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- SDCL § 58-17E-45 · Consumer's right to return plan or program--Refund.
- SDCL § 58-17E-46 · Notice to director of change in plan.
- SDCL § 58-17E-47 · Construction with trade practices statute.
- SDCL § 58-17F-1 · Definitions.
- SDCL § 58-17F-2 · Health benefit plan defined.
- SDCL § 58-17F-3 · Medical director required for managed care plans.
- SDCL § 58-17F-4 · Health carrier to provide written information to prospective enrollees--Specific information required.
- SDCL § 58-17F-5 · Health carrier to maintain provider network sufficient to assure services without unreasonable delay--Emergency services--Determination of sufficiency.
- SDCL § 58-17F-6 · Where provider network is insufficient, covered benefit to be made available at no greater cost.
- SDCL § 58-17F-7 · Health carrier to ensure provider proximity to covered persons.
- SDCL § 58-17F-8 · Health carrier to monitor provider ability, capacity, and authority--Financial capability to be monitored in capitated plans.
- SDCL § 58-17F-9 · Factors to consider in determining network adequacy.
- SDCL § 58-17F-10 · Access plan required for managed care plans--Annual update--Contents--Exemptions for discounted fee-for-service networks.
- SDCL § 58-17F-11 · Requirements for health carrier and providers in managed care plans.
- SDCL § 58-17F-12 · Provisions governing contractual arrangements between health carriers and intermediaries.
- SDCL § 58-17F-13 · Sample contract forms to be filed with director--Material changes to be submitted--Certain changes not material--Director's inaction within certain time deemed approval--Contract copies to be provided upon request.
- SDCL § 58-17F-14 · Contract does not relieve health carrier of liability.
- SDCL § 58-17F-15 · Remedies available to director against health carrier found not in compliance.
- SDCL § 58-17F-16 · Managed care contractor to register with director.
- SDCL § 58-17F-17 · Filing changes in registration information.
- SDCL § 58-17F-18 · Request for information from managed care contractor.
- SDCL § 58-17F-19 · Activities of nonregistered managed care contractor prohibited.
- SDCL § 58-17F-20 · Registration fee for managed care contractor.
- SDCL § 58-17F-21 · Promulgation of rules.
- SDCL § 58-17G-1 · Definitions.
- SDCL § 58-17G-2 · Health benefit plan defined.
- SDCL § 58-17G-3 · Health carrier to develop and maintain systems to measure quality of services--System requirements--Description of quality assessment program to be filed with director.
- SDCL § 58-17G-4 · Health carrier issuing closed plan to develop quality improvement activities--Minimum requirements of quality improvement activities.
- SDCL § 58-17G-5 · Carrier may be deemed in compliance if private accrediting body meets requirements.
- SDCL § 58-17G-6 · Division to monitor complaints regarding managed care policies.
- SDCL § 58-17G-7 · Promulgation of rules.
- SDCL § 58-17H-1 · Definitions.
- SDCL § 58-17H-2 · Health benefit plan defined.
- SDCL § 58-17H-3 · Urgent care request defined.
- SDCL § 58-17H-4 · Applicability of chapter.
- SDCL § 58-17H-5 · Health carrier to provide emergency services coverage without requiring prior authorization--Standards for coverage of emergency services.
- SDCL § 58-17H-6 · In-network emergency services.
- SDCL § 58-17H-7 · Cost-sharing requirements for out-of-network emergency services.
- SDCL § 58-17H-8 · Cost-sharing requirements for covered persons--Payments to out-of-network providers.
- SDCL § 58-17H-9 · Exceptions for payments by capitated and other plans without negotiated fees.
- SDCL § 58-17H-10 · Negotiated amounts for in-network providers for a particular emergency service.
- SDCL § 58-17H-11 · General cost-sharing requirements allowed.
- SDCL § 58-17H-12 · Access to representative for post-evaluation or post-stabilization services.
- SDCL § 58-17H-13 · Health carrier may be deemed to meet emergency medical coverage requirements if met by private accrediting body.
- SDCL § 58-17H-14 · Health carrier responsibility for utilization review activities.
- SDCL § 58-17H-15 · Director to hold health carrier responsible for utilization review performance of contractor.
- SDCL § 58-17H-16 · Written utilization review program required--Contents of program document.
- SDCL § 58-17H-17 · Utilization review program to use documented clinical review criteria--Criteria to be available to authorized agencies upon request.
- SDCL § 58-17H-18 · Program to be administered by qualified licensed health care professionals.
- SDCL § 58-17H-19 · Determinations to be issued in timely manner--Process to ensure consistency.
- SDCL § 58-17H-20 · Effectiveness and efficiency of program to be routinely reviewed.
- SDCL § 58-17H-21 · Data systems to support program activities and generate management reports.
- SDCL § 58-17H-22 · Health carrier oversight of delegated activities--Requirements.
- SDCL § 58-17H-23 · Utilization review to be coordinated with other medical management activity of health carrier.
- SDCL § 58-17H-24 · Health carrier to provide free access to review staff.
- SDCL § 58-17H-25 · Only information necessary for review or determination to be collected.
- SDCL § 58-17H-26 · Independence and impartiality required for utilization review.
- SDCL § 58-17H-27 · Written procedures required for making determinations--Notification.
- SDCL § 58-17H-28 · Prospective review determinations--Timing--Notification of requirements--Extension of time.
- SDCL § 58-17H-29 · Concurrent review determinations--Timing--Notification requirements.
- SDCL § 58-17H-30 · Retrospective review determinations--Timing--Notification requirements.
- SDCL § 58-17H-30.1 · Retroactive denial of paid claim--Restriction--Requirement--Exclusions--Enforcement.
- SDCL § 58-17H-30.2 · Retroactive denial of paid claim--Payment amount.
- SDCL § 58-17H-31 · Calculation of time period for determination for prospective and retrospective reviews.
- SDCL § 58-17H-32 · Notification of adverse determination--Contents.
- SDCL § 58-17H-33 · Information required to be provided to covered persons and prospective covered persons.
- SDCL § 58-17H-34 · Health carrier may be deemed to meet utilization review requirements if met by private accrediting body.
- SDCL § 58-17H-35 · Registration of utilization review organizations--Required information.
- SDCL § 58-17H-36 · Filing changes in registration information.
- SDCL § 58-17H-37 · Requests for information from utilization review organizations.
- SDCL § 58-17H-38 · Activities of nonregistered utilization review organizations prohibited.
- SDCL § 58-17H-39 · Registration fee for utilization review organizations.
- SDCL § 58-17H-40 · Urgent care requests--Written procedures required for receipt and determination of requests.
- SDCL § 58-17H-41 · Insufficient information for determination--Notice and statement of necessary information.
- SDCL § 58-17H-42 · Insufficient information for determination of prospective urgent care requests.
- SDCL § 58-17H-43 · Urgent care requests--Timely notification of determination.
- SDCL § 58-17H-44 · Time within which to submit necessary information.
- SDCL § 58-17H-45 · Urgent care requests--Notice of determination--Failure to submit necessary information as grounds for denial of certification.
- SDCL § 58-17H-46 · Concurrent review urgent care requests--Extended care requests--Time for determination and notice.
- SDCL § 58-17H-47 · Calculation of time periods for determination.
- SDCL § 58-17H-48 · Notification of adverse determination--Requirements.
- SDCL § 58-17H-49 · Promulgation of rules.
- SDCL § 58-17H-50 · Coverage for cancer treatment medication.
- SDCL § 58-17H-51 · Reclassification of benefits with respect to cancer treatment medications.
- SDCL § 58-17H-52 · Medical management practices complying with chapter.
- SDCL § 58-17H-53 · Step therapy protocols.
- SDCL § 58-17H-54 · Step therapy protocols--Process--Transparency.
- SDCL § 58-17H-55 · Step therapy override exceptions.
- SDCL § 58-17H-56 · Limitations.
- SDCL § 58-17H-57 · Utilization review organization or health carrier--Annual review--Report--Contents--Publication.
- SDCL § 58-17H-58 · Utilization review organization or health carrier--Health care service review--Prior authorization requirement elimination.
- SDCL § 58-17H-59 · Utilization review organization or health carrier--Health care service review--Annual report--Contents--Publication.
- SDCL § 58-17H-60 · Utilization review organization or health carrier--Health care service--Excluded services.
- SDCL § 58-17I-1 · Definitions.
- SDCL § 58-17I-2 · Health benefit plan defined.
- SDCL § 58-17I-3 · Urgent care request defined.
- SDCL § 58-17I-4 · Register of grievances required--Information to be compiled--Maintenance.
- SDCL § 58-17I-5
- SDCL § 58-17I-6 · Grievance procedures--Filing--Certificate of compliance--Contact information.
- SDCL § 58-17I-7 · Review of adverse determination--Time for filing--Designation and notice of reviewers--Scope of review.