reglab/housing_qa huggingface dataset:
SD Codified L § 58-17I-10 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17I - Grievance Procedure|Section 58-17I-10 - Procedures for providing new or additional evidence.

58-17I-10. Procedures for providing new or additional evidence.Prior to issuing a decision in accordance with the timeframes provided in §58-17I-9, the health carrier shall provide free of charge to covered person, or the covered person's authorized representative, any new or additional evidence, relied upon or generated by the health carrier, or at the direction of the health carrier, in connection with the grievance sufficiently in advance of the date the decision is required to be provided to permit the covered person, or the covered person's authorized representative, a reasonable opportunity to respond prior to that date.Before the health carrier issues or provides notice of a final adverse determination in accordance with the timeframes provided in §58-17I-9 that is based on new or additional rationale, the health carrier shall provide the new or additional rationale to the covered person, or the covered person's authorized representative, free of charge as soon as possible and sufficiently in advance of the date the notice of final adverse determination is to be provided to permit the covered person, or the covered person's authorized representative a reasonable opportunity to respond prior to that date. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub.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, §82.
SD Codified L § 58-17I-12 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17I - Grievance Procedure|Section 58-17I-12 - Expedited review for adverse determinations involving urgent care requests--Appointment of peers for review.

58-17I-12. Expedited review for adverse determinations involving urgent care requests--Appointment of peers for review.Each health carrier shall establish written procedures for the expedited review of urgent care requests of grievances involving an adverse determination. In addition, a health carrier shall provide expedited review of a grievance involving an adverse determination with respect to concurrent review urgent care requests involving an admission, availability of care, continued stay, or health care service for a covered person who has received emergency services, but has not been discharged from a facility. The procedures shall allow a covered person or the covered person's authorized representative to request an expedited review under this section orally or in writing.Each health carrier shall appoint at least one appropriate clinical peer in the same or similar specialty as would typically manage the case being reviewed to review the adverse determination. The clinical peer may not have been involved in making the initial adverse determination. (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, §84.
SD Codified L § 58-17I-13 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17I - Grievance Procedure|Section 58-17I-13 - Transmission of necessary information for certain expedited reviews.

58-17I-13. Transmission of necessary information for certain expedited reviews.In an expedited review that is not an initial determination for benefits, all necessary information, including the health carrier's decision, shall be transmitted between the health carrier and the covered person or, if applicable, the covered person's authorized representative, by telephone, facsimile, or the most expeditious method available. (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, §85.
SD Codified L § 58-17I-14 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17I - Grievance Procedure|Section 58-17I-14 - Expedited review decision not initial determination for benefits--Notification--Time periods--Continuation of service involving concurrent review urgent care requests.

58-17I-14. Expedited review decision not initial determination for benefits--Notification--Time periods--Continuation of service involving concurrent review urgent care requests.An expedited review decision, that is not an initial determination for benefits, shall be made and the covered person or, if applicable, the covered person's authorized representative, shall be notified of the decision in accordance with §58-17I-15 as expeditiously as the covered person's medical condition requires, but in no event more than seventy-two hours after the date of receipt of the request for the expedited review. If the expedited review is of a grievance involving an adverse determination with respect to a concurrent review urgent care request, the service shall be continued without liability to the covered person until the covered person has been notified of the determination.For purposes of calculating the time periods within which a decision is required to be made under this section, the time period within which the decision is required to be made shall begin on the date the request is filed with the health carrier in accordance with the health carrier's procedures established pursuant to §58-17I-6 for filing a request, without regard to whether all of the information necessary to make the determination accompanies the filing. (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, §86.
SD Codified L § 58-17I-16 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17I - Grievance Procedure|Section 58-17I-16 - Promulgation of rules.

58-17I-16. Promulgation of rules.The director, in consultation with the secretary, shall promulgate rules, pursuant to chapter 1-26, to establish time frames relative to the filing of grievances, the disposition of grievances, and the response to the aggrieved person. Rules may also be promulgated covering definition of terms, grievance procedures, and content of reports. (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, §88.
SD Codified L § 58-17J-1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17J - Patient Choice In Selection Of Health Care Provider|Section 58-17J-1 - Definitions.

58-17J-1. Definitions.Terms used in this chapter mean:(1)"Health benefit plan," any hospital or medical expense policy or certificate, hospital or medical service plan, nonprofit hospital, medical-surgical health service corporation contract or certificate, provider sponsored integrated health delivery network, self-insured plan or plan provided by multiple employer welfare arrangements, health maintenance organization subscriber contract of more than six-month duration, or any health benefit plan that affects the rights of a South Dakota insured and bears a reasonable relation to South Dakota, whether delivered or issued for delivery in South Dakota. The term does not include specified disease, hospital indemnity, fixed indemnity, accident only, credit, dental, vision, Medicare supplement, long-term care or disability income insurance, coverage issued as a supplement to liability insurance, workers' compensation or similar insurance, automobile medical payment insurance, or any plan or coverage exempted from state regulation by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 18;(2)"Health insurer," any entity within the definitions set forth in subdivisions 58-17F-1(11), (12), and (15), any entity offering a health benefit plan as defined by §58-17F-2, all self-insurers or multiple employer welfare arrangements, and self-insured employer-organized associations. The term does not include any entity exempted from state regulation by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 18;(3)"Health care provider," any individual or entity within the scope of the definition of health care provider as defined by subdivision 58-17F-1(9). Source: SL 2015, ch 278 (Initiated Measure 17), §2, eff. Nov. 13, 2014.
SD Codified L § 58-17J-2 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17J - Patient Choice In Selection Of Health Care Provider|Section 58-17J-2 - Patient choice--Health care provider participation.

58-17J-2. Patient choice--Health care provider participation.No health insurer, including the South Dakota Medicaid program, may obstruct patient choice by excluding a health care provider licensed under the laws of this state from participating on the health insurer's panel of providers if the provider is located within the geographic coverage area of the health benefit plan and is willing and fully qualified to meet the terms and conditions of participation as established by the health insurer. Source: SL 2015, ch 278 (Initiated Measure 17), §1, eff. Nov. 13, 2014.
SD Codified L § 58-17K-2 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17K - Health Care Cost Transparency|Section 58-17K-2 - Cost-sharing information described--Required disclosure to enrollees.

58-17K-2. Cost-sharing information described--Required disclosure to enrollees. At the request of an enrollee, the health insurer shall provide:(1)An estimate, which is accurate at the time of the request, of the enrollee's cost-sharing liability for a requested covered item or service furnished by a provider reflecting any cost-sharing reductions the enrollee would receive that is calculated based on:(a)Accumulated amounts;(b)In-network negotiated rate, reflected as a dollar amount, or underlying fee schedule rate, reflected as a dollar amount, to the extent it is different from the negotiated rate; and(c)Out-of-network allowed amount or any other rate that provides a more accurate estimate of an amount the health insurer will pay for the requested covered item or service, reflected as a dollar amount. In circumstances in which a health insurer reimburses an out-of-network provider a percentage of the billed charge for a covered item or service, the out-of-network allowed amount will be that percentage;(2)Information for an item or service subject to a bundled payment arrangement and a list of the items and services included in the bundled payment arrangement for which cost-sharing information is being disclosed;(3)If applicable, notification that coverage of a specific item or service is subject to a prerequisite; and(4)Further information and consumer notices required for compliance with federal standards as provided under rules promulgated pursuant to chapter 1-26 by the director. Source: SL 2021, ch 213, § 2.
SD Codified L § 58-17K-3 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17K - Health Care Cost Transparency|Section 58-17K-3 - Cost-sharing information disclosed--Required internet method and format.

58-17K-3. Cost-sharing information disclosed--Required internet method and format. The cost-sharing information to be provided under this chapter shall be made available without a subscription or other fee through a self-service tool on a website that provides real-time responses based on cost-sharing information that is accurate at the time of request. A health insurer shall ensure the self-service tool allows enrollees to:(1)Search for cost-sharing information for a covered item or service by an in-network provider by inputting:(a)A billing code or a descriptive term;(b)The name of an in-network provider; and(c)Other factors utilized by the health insurer that are relevant for determining the applicable cost-sharing information;(2)Search for an out-of-network allowed amount, percentage of billed charges, or other rate for a covered item or service by an out-of-network provider by inputting:(a)A billing code or a descriptive term; and(b)Other factors utilized by the health insurer that are relevant for determining the applicable out-of-network allowed amount or other rate; and(3)Refine and reorder search results based on geographic proximity of in-network providers and the amount of the enrollee's estimated cost-sharing liability. Source: SL 2021, ch 213, § 3.
SD Codified L § 58-17K-4 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17K - Health Care Cost Transparency|Section 58-17K-4 - Cost-sharing information disclosed--Paper or other method on request--Limit on providers per request.

58-17K-4. Cost-sharing information disclosed--Paper or other method on request--Limit on providers per request. An enrollee may request, in accordance with § 58-17K-3, the required cost-sharing information be provided in a paper form. In responding to such a request, a health insurer may limit the number of providers to no fewer than twenty providers per request. A health insurer shall disclose the applicable provider-per-request limit to the enrollee, provide the cost-sharing information in paper form, and mail the cost-sharing information no later than two business days after receiving a request without a subscription or other fee.An enrollee may request to receive cost-sharing information through other methods, including phone or e-mail, as long as the enrollee agrees to the disclosure method and the required cost-sharing information request is fulfilled at least as rapidly as required by the paper method. Source: SL 2021, ch 213, § 4.
SD Codified L § 58-17K-5 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17K - Health Care Cost Transparency|Section 58-17K-5 - Prescription drug file--Required public disclosure--Method, format, and updates.

58-17K-5. Prescription drug file--Required public disclosure--Method, format, and updates. A health insurer shall make available to the public on a website a machine-readable prescription drug file that includes:(1)A health insurance oversight identifier or employer identification number;(2)The NDC and the proprietary and nonproprietary name assigned to the NDC by the Food and Drug Administration;(3)A negotiated rate that is:(a)Reflected as a dollar amount by an in-network provider, including an in-network pharmacy or other prescription drug dispenser;(b)Associated with the national provider identifier, tax identification number, or place of service code; and(c)Associated with the last date of the contract term; and(4)Historical net prices that are:(a)Reflected as a dollar amount by an in-network provider, including an in-network pharmacy or other prescription drug dispenser;(b)Associated with the national provider identifier, tax identification number, or place of service code; and(c)Associated with the ninety-day time period that begins one hundred eighty days prior to publication date of the machine-readable file for each provider-specific historical net price that applies to each NDC, unless a health insurer must omit data in relation to a particular NDC and provider when compliance with this subsection would require the health insurer to report payment of historical net prices calculated using fewer than twenty different claims for payments.The prescription drug file shall be available in the method and format as promulgated by the director in rule pursuant to chapter 1-26. The prescription drug file shall be publicly available and accessible to any person free of charge and without conditions, including the establishment of a user account, password, or other credentials, or submission of personally identifiable information to access the file.A health insurer shall update the prescription drug file monthly and indicate the date the file was most recently updated. Source: SL 2021, ch 213, § 5.
SD Codified L § 58-17K-6 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17K - Health Care Cost Transparency|Section 58-17K-6 - Cost-sharing information or prescription drug file--Third party contract to provide information--Health insurer responsible.

58-17K-6. Cost-sharing information or prescription drug file--Third party contract to provide information--Health insurer responsible. A health insurer may enter into a written agreement with a third-party administrator, health care claims clearinghouse, pharmacy benefit manager, or other third party to provide the required cost-sharing information or prescription drug file in compliance with this chapter. If a health insurer chooses to enter into an agreement and the contracted party fails to provide the information or file, the health insurer is in violation of this chapter. Source: SL 2021, ch 213, § 6.
SD Codified L § 58-17K-7 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17K - Health Care Cost Transparency|Section 58-17K-7 - Acting in good faith--Error or omission--Reliance on other entity.

58-17K-7. Acting in good faith--Error or omission--Reliance on other entity. A health insurer acting in good faith and with reasonable diligence is not in violation of this chapter solely because the health insurer:(1)Makes an error or omission in a disclosure required in this chapter, provided the health insurer corrects the information as soon as practicable; or(2)Maintains an internet website that is temporarily inaccessible, provided the health insurer makes the information available as soon as practicable.To the extent this chapter requires a health insurer to obtain information from any other entity, the health insurer does not fail to comply with this chapter if the health insurer relies in good faith on the information from the other entity, unless the health insurer knows, or reasonably should know, the information is incomplete or inaccurate. Source: SL 2021, ch 213, § 7.
SD Codified L § 58-17K-8 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17K - Health Care Cost Transparency|Section 58-17K-8 - Compliance with applicable laws required.

58-17K-8. Compliance with applicable laws required. Nothing in this chapter alters or affects a health insurer's duty to comply with requirements under applicable state and federal laws, including those governing accessibility, privacy, or security of information required to be disclosed under this chapter, or those governing the ability of properly authorized representatives to access enrollee information held by a health insurer. Source: SL 2021, ch 213, § 8.
SD Codified L § 58-17K-9 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17K - Health Care Cost Transparency|Section 58-17K-9 - Applicability to certain plans.

58-17K-9. Applicability to certain plans. Nothing in this chapter applies to:(1)A grandfathered health plan;(2)A health reimbursement arrangement or other account-based group health plan as defined in 29 CFR 2590.715-2711(d)(6) as of January 1, 2020;(3)A short term limited duration plan;(4)Accident insurance;(5)Credit insurance;(6)Disability income insurance;(7)Specified disease insurance;(8)Dental insurance;(9)Vision insurance;(10)Coverage issued as a supplement to liability insurance;(11)A medical payment under automobile or homeowner's insurance;(12)Insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability policy or equivalent self-insurance;(13)Hospital income or indemnity insurance;(14)Long-term care insurance; and(15)Medicare supplement insurance. Source: SL 2021, ch 213, § 9.
SD Codified L § 58-17K-10 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17K - Health Care Cost Transparency|Section 58-17K-10 - Rules and regulations.

58-17K-10. Rules and regulations. The director shall promulgate rules, pursuant to chapter 1-26, for the following:(1)The definition of terms;(2)Required cost-sharing liability disclosures;(3)The method and format requirements for disclosures;(4)Calculations pertaining to information, disclosure, and historical net prices under this chapter;(5)Required information, including bundled payment arrangements, preventive services, and accumulated amounts;(6)The applicability of this chapter to certain plans; and(7)If any federal standards are in place which would require additional steps to meet those standards beyond what is required by this chapter, additional rules to require the price transparency in this state to minimally meet the federal standards. Source: SL 2021, ch 213, § 10.
SD Codified L § 58-17K-11 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17K - Health Care Cost Transparency|Section 58-17K-11 - Plan years effective.

58-17K-11. Plan years effective. The provisions of § 58-17K-5 are effective for plan years beginning on or after January 1, 2022. The provisions of §§ 58-17K-2 to 58-17K-4, inclusive, are effective for plan years beginning on or after January 1, 2024. Source: SL 2021, ch 213, § 11.
SD Codified L § 58-18-1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 18 - Group And Blanket Health Insurance Policies|Section 58-18-1 - "Group health insurance" defined.

58-18-1. Group health insurance defined.Group health insurance is that form of health insurance covering groups of persons as defined in §§58-18-2 to 58-18-6, inclusive, with or without one or more members of their families or one or more of their dependents, or covering one or more members of the families or one or more dependents of such groups of persons, and issued upon the basis set forth in §§58-18-2 to 58-18-7, inclusive. Insurance issued on a blanket basis pursuant to §58-18-12 is a form of group health insurance. Source: SL 1966, ch 111, ch 26, §1; SL 2000, ch 250, §1.