">disorder</span><span style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0">.</span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727000002"> </span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    Time units are for face-to-face </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">or telehealth </span><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0">session times with the recipient</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> or a collateral contact</span><span style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">the </span><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0">covered procedure codes.</span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727000002"> </span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    </span><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0">T</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">he maximum allowable coverage for </span><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0">psychotherapy</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> services may not exceed 40 hours of therapy in a 12-month period</span><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0">, unless prior authorization has been received from the department</span><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0">.</span><span style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727000002"> </span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    </span><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0-000001">Source:</span><span style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" 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 style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    </span><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0-000001">General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0">.</span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">    </span><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0-000001">Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0">(1)(2)(4)</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727C0">, </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="s1f6487f5-968b-403a-bca3-50954459b727C0">.1.</span></p><p dir="ltr" class="s1f6487f5-968b-403a-bca3-50954459b727P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s1f6487f5-968b-403a-bca3-50954459b727000002"> </span></p></div></body></html><br /><hr><br /><html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>p.s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0 { 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.s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000003 { 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="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:10"><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000000">67:16:41:10</span></a><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000001">.  Noncovered services.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> The department does not cover and the provider may not submit a claim for:</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (1)  Mental health services not </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">defined in </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">§</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:01"><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000003">67:16:41:01</span></a><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (2)  Mental health treatment provided without the recipient physically present in a face-to-face session with the mental health provider</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">, except for telehealth treatment and collateral contact</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (3)  Treatment for a </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">mental health disorder</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> not </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">included in the diagnosis codes set forth</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> in § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:05"><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000003">67:16:41:05</span></a><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (4)  Mental health treatment provided before </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">a</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> diagnostic assessment is completed</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">, except treatment provided with a provisional diagnosis of a mental health disorder during the thirty-day time period the mental health provider has to complete the diagnostic assessment</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (5)  Mental health treatment provided after </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">thirty days from the date of intake</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> if a treatment plan has not been completed;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (6)  Mental health treatment provided if a required </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">treatment plan </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">review has not been completed;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (7)  Court appearance, staffing sessions, or treatment team appearances;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (8)  Mental health services provided to a recipient incarcerated in a correctional facility;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (9)  Mental health services provided to a recipient in an institution for mental diseases</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">or an inte</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">rm</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">ediate care facility for individuals with intellectual disabilities;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (10)  Mental health treatment </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">that</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> does not demonstrate a </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">reasonably timed </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">continuum of progress toward the specific goals stated in the treatment plan</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> as determined by the peer review entity;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (11)  Mental health treatment </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">that</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> is not listed in the treatment plan or documented in the recipient's clinical record</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> even though the service is allowable under this chapter;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (12)  Mental health treatment provided to a recipient who</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> is:</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (a)  I</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">ncapable of cognitive functioning due to age or mental incapacity</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">;</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> or</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (b)  U</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">nable to receive any benefit from the service;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (13)  Mental health services performed without relationship to evaluations or psychotherapy for a specific condition, symptom, or complaint;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (14)  Time spent preparing reports, treatment plans, or clinical records outside the scope of covered procedure codes;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (15)  A service designed to assist a recipient regulate a bodily function controlled by the autonomic nervous system</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> by using an instrument to monitor the function and signal the changes in the function;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (16)  Alcohol or drug rehabilitation therapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (17)  Missed or canceled appointments;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (18)  Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">members </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">or another responsible person;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (19)  Medical hypnotherapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (20)   Field trips and other off-site activities;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (21)  Consultations or meetings between an employer and employee;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (22)  Review of work product by the treating mental health provider;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (23)  Telephone consultations with or on behalf of the recipient</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">, except for collateral contact</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (24)  Educational, vocational, socialization, or recreational services</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> or components of services</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">including:</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (a)  Activity group therapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (b)  Assertiveness training;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (c)  Bioenergetics therapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (d)  Consciousness training;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (e)  Dance therapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (f)  Day care;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (g)  Educational activities;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (h)  Family counseling;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (i)  Growth groups or psychotherapy for nonspecific conditions of distress;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (j)  Guided imagery;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (k)  Marital counseling;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (l)  Marriage enrichment;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (m)  Milieu therapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (n)  Music therapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (o)  Obesity control therapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (p)  Occupational therapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (q)  Parental counseling or bonding;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (r)  Peer relations therapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (s)  Play observation;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (t)  Primal scream therapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (u)  Recorded psychotherapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (v)  Recreational therapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (w)  Religious counseling;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (x)  Rolfing or structural integration;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (y)  Sensitivity training;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (z)  Sex therapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (aa)  Sleep observation;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (bb)  Tape therapy;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (cc)  Training disability service;</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (dd)  Vocational counseling; and</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">        (ee)  Z-therapy; and</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    (25)  Mental health treatment delivered in excess of the frequency</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> prescribed</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> in the treatment plan.</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000001">Source:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> 22 SDR 6, effective July 26, 1995; 26 SDR 168, effective July 1, 2000; 37 SDR 53, effective September 23, 2010; 40 SDR 122, effective January 8, 2014</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">; 45 SDR 82, effective December 10, 2018</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">; 46 SDR 50, effective October 10, 2019; 48 SDR 39, effective October 3, 2021; 49 SDR 21, effective September 12, 2022; 50 SDR 63, effective November 27, 2023</span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">.</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000001">General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">.</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000001">Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">.</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    </span><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000001">Cross-References:</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">Treatment plan, § </span><a href="https://sdlegislature.gov/Rules?Rule=67:61:07:06"><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000003">67:61:07:06</span></a><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">.</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">Treatment plan, § </span><a href="https://sdlegislature.gov/Rules?Rule=67:62:08:07"><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000003">67:62:08:07</span></a><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">.</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">Treatment plan review -- Six month review, § </span><a href="https://sdlegislature.gov/Rules?Rule=67:62:08:08"><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0-000003">67:62:08:08</span></a><span style="white-space: pre-wrap;" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0C0">.</span></p><p dir="ltr" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s773f8e3b-f172-4ad8-a85c-0ad598de34f0000002"> </span></p></div></body></html><br /><hr><br /><html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 67:16:41:11 Prior authorization.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:41:11"> <META NAME="Description" Content="Administrative Rules 67:16:41:11 Prior authorization."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 10"> <meta name=Originator content="Microsoft Word 10"> <link rel=File-List href="6716410001100d_files/filelist.xml"> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Author>lrpr14533</o:Author> <o:LastAuthor>lrpr14296</o:LastAuthor> <o:Revision>2</o:Revision> <o:TotalTime>1</o:TotalTime> <o:Created>2010-09-27T15:01:00Z</o:Created> <o:LastSaved>2010-09-27T15:01:00Z</o:LastSaved> <o:Pages>1</o:Pages> <o:Words>149</o:Words> <o:Characters>851</o:Characters> <o:Company>State of South Dakota</o:Company> <o:Lines>7</o:Lines> <o:Paragraphs>1</o:Paragraphs> <o:CharactersWithSpaces>999</o:CharactersWithSpaces> <o:Version>10.6858</o:Version> </o:DocumentProperties> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:PunctuationKerning/> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--> <style> <!-- /* Font Definitions */ @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:536902279 -2147483648 8 0 511 0;} @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-1610611985 1073750139 0 0 159 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:Times; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style> <!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:Calibri;} </style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="2050"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> </head> <body lang=EN-US style='tab-interval:.5in'> <div class=Section1> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>67:16:41:11.&nbsp;&nbsp;Prior authorization.</b> A mental health provider must have prior authorization from the department before providing any treatment listed in &#167;&nbsp;67:16:41:09 which will exceed the limits established in this chapter. Authorization is based on documentation submitted to the department by the mental health provider. The documentation must include the provider's written treatment plan, the diagnosis, and the planned treatment. Failure to obtain approval from the department before providing the service is cause for the department to determine that the service is a noncovered service.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>The department may verbally authorize treatment; however, the department must verify a verbal authorization in writing before the services are paid.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Treatment which exceeds the established limits is subject to peer reviews according to &#167;&nbsp;67:16:41:15.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>Source:</b> 22 SDR 6, effective July 26, 1995; 37 SDR 53, effective September 23, 2010.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A><o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A><o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:41:12 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:41:12"> <META NAME="Description" Content="Administrative Rules 67:16:41:12 Repealed."> <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;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt;} @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>67:16:41:12.&nbsp;&nbsp;Handwritten originals required.</b> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>Repealed</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> 22 SDR 6, effective July 26, 1995; 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;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:41:13 Claim requirements.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:41:13"> <META NAME="Description" Content="Administrative Rules 67:16:41:13 Claim requirements."> <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;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:41:13.&nbsp;&nbsp;Claim requirements.</b> A claim for services provided under this chapter must be submitted on a form which contains the following information:</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;The recipient's full name;</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;The recipient's medical assistance identification number from the recipient's medical identification card;</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;Third-party liability information required under chapter 67:16:26;</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;Date of service;</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;Place of service;</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;The provider's usual and customary charge. The provider may not subtract other third-party or cost-sharing from this charge;</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;Units of service furnished, if more than one;</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;The applicable procedure codes contained in &#167; 67:16:41:09;</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; (9)&nbsp;&nbsp;The applicable diagnosis codes adopted in &#167; 67:16:01:26;</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;The provider's name and National Provider Identification (NPI) number; 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; (11)&nbsp;&nbsp;Type of service provided.</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> 22 SDR 6, effective July 26, 1995; 40 SDR 122, effective January 7, 2014; 42 SDR 51, effective October 13, 2015.</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></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>Cross-Reference:</b> Claims, ch 67:16:35.</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>Note:</b> The CMS 1500 form substantially meets the requirements of this rule and its content and appearance are acceptable to the department. These forms are available for direct purchase through the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402. (202) 783-3238 - pricing desk.</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> <br /><hr><br /><html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>p.sc9812c6e-922e-42ec-b8e2-5acfe128885cP0 { 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.sc9812c6e-922e-42ec-b8e2-5acfe128885cC0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc9812c6e-922e-42ec-b8e2-5acfe128885c000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000003 { 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="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:14"><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000000">67:16:41:14</span></a><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000001">.  Billing requirements.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> The following </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">requirements </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">apply to services billed under this chapter:</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (1)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">Each</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim must contain the medical assistance provider identification number of the individual delivering the service;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (2)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">may not be submitted </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">for a diagnostic assessment </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">t</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">h</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">at</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> exceeds four hours</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> unless there has been a break of at least 12 months in the delivery of mental health treatment to the recipient;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (3)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">may not be submitted </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">for a diagnostic assessment until the assessment is completed and recorded in the recipient's clinical record;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (4)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">may not be submitted </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">for mental health treatment provided before the diagnostic assessment is completed</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">, except for treatment provided with a provisional diagnosis of a mental health disorder during the 30-day time period the mental health provider has to complete the diagnostic assessment</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (5)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">may not be submitted </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">for mental health services provided after the fourth face-to-face </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">or telehealth </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">session with</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> the</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> recipient and before the effective date of the treatment plan;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (6)  If a psychotherapy session is provided to more than one individual</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> the</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">service must be billed as family or group psychotherapy, whichever is appropriate, even if the</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">individual is the only one eligible for the medical assistance program;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (7)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">I</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">f a recipient is involved in a psychotherapy session only as part of a family or group session for </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">the </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">treatment of another family member who is a mental health client</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">, a claim for the session may not be submitted for that recipient</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (8)  Except for a psychiatric diagnostic interview examination and a diagnostic assessment, a claim </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">may not be submitted </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">for mental health treatment</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">unless</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> the recipient </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">has</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> a primary diagnosis of a mental </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">health </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">disorder; and</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (9)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">may be submitted </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">for each eligible recipient</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> who is</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> in a family or group psychotherapy session </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">and</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> is actively receiving psychotherapy</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">, if</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> each family or group member for whom services are billed to the medical assistance program ha</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">s</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> a complete clinical record </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">t</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">h</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">at</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> meets the requirements of § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:08"><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000003">67:16:41:0</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000003">8</span></a><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">.</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> provider </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">shall</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> submit claims at the provider's usual and customary charge</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim may contain only those procedure codes listed </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">on the department's fee schedule website</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">.</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000001">Source:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> 22 SDR 6, effective July 26, 1995; 26 SDR 168, effective July 1, 2000; 37 SDR 53, effective September 23, 2010; 46 SDR 50, effective October 10, 2019</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">; 48 SDR 39, effective October 3, 2021; 49 SDR 21, effective September 12, 2022</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">.</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000001">General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">.</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000001">Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">(1)(2)</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">.</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p></div></body></html><br /><hr><br /><html> <head> <title>Rule 67:16:41:15 Utilization review.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:41:15"> <META NAME="Description" Content="Administrative Rules 67:16:41:15 Utilization review."> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Originator content="Microsoft Word 10"> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:41:15.&nbsp;&nbsp;Utilization review.</b> Utilization review may be conducted on the following levels:</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;Computerized claim processing;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;Postpayment review; and</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;Peer review.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A peer review entity appointed by the department shall review claims to determine and ensure the appropriate quality, quantity, and medical necessity of mental health services provided.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 22 SDR 6, effective July 26, 1995.</font></p> <p><font size=3 face="Times New Roman">&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></font></p> <p><font size=3 face="Times New Roman">&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></font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:41:16 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:41:16"> <META NAME="Description" Content="Administrative Rules 67:16:41:16 Repealed."> <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;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:41:16.&nbsp;&nbsp;Cost sharing.</b> Repealed.</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> 22 SDR 6, effective July 26, 1995; 31 SDR 191, effective June 8, 2005; 42 SDR 51, effective October 13, 2015.</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> <br /><hr><br /><html> <head> <title>Rule 67:16:41:17 Application of other chapters.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:41:17"> <META NAME="Description" Content="Administrative Rules 67:16:41:17 Application of other chapters."> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Originator content="Microsoft Word 10"> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:41:17.&nbsp;&nbsp;Application of other chapters.</b> In addition to the rules contained in this chapter, providers and recipients must meet the requirements of chapters 67:16:01, 67:16:26, 67:16:33, 67:16:34, 67:16:35, and if applicable, 67:16:39.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 22 SDR 6, effective July 26, 1995.</font></p> <p><font size=3 face="Times New Roman">&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></font></p> <p><font size=3 face="Times New Roman">&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></font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html>