67:16:41:10Noncovered services.

The department does not cover and the provider may not submit a claim for: (1) Mental health services not defined in § 67:16:41:01; (2) Mental health treatment provided without the recipient physically present in a face-to-face session with the mental health provider, except for telehealth treatment and collateral contact; (3) Treatment for a mental health disorder not included in the diagnosis codes set forth in § 67:16:41:05; (4) Mental health treatment provided before a diagnostic assessment is completed, except treatment provided with a provisional diagnosis of a mental health disorder during the thirty-day time period the mental health provider has to complete the diagnostic assessment; (5) Mental health treatment provided after thirty days from the date of intake, if a treatment plan has not been completed; (6) Mental health treatment provided if a required treatment plan review has not been completed; (7) Court appearance, staffing sessions, or treatment team appearances; (8) Mental health services provided to a recipient incarcerated in a correctional facility; (9) Mental health services provided to a recipient in an institution for mental diseases or an intermediate care facility for individuals with intellectual disabilities; (10) Mental health treatment that does not demonstrate a reasonably timed continuum of progress toward the specific goals stated in the treatment plan, as determined by the peer review entity; (11) Mental health treatment that is not listed in the treatment plan or documented in the recipient's clinical record, even though the service is allowable under this chapter; (12) Mental health treatment provided to a recipient who is: (a) Incapable of cognitive functioning due to age or mental incapacity; or (b) Unable to receive any benefit from the service; (13) Mental health services performed without relationship to evaluations or psychotherapy for a specific condition, symptom, or complaint; (14) Time spent preparing reports, treatment plans, or clinical records outside the scope of covered procedure codes; (15) A service designed to assist a recipient regulate a bodily function controlled by the autonomic nervous system, by using an instrument to monitor the function and signal the changes in the function; (16) Alcohol or drug rehabilitation therapy; (17) Missed or canceled appointments; (18) Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family members or another responsible person; (19) Medical hypnotherapy; (20) Field trips and other off-site activities; (21) Consultations or meetings between an employer and employee; (22) Review of work product by the treating mental health provider; (23) Telephone consultations with or on behalf of the recipient, except for collateral contact; (24) Educational, vocational, socialization, or recreational services, or components of services, including: (a) Activity group therapy; (b) Assertiveness training; (c) Bioenergetics therapy; (d) Consciousness training; (e) Dance therapy; (f) Day care; (g) Educational activities; (h) Family counseling; (i) Growth groups or psychotherapy for nonspecific conditions of distress; (j) Guided imagery; (k) Marital counseling; (l) Marriage enrichment; (m) Milieu therapy; (n) Music therapy; (o) Obesity control therapy; (p) Occupational therapy; (q) Parental counseling or bonding; (r) Peer relations therapy; (s) Play observation; (t) Primal scream therapy; (u) Recorded psychotherapy; (v) Recreational therapy; (w) Religious counseling; (x) Rolfing or structural integration; (y) Sensitivity training; (z) Sex therapy; (aa) Sleep observation; (bb) Tape therapy; (cc) Training disability service; (dd) Vocational counseling; and (ee) Z-therapy; and (25) Mental health treatment delivered in excess of the frequency prescribed in the treatment plan.

Source: 22 SDR 6, effective July 26, 1995; 26 SDR 168, effective July 1, 2000; 37 SDR 53, effective September 23, 2010; 40 SDR 122, effective January 8, 2014; 45 SDR 82, effective December 10, 2018; 46 SDR 50, effective October 10, 2019; 48 SDR 39, effective October 3, 2021; 49 SDR 21, effective September 12, 2022; 50 SDR 63, effective November 27, 2023.