S.D. Admin. R. 67:16:41:09
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.
Mental health services and associated rates of payment are subject to review and amendment under § 67:16:01:28.
Payment for psychiatric therapeutic procedures is limited to those recipients who have been determined to have a primary diagnosis of a mental disorder 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.
Time units are for face-to-face or telehealth session times with the recipient or collateral contact and do not include time used for traveling, reporting, charting, or other administrative functions outside the scope of covered procedure codes.
The maximum allowable coverage for all psychotherapy services may not exceed 40 hours of therapy in a 12-month period unless prior authorized by the department. For purposes of this limit, procedure codes without an associated time will be considered one hour.
S.D. Admin. R. 67:16:41:09
General Authority: SDCL 28-6-1(1)(2)(4).
Law Implemented: SDCL 28-6-1, 28-6-1.1.