S.D. Admin. R. 67:54:05:05

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

Section 67:54:05:05 - Determination of need for specialized psychiatric services

The utilization control team shall determine the individual's need for specialized psychiatric services. The determination must be based on the following criteria:

(1) A comprehensive history and physical examination of the person, including a complete medical history, a review of all body systems, and a specific evaluation of the person's neurological system in the areas of motor function, sensory functioning, gait, deep tendon reflexes, cranial nerves, and abnormal reflexes and, in the case of abnormal findings which are the basis for the determination of the need for nursing facility placement, additional evaluations conducted by appropriate specialists;

(2) A comprehensive drug history including current or immediate past use of medications that could mask symptoms or mimic mental illness;

(3) A psychosocial evaluation of the person, including current living arrangements and medical and support systems;

(4) A comprehensive psychiatric evaluation including a complete psychiatric history; evaluation of intellectual and memory functioning; orientation; description of current attitudes and affect; overt behaviors; suicidal or homicidal ideation; paranoia, degree of reality testing, presence and content of delusions, and hallucinations; and

(5) A functional assessment of the individual's ability to engage in activities of daily living and the level of support that would be needed to assist the individual to perform these activities while living in the community. The assessment shall indicate whether this level of support can be provided to the individual in an alternative community setting or whether the level of support needed is such that nursing facility placement is required. The functional assessment must address self-monitoring of health status, self-administering and scheduling of medical treatment, including medication compliance, self-monitoring of nutritional status, handling money, dressing appropriately, and grooming.

S.D. Admin. R. 67:54:05:05

20 SDR 170, effective 4/18/1994.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.