<html> <head> <title>Rule 67:16:48:03 Services not covered.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:48:03"> <META NAME="Description" Content="Administrative Rules 67:16:48:03 Services not covered."> <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:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin-top:0in; margin-right:0in; margin-bottom:10.0pt; margin-left:0in; line-height:115%; font-size:11.0pt; font-family:"Calibri",sans-serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-family:"Calibri",sans-serif; color:black;} .MsoPapDefault {margin-bottom:10.0pt; line-height:115%;} @page WordSection1 {size:8.5in 11.0in; margin:49.7pt 1.0in 49.7pt 63.35pt;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>67</span></b><b><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>:</span></b><b><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>16</span></b><b><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>:</span></b><b><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>48</span></b><b><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>:</span></b><b><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>03</span></b><b><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.&nbsp;&nbsp;Services not covered.</span></b><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> The following services are not covered under the</span><span style='font-size: 12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size: 12.0pt;font-family:"Times New Roman",serif'>provisions of this chapter:</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>Treatment for a diagnosis of substance use disorder that exceeds the limits established</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>by the division, unless prior authorization is approved by the division;</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>Out-of-state substance use disorder treatment unless the division determines that</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>appropriate in-state treatment is not available;</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>3</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>Treatment for a gambling disorder</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>;</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp;Room and board for residential services;</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (5)&nbsp;&nbsp;Substance use disorder treatment before the integrated assessment is completed;</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (6)&nbsp;&nbsp;Substance use disorder treatment after 30 days if the treatment plan has not been completed;</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (7)&nbsp;&nbsp;Substance use disorder treatment if a required review has not been completed;</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (8)&nbsp;&nbsp;Court appearances, staffing sessions, or treatment team appearances; and</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (9)&nbsp;&nbsp;Substance use disorder services provided to a recipient incarcerated in a correctional facility</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>43</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> SDR </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>80</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>, effective </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>December 5, 2016</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>; 44 SDR 192, effective July 2, 2018.</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><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 </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>28</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>-</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>6</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>-</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>1(1)(4).</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><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)(4)</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'>.</span></p> <p class=MsoNormal><span style='font-size:12.0pt;line-height:115%;font-family: "Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html>