S.D. Admin. R. 67:16:48:06

Current through Register Vol. 51, page 67, December 16, 2024

Section 67:16:48:06 - Prior authorization for psychiatric residential treatment programs for substance use disorders

The requirements for prior authorization of a psychiatric residential treatment program for a substance use disorder are as follows:

(1) An addiction counselor completes an integrated assessment, the assessment indicates a diagnosis of a substance use disorder, and the addiction counselor determines the adolescent meets the criteria for placement in, transfer to, or continued stay in a substance use disorder treatment program;

(2) A physician or other licensed practitioner refers the adolescent for placement in, transfer to, or continued stay in a substance use disorder treatment program;

(3) The division authorizes the treatment; and

(4) The certification team, based on medical documentation, determines the treatment is medically necessary and meets the requirements listed in 42 CFR 441.152, as amended to July 1, 2016. The certification team shall notify the division of their determination that medical necessity has been met or if the adolescent does not meet the severity of illness criteria.

S.D. Admin. R. 67:16:48:06

43 SDR 80, effective 12/5/2016; 44 SDR 94, effective 12/4/2017

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1(1)(2)(4).

Treatment for an adolescent with a substance use disorder --Out-of-state, § 67:16:48:08.