South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:48 - Treatment for substance use disorders
Section 67:16:48:08 - Treatment for a substance use disorder - Out-of-state
Current through Register Vol. 51, page 43, September 23, 2024
Out-of-state treatment for a substance use disorder is limited to those services provided in a facility which is licensed or accredited in another state as a substance use disorder treatment facility. Treatment is covered if the following additional requirements are met:
(1) An addiction counselor within that state completes an integrated assessment and sends the completed assessment to the division. The assessment must include a biopsychosocial history with appropriate testing instrument scores, indicate a diagnosis of a substance use disorder, and contain the credentials of the counselor completing the assessment;
(2) For intensive inpatient treatment or psychiatric residential treatment, a physician or other licensed practitioner refers the recipient for placement in, transfer to, or continued stay in a substance use disorder treatment program;
(3) The division authorizes the treatment, and no appropriate in-state treatment is available; and
(4) The psychiatric residential treatment provided meets the prior authorization requirements found in § 67:16:48:06.
Out-of-state outpatient services do not require prior authorization when provided within 50 miles of the South Dakota border.
General Authority: SDCL 28-6-1(1)(2).
Law Implemented: SDCL 28-6-1(1)(2).
