S.D. Admin. R. 67:16:47:04.04

Current through Register Vol. 51, page 54, October 28, 2024

Section 67:16:47:04.04 - Certification team - Responsibilities

In order to meet the covered service conditions of subdivision 67:16:47:04(3), the certification team, based on medical documentation, must certify the existence of the following:

(1) The individual requires intensive professional assistance and therapy for behavioral or emotional problems in the highly structured, self-contained environment of a residential treatment center, an intensive residential treatment center, or a psychiatric residential treatment facility;

(2) The services are medically necessary;

(3) The outpatient resources available in the community do not meet the individual's treatment needs;

(4) The proper treatment for the individual's mental illness requires services on an inpatient basis under the direction of a physician;

(5) The individual has a diagnosis of one of the diagnoses listed in § 67:16:47:04.05 and is experiencing problems related to the diagnosis in one of the categories listed in § 67:16:47:04.06; has a history of a psychiatric diagnosis and is posing an imminent danger to self or others; or, in the absence of an identified psychiatric diagnosis, is exhibiting symptoms and behavior of such severity that it places the individual or others at risk and warrants residential treatment under the direction of a physician; and

(6) The services can reasonably be expected to improve the individual's condition or prevent further regression so that the services will no longer be needed.

S.D. Admin. R. 67:16:47:04.04

34 SDR 180, effective 12/26/2007; 42 SDR 51, effective 10/13/2015

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 26-6-14, 28-6-1.

Covered services must be medically necessary, § 67:16:01:06.02.