reglab/housing_qa huggingface dataset:
SD Codified L § 58-17F-18 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-18 - Request for information from managed care contractor.

58-17F-18. Request for information from managed care contractor.The director or the secretary may request information from any managed care contractor at any time pertaining to its activities in this state. The managed care contractor shall respond to all requests for information within twenty days. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §18.
SD Codified L § 58-17F-19 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-19 - Activities of nonregistered managed care contractor prohibited.

58-17F-19. Activities of nonregistered managed care contractor prohibited.No managed care contractor may engage in managed care activities in this state unless the managed care contractor is properly registered. The director may issue a cease and desist order against any managed care contractor which fails to comply with the requirements of §§58-17F-16 to 58-17F-20, inclusive, prohibiting the managed care contractor from engaging in managed care activities in this state. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §19.
SD Codified L § 58-17F-20 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-20 - Registration fee for managed care contractor.

58-17F-20. Registration fee for managed care contractor.The director may require the payment of a fee in conjunction with the initial or annual registration of a managed care contractor not to exceed two hundred fifty dollars per registration. The fee shall be established by rules promulgated pursuant to chapter 1-26. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §20.
SD Codified L § 58-17F-21 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17F - Network Adequacy Standards|Section 58-17F-21 - Promulgation of rules.

58-17F-21. Promulgation of rules.The director may, after consultation with the secretary, promulgate, pursuant to chapter 1-26, reasonable rules to protect the public in its purchase of network health insurance products and to achieve the goals of this chapter, by ensuring adequate networks and by assuring quality of health care to the public that purchases network products. The rules may include:(1)Definition of terms;(2)Provider/covered person ratios;(3)Geographic access requirements;(4)Accessibility of care;(5)Contents of reports and filings;(6)Notification requirements;(7)Selection criteria; and(8)Record keeping. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §21.
SD Codified L § 58-17G-3 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17G - Quality Assessment And Improvements|Section 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.

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.Any health carrier that provides managed care plans shall develop and maintain the infrastructure and disclosure systems necessary to measure the quality of health care services provided to covered persons on a regular basis and appropriate to the types of plans offered by the health carrier. A health carrier shall:(1)Utilize a system designed to assess the quality of health care provided to covered persons and appropriate to the types of plans offered by the health carrier. The system shall include systematic collection, analysis, and reporting of relevant data in accordance with statutory and regulatory requirements. The level of quality assessment activities undertaken by a health plan may vary based on the plan's structure with the least amount of quality assessment activities required being those plans which are open and the provider network is simply a discounted fee for service preferred provider organization; and(2)File a written description of the quality assessment program with the director in the prescribed general format, which shall include a signed certification by a corporate officer of the health carrier that the filing meets the requirements of this chapter. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §23.
SD Codified L § 58-17G-4 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17G - Quality Assessment And Improvements|Section 58-17G-4 - Health carrier issuing closed plan to develop quality improvement activities--Minimum requirements of quality improvement activities.

58-17G-4. Health carrier issuing closed plan to develop quality improvement activities--Minimum requirements of quality improvement activities.Any health carrier that issues a closed plan, or a combination plan having a closed component, shall, in addition to complying with the requirements of §58-17G-3, develop and maintain the internal structures and activities necessary to improve the quality of care being provided. Quality improvement activities for a health carrier subject to the requirements of this section shall involve:(1)Developing a written quality improvement plan designed to analyze both the processes and outcomes of the health care delivered to covered persons;(2)Establishing an internal system to implement the quality improvement plan and to specifically identify opportunities to improve care and using the findings of the system to improve the health care delivered to covered persons; and(3)Assuring that participating providers have the opportunity to participate in developing, implementing, and evaluating the quality improvement system.The health carrier shall provide a copy of the quality improvement plan to the director or secretary, if requested. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §24.
SD Codified L § 58-17G-5 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17G - Quality Assessment And Improvements|Section 58-17G-5 - Carrier may be deemed in compliance if private accrediting body meets requirements.

58-17G-5. Carrier may be deemed in compliance if private accrediting body meets requirements.If the director and secretary find that the requirements of any private accrediting body meet the requirements of network adequacy, quality assurance, or quality improvement as set forth in this chapter, the carrier may, at the discretion of the director and secretary, be deemed to have met the applicable requirements. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §25.
SD Codified L § 58-17G-6 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17G - Quality Assessment And Improvements|Section 58-17G-6 - Division to monitor complaints regarding managed care policies.

58-17G-6. Division to monitor complaints regarding managed care policies.The Division of Insurance shall separately monitor complaints regarding managed care policies. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §26.
SD Codified L § 58-17G-7 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17G - Quality Assessment And Improvements|Section 58-17G-7 - Promulgation of rules.

58-17G-7. Promulgation of rules.The director may, after consultation with the secretary, promulgate, pursuant to chapter 1-26, reasonable rules to protect the public in its purchase of network health insurance products and to achieve the goals of this chapter, by assuring quality of health care to the public that purchases network products. The rules may include:(1)Definition of terms;(2)Contents of reports and filings;(3)Record keeping;(4)Setting of quality criteria based upon type of network; and(5)Quality assurance plans or quality improvement plans or both. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §27.
SD Codified L § 58-17H-3 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-3 - Urgent care request defined.

58-17H-3. Urgent care request defined.For the purposes of this chapter, the term, urgent care request means a request for a health care service or course of treatment with respect to which the time periods for making a nonurgent care request determination:(1)Could seriously jeopardize the life or health of the covered person or the ability of the covered person to regain maximum function; or(2)In the opinion of a physician with knowledge of the covered person's medical condition, would subject the covered person to severe pain that cannot be adequately managed without the health care service or treatment that is the subject of the request.Except as provided in subdivision (1) of this section, in determining whether a request is to be treated as an urgent care request, an individual acting on behalf of the health carrier shall apply the judgment of a prudent layperson who possesses an average knowledge of health and medicine. Any request that a physician with knowledge of the covered person's medical condition determines is an urgent care request within the meaning of subdivisions (1) and (2) of this section shall be treated as an urgent care request. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §92.
SD Codified L § 58-17H-4 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-4 - Applicability of chapter.

58-17H-4. Applicability of chapter.The provisions of this chapter apply to any health carrier that provides or performs utilization review services. The requirements of this chapter also apply to any designee of the health carrier or utilization review organization that performs utilization review functions on the carrier's behalf. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §29.
SD Codified L § 58-17H-5 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-5 - Health carrier to provide emergency services coverage without requiring prior authorization--Standards for coverage of emergency services.

58-17H-5. Health carrier to provide emergency services coverage without requiring prior authorization--Standards for coverage of emergency services.If conducting utilization review or making a benefit determination for emergency services, a health carrier that provides benefits for services in an emergency department of a hospital shall comply with the provisions of §§58-17H-5 to 58-17H-13, inclusive. A health carrier shall cover emergency services necessary to screen and stabilize a covered person and may not require prior authorization of such services if a prudent layperson would have reasonably believed that an emergency medical condition existed even if the emergency services are provided on an out of-network basis. A health carrier shall cover emergency services whether the health care provider furnishing the services is a participating provider with respect to such services. If the emergency services are provided out-of-network, the services shall be covered without imposing any administrative requirement or limitation on coverage that is more restrictive than the requirements or limitations that apply to emergency services received from network providers. Emergency services are provided out-of-network by complying with the cost sharing requirements set forth in §§58-17H-7 to 58-17H-10, inclusive, and without regard to any other term or condition of coverage other than the exclusion of or coordination of benefits, an affiliation or waiting periods as permitted under section 2704 of the Public Health Service Act, as amended to January 1, 2011, or cost sharing requirements as set forth in §§58-17H-6 to 58-17H-10, inclusive. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §30.
SD Codified L § 58-17H-6 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-6 - In-network emergency services.

58-17H-6. In-network emergency services.Coverage of in-network emergency services are subject to applicable copayments, coinsurance, and deductibles. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §31.
SD Codified L § 58-17H-7 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-7 - Cost-sharing requirements for out-of-network emergency services.

58-17H-7. Cost-sharing requirements for out-of-network emergency services.Cost-sharing requirements for out-of-network emergency services expressed as a copayment amount or coinsurance rate imposed with respect to a covered person cannot exceed the cost-sharing requirement imposed with respect to a covered person if the services were provided in-network. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §32.
SD Codified L § 58-17H-8 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-8 - Cost-sharing requirements for covered persons--Payments to out-of-network providers.

58-17H-8. Cost-sharing requirements for covered persons--Payments to out-of-network providers.Notwithstanding §58-17H-7, a covered person may be required to pay, in addition to the in-network cost-sharing, the excess of the amount the out-of-network provider charges over the amount the health carrier is required to pay pursuant to this section.A health carrier complies with the requirements of this section if it provides payment of emergency services provided by an out-of-network provider in an amount not less than the greatest of the following:(1)The amount negotiated with in-network providers for emergency services, excluding any in-network copayment or coinsurance imposed with respect to the covered person;(2)The amount of the emergency service calculated using the same method the plan uses to determine payments for out-of-network services, but using the in-network cost-sharing provisions instead of the out-of-network cost-sharing provisions; or(3)The amount that would be paid under Medicare for the emergency services, excluding any in-network copayment or coinsurance requirements. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §33.
SD Codified L § 58-17H-9 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-9 - Exceptions for payments by capitated and other plans without negotiated fees.

58-17H-9. Exceptions for payments by capitated and other plans without negotiated fees.For capitated or other health benefit plans that do not have a negotiated per-service amount for in-network providers, subdivision 58-17H-8(1) does not apply. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §34.
SD Codified L § 58-17H-10 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-10 - Negotiated amounts for in-network providers for a particular emergency service.

58-17H-10. Negotiated amounts for in-network providers for a particular emergency service.If a health benefit plan has more than one negotiated amount for in-network providers for a particular emergency service, the amount in subdivision 58-17H-8(1) is the median of these negotiated amounts. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.") Source: SL 2011, ch 219, §35.