<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>