S.D. Admin. R. 67:16:40:07

Current through Register Vol. 51, page 57, November 12, 2024

Section 67:16:40:07 - Admission requirements - Psychiatric care

An individual's psychiatric care is a covered service under this chapter if the hospital received authorization for the admission under § 67:16:40:04 and the following conditions are met:

(1) A physician or other licensed practitioner completed a medical assessment of the individual and had at least a telephone consultation with a psychiatrist. The psychiatric consultation or diagnosis must include a treatable mental health condition. An admission is not allowed on the basis of a previous diagnosis if symptoms associated with the diagnosis are not active at the time of the admission;

(2) Outpatient services have failed or are not available in the community, or available services do not meet the treatment needs of the individual;

(3) Treatment of the individual's psychiatric condition requires services on an inpatient basis under the direction of a physician or other licensed practitioner, and there is an expectation that the individual will improve with psychiatric treatment of less than ten days;

(4) Inpatient services are expected to improve the individual's condition or prevent further regression so that the inpatient services will no longer be needed; and

(5) The individual meets one of the following criteria:

(a) Exhibits behavior which supports a reasonable expectation that the individual will inflict serious physical injury upon himself or others in the very near future, including a recently expressed threat which, if considered in light of its context or in light of the individual's recent previous acts, is substantially supportive of an expectation that the threat will be carried out;

(b) Exhibits psychotic behavior with hallucinations or delusions;

(c) Is admitted under the provisions of SDCL 27A-10-1 and 27A-10-2 for a 24-hour hold for an evaluation; or

(d) Experiences reactions or intolerances to medications which cannot be managed in an outpatient or medical floor setting.

S.D. Admin. R. 67:16:40:07

21 SDR 123, effective 1/19/1995; 44 SDR 94, effective 12/4/2017

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1(1)(2).