reglab/housing_qa huggingface dataset:
SD Codified L § 58-17-151 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-151 - Applications to be credentialed.

58-17-151. Applications to be credentialed.Within ten business days of receiving a request for an application to be credentialed by a health care professional, a health insurer or other entity responsible for the credentialing of health care professionals on behalf of the health insurer shall send an application form to the professional, unless the application to be credentialed is available electronically on a public website. The application form shall identify and itemize all documentation and other information that the insurer or entity must receive in order for an application to be complete. Source: SL 2014, ch 236, §3.
SD Codified L § 58-17-152 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-152 - Application of §§ 58-17-149 to 58-17-151.

58-17-152. Application of §§58-17-149 to 58-17-151.Nothing in §§58-17-149 to 58-17-151, inclusive, applies to services provided by a health care professional that are covered by Medicaid, Medicare, TRICARE, or other health care benefit program subject to federal regulations regarding eligibility and provider payments. Nothing in §§58-17-149 to 58-17-151, inclusive, requires a health insurer or other entity responsible for credentialing health care professionals on behalf of the health insurer to take any action in violation of the requirements of the National Committee for Quality Assurance (NCQA) or Utilization Review Accreditation Commission (URAC).Nothing in §§58-17-149 to 58-17-151, inclusive, requires a health insurer or other entity responsible for credentialing health care professionals on behalf of the health insurer to credential a health care professional or to permit a non-credentialed health care professional to participate in the health insurer's provider network. Source: SL 2014, ch 236, §4.
SD Codified L § 58-17-153 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-153 - Coverage for treatment of hearing impairment for persons under age nineteen.

58-17-153. Coverage for treatment of hearing impairment for persons under age nineteen.Any qualified health plan issued on or after January 1, 2015, that offers coverage for professional audiology services shall include coverage for medically necessary physician services appropriate for the treatment of hearing impairment to a person under the age of nineteen. This shall include professional services rendered by an audiologist licensed pursuant to chapter 36-24.The benefits provided shall be subject to the same dollar limits, deductibles, coinsurance and other limitations provided for other covered benefits in the policy.Nothing in this section requires the payment by the health plan of hearing aids, devices, or equipment to correct hearing impairment or loss. Source: SL 2014, ch 237, §1.
SD Codified L § 58-17-154 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-154 - Definitions for §§ 58-17-155 to 58-17-162.

58-17-154. Definitions for §§58-17-155 to 58-17-162.Terms used in §§58-17-155 to 58-17-162, inclusive, mean:(1)"Applied behavior analysis," the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior;(2)"Autism spectrum disorder," a complex neurodevelopmental medical disorder characterized by social impairment, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior;(3)"Behavioral health treatment," evidence-based interventions that:(a)Achieve specific improvements in functional capacity of a person; and(b)Are provided or supervised by a licensed practitioner as provided in §58-17-159;(4)"Treatment," evidence-based care which is prescribed or ordered for a person diagnosed with an autism spectrum disorder by a licensed physician or psychologist, including:(a)Behavioral health treatment;(b)Pharmacy care; and(c)Therapeutic care. Source: SL 2015, ch 250, §1; SL 2017, ch 212, §1, eff. Jan. 1, 2018.
SD Codified L § 58-17-155 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-155 - Exceptions to application of §§ 58-17-154 to 58-17-162.

58-17-155. Exceptions to application of §§58-17-154 to 58-17-162.Nothing in §§58-17-154 to 58-17-162, inclusive, applies to nongrandfathered plans in the individual and small group markets that are required to include essential health benefits under the federal Patient Protection and Affordable Care Act of 2010, as in effect on January 1, 2015, or to Medicare supplement, accident-only, specified disease, hospital indemnity, disability income, long-term care, major medical policies with a limited duration of less than twelve months, or other limited benefit hospital insurance policies, or any plan or coverage exempted from state regulation by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 18, as in effect on January 1, 2015. Source: SL 2015, ch 250, §2.
SD Codified L § 58-17-156 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-156 - Policies, contracts, certificates, and plans subject to §§ 58-17-154 to 58-17-162.

58-17-156. Policies, contracts, certificates, and plans subject to §§58-17-154 to 58-17-162.Except as provided in §58-17-155, §§58-17-154 through 58-17-162 apply to all individual and group health insurance policies, contracts, and certificates issued by health carriers as defined in §58-17H-1 and self-funded nonfederal governmental plans with the exception of the state employee health plan sponsored by the State of South Dakota. Source: SL 2015, ch 250, §3; SL 2020, ch 209, § 6.
SD Codified L § 58-17-157 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-157 - Coverage for applied behavior analysis for treatment of autism spectrum disorders.

58-17-157. Coverage for applied behavior analysis for treatment of autism spectrum disorders.Every policy, contract, certificate, or plan subject to the provisions of §§58-17-154 to 58-17-162, inclusive, shall provide coverage for applied behavior analysis for the treatment of autism spectrum disorders consistent with §§58-17-154 to 58-17-162, inclusive. Source: SL 2015, ch 250, §4.
SD Codified L § 58-17-158 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-158 - Authorization, prior approval, and other care management requirements--Annual maximum benefit.

58-17-158. Authorization, prior approval, and other care management requirements--Annual maximum benefit.Coverage for an applied behavior analysis may be subject to pre-authorization, prior approval, and other care management requirements including limits on the number of individual visits a person may make for applied behavior analysis subject to the general care management provisions of the plan, and may be subject to dollar limits, deductibles, copayments, or coinsurance provisions that apply to other medical or surgical services covered under the policy. The coverage for applied behavior analysis shall provide an annual maximum benefit that may not be less than the following:(1)Through age 6 $36,000(2)Age 7 through age 13 $25,000(3)Age 14 through age 18 $12,500 Source: SL 2015, ch 250, §5.
SD Codified L § 58-17-159 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-159 - Qualifications of person performing or supervising applied behavior analysis.

58-17-159. Qualifications of person performing or supervising applied behavior analysis.Any person who performs or supervises applied behavior analysis shall:(1)Be licensed by the South Dakota Board of Medical and Osteopathic Examiners or the Board of Examiners of Psychologists and have documented training and competence in applied behavior analysis; or(2)Be licensed by the South Dakota Board of Social Workers as a licensed behavior analyst. Source: SL 2015, ch 250, §6; SL 2017, ch 212, §2, eff. Jan. 1, 2018.
SD Codified L § 58-17-160 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-160 - Review of treatment.

58-17-160. Review of treatment.A health carrier or plan provider subject to §§58-17-154 to 58-17-162, inclusive, shall have the right to request a review of the treatment that a person is receiving not more than once every three months unless the insurer and the person's licensed physician or licensed psychologist execute an agreement that a more frequent review is necessary. Any agreement regarding the right to review a treatment plan more frequently applies only to a particular person receiving applied behavior analysis and may not apply to all persons receiving applied behavior analysis by a licensed physician, licensed psychologist, or licensed behavior analyst. The cost of obtaining a review under this section shall be paid by the health carrier or plan. Source: SL 2015, ch 250, §7; SL 2017, ch 212, §3, eff. Jan. 1, 2018.
SD Codified L § 58-17-161 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-161 - Services under individualized service plan, family service plan, or education program.

58-17-161. Services under individualized service plan, family service plan, or education program.Nothing in §§58-17-154 to 58-17-162, inclusive, may be construed to affect any obligation to provide services to a person under an individualized family service plan, an individualized education program, or an individualized service plan. Source: SL 2015, ch 250, §8.
SD Codified L § 58-17-162 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-162 - Effective date of §§ 58-17-154 to 58-17-161.

58-17-162. Effective date of §§58-17-154 to 58-17-161.The effective date of §§58-17-154 to 58-17-161, inclusive, is the first plan year, policy year, or renewal date on or after January 1, 2016. Source: SL 2015, ch 250, §9.
SD Codified L § 58-17-163 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-163 - Dental care insurers to honor assignment of benefits.

58-17-163. Dental care insurers to honor assignment of benefits.Any insurer that provides dental care insurance to a person shall honor an assignment, made in writing by the person insured under the policy, of payments due under the policy to a dentist or a dental corporation for dental care services provided to the person that is insured under the policy. Upon notice of the assignment, the insurer shall make payments directly to the dentist or dental corporation providing the dental care services. A dentist or dental corporation with a valid assignment may bill the insurer and notify the insurer of the assignment. Upon request of the insurer, the dentist or dental corporation shall provide a copy of the assignment to the insurer. Source: SL 2017, ch 213, §1.
SD Codified L § 58-17-164 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-164 - Revocation of assignment of dental insurance benefits.

58-17-164. Revocation of assignment of dental insurance benefits.A person may revoke an assignment made pursuant to §58-17-163 with or without the consent of the dentist or dental corporation. The revocation shall be in writing. The person shall provide notice of the revocation to the insurer. The insurer shall send a copy of the revocation notice to the dentist or dental corporation subject to the assignment. The revocation is effective when both the insurer and the dentist or dental corporation have received a copy of the revocation notice. The revocation is only effective for any charges incurred after both parties have received the revocation notice. Source: SL 2017, ch 213, §2.
SD Codified L § 58-17-165 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-165 - Reimbursement of payment from insured following receipt of payment from insurer.

58-17-165. Reimbursement of payment from insured following receipt of payment from insurer.If, under an assignment authorized in §58-17-163, a dentist or dental corporation collects payment from a person and subsequently receives payment from the insurer, the dentist or dental corporation shall reimburse the person, less any applicable copayments, deductibles, or coinsurance amounts, within forty-five days. Source: SL 2017, ch 213, §3.
SD Codified L § 58-17-166 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-166 - Scope of benefits not affected--Medical benefits not included .

58-17-166. Scope of benefits not affected--Medical benefits not included .Nothing in §§58-17-163 to 58-17-165, inclusive, limits an insurer's ability to determine the scope of the insurer's benefits, services, or any other terms of the insurer's policies or to negotiate any contract with a licensed health care provider regarding reimbursement rates or any other lawful provisions.The provisions of §§58-17-163 to 58-17-166, inclusive, apply only to any policy of insurance insuring dental care services. The provisions of §§58-17-163 to 58-17-166, inclusive, do not apply to any service payable as a medical benefit pursuant to a health benefit plan as defined in subdivision 58-17-66(9). Source: SL 2017, ch 213, §4.
SD Codified L § 58-17-167 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-167 - Definitions pertaining to telehealth coverage.

58-17-167. Definitions pertaining to telehealth coverage.Terms used in §§58-17-167 to 58-17-170, inclusive, mean:(1)"Health care professional," as defined in §58-17F-1;(2)"Health care services," as defined in §58-17F-1;(3)"Health insurer," as defined in §58-17-100;(4)"Telehealth," the delivery of health care services through the use of HIPAA-compliant interactive audio-video. The term does not include the delivery of health care services through audio-only telephone, electronic mail message, text message, mail service, facsimile transmission, or any combination thereof. Source: SL 2019, ch 211, §1.
SD Codified L § 58-17-168 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-168 - Coverage for health care services provided through telehealth.

58-17-168. Coverage for health care services provided through telehealth.No health insurer may exclude a service for coverage solely because the service is provided through telehealth and not provided through in-person consultation or contact between a health care professional and a patient. Health care services delivered by telehealth must be appropriate and delivered in accordance with applicable law and generally accepted health care practices and standards prevailing at the time the health care services are provided, including rules adopted by the appropriate professional licensing board having oversight of the health care professional providing the health care services. Health insurers are not required to provide coverage for health care services that are not medically necessary.This section does not:(1)Prohibit a health insurer from establishing criteria that a health care professional must meet to demonstrate the safety and efficacy of delivering a particular health care service via telehealth that the health insurer does not already reimburse other health care professionals for delivering via telehealth so long as the criteria are not unduly burdensome or unreasonable for the particular services;(2)Prevent a health insurer from requiring a health care professional to agree to certain documentation or billing practices designed to protect the health insurer or patients from fraudulent claims so long as the practices are not unduly burdensome or unreasonable for the particular services; or(3)Prevent a health insurer from including a deductible, copayment, or coinsurance requirement for a health care service provided via telehealth, if the deductible, copayment, or coinsurance is not in addition to and does not exceed the deductible, copayment, or coinsurance applicable if the same services were provided through in-person contact. Source: SL 2019, ch 211, §2.
SD Codified L § 58-17-169 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-169 - Discrimination between coverage for services provided in person and through telehealth prohibited.

58-17-169. Discrimination between coverage for services provided in person and through telehealth prohibited.A health insurance policy, contract, or plan providing for third-party payment may not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth as long as the services are appropriate to be provided through telehealth. Nothing in §§58-17-167 to 58-17-170, inclusive, prohibits a health insurer and a health care professional from entering into a contract for telehealth with terms subject to negotiation. Source: SL 2019, ch 211, §3.
SD Codified L § 58-17-170 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17 - Health Insurance Policies|Section 58-17-170 - Application of telehealth coverage requirements.

58-17-170. Application of telehealth coverage requirements.The requirements of §§58-17-168 and 58-17-169 apply to any health insurer offering any individual or group health insurance policy, contract, certificate, or plan delivered, issued for delivery, or renewed in South Dakota on or after January 1, 2020. The requirements of §§58-17-168 and 58-17-169 do not apply to any plan, policy, or contract providing coverage only for:(1)Specified disease;(2)Hospital indemnity;(3)Fixed indemnity;(4)Accident-only;(5)Credit accident and health insurance;(6)Vision;(7)Prescription drug;(8)Medicare supplement;(9)Long-term care;(10)Disability income insurance;(11)Coverage issued as a supplement to liability insurance;(12)Workers' compensation or similar insurance;(13)Automobile medical payment insurance; or(14)Individual health benefit plans of six-months or less duration that are not renewable.The requirements of §§58-17-168 and 58-17-169 do not apply to services offered that are not part of the policy, contract, certificate, or plan offered and for which there is no premium charged. Source: SL 2019, ch 211, §4.
SD Codified L § 58-17A-1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17A - Medicare Supplement Policies|Section 58-17A-1 - Definition of terms.

58-17A-1.Definition of terms.Terms used in this chapter mean:(1)"Applicant," in the case of an individual medicare supplement policy or subscriber contract, the person who seeks to contract for insurance benefits; and in the case of a group medicare supplement policy or subscriber contract, the proposed certificate holder;(2)"Certificate," any certificate issued under a group medicare supplement policy, which policy has been delivered or issued for delivery in this state;(3)"Certificate form," the form on which the certificate is delivered or issued for delivery by the issuer;(4)"Issuer," includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this state medicare supplement policies or certificates;(5)"Medicare," the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 and as amended through December31, 1991;(6)"Medicare supplement policy," a group or individual policy of health insurance or a subscriber contract of nonprofit hospital, medical and surgical service plans, or health maintenance organizations, which is advertised, marketed, or designed primarily as a supplement to reimbursements under medicare for the hospital, medical or surgical expenses of persons eligible for medicare. The term does not include insurance policies or health care benefit plans, including group conversion policies, provided to medicare eligible persons which policies are not marketed or held to be medicare supplement policies or benefit plans, nor does it apply to a policy or contract of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or combination thereof, for employees or former employees or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations. The term does not include a policy issued pursuant to a contract under Section 1876 of the federal Social Security Act, 42 U.S.C. §1395 et seq., or a policy issued under a demonstration project specified in 42 U.S. C. §1395ss(g)(i). The term does not include any medicare advantage plan established under Medicare Part C, any outpatient prescription drug plan established under Medicare Part D, or any health care prepayment plan that provides benefits pursuant to an agreement under §1833(a)(1)(A) of the Social Security Act;(7)"Policy form," the form on which the policy is delivered or issued for delivery by the issuer. Source: SL 1982, ch 360, §1; SL 1989, ch 431, §1; SL 1990, ch 396, §1; SL 1992, ch 347, §1; SL 1996, ch 293, §1; SL 2005, ch 267, §1.
SD Codified L § 58-17A-2 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17A - Medicare Supplement Policies|Section 58-17A-2 - Regulations to establish specific standards for policy provisions.

58-17A-2. Regulations to establish specific standards for policy provisions.The director shall promulgate rules pursuant to chapter 1-26 to establish specific standards and requirements for medicare supplement policies and certificates. The standards and requirements shall be in addition to and in accordance with applicable laws of this state and may cover, but are not limited to:(1)Terms of renewability;(2)Initial and subsequent conditions of eligibility;(3)Nonduplication of coverage;(4)Probationary periods;(5)Benefit limitations, exceptions, and reductions;(6)Elimination periods;(7)Requirements for replacement;(8)Recurrent conditions;(9)Definitions of terms;(10)Filing requirements for forms and rates and rate schedules;(11)Marketing practices;(12)Reporting practices;(13)Compensation arrangements between insurers or other entities and their agents, representatives, or producers;(14)Suitability and appropriateness of policy sold;(15)Data on application forms;(16)Continuation and conversion rights;(17)Loss ratio requirements and refund and credit calculations;(18)Suspension and reinstitution of coverage; and(19)Refund of premium for duplication and suspension and reinstitution of coverage.The director may promulgate rules pursuant to chapter 1-26 that specify prohibited policy or certificate provisions not otherwise specifically authorized by statute which, in the opinion of the director, are unjust, unfair, or unfairly discriminatory to any person insured or proposed for coverage under a medicare supplement policy or certificate. The director may also promulgate rules assuring public access to rate and form information, establishing procedures for rate and form approvals or disapprovals, and establishing a uniform methodology for calculating and reporting loss ratios.The director shall promulgate rules pursuant to chapter 1-26 to establish minimum standards for benefits and claims payment under medicare supplement policies and certificates and to establish procedures for rate hearings. Source: SL 1982, ch 360, §2; SL 1989, ch 431, §2; SL 1990, ch 396, §2; SL 1992, ch 347, §2.