reglab/housing_qa huggingface dataset:
SD Codified L § 58-29E-8 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29E - Pharmacy Benefits Management|Section 58-29E-8 - Dispensation of substitute prescription drug for prescribed drug.

58-29E-8. Dispensation of substitute prescription drug for prescribed drug.With regard to the dispensation of a substitute prescription drug for a prescribed drug to a covered individual, when the pharmacy benefits manager requests a substitution, the following provisions apply:(1)The pharmacy benefits manager may request the substitution of a lower- priced generic and therapeutically equivalent drug for a higher-priced prescribed drug;(2)With regard to substitutions in which the substitute drug's net cost is more for the covered individual or the covered entity than the prescribed drug, the substitution must be made only for medical reasons that benefit the covered individual. If a substitution is being requested pursuant to this subdivision, the pharmacy benefits manager shall obtain the approval of the prescribing health professional.Nothing in this section permits the substitution of an equivalent drug product contrary to §36-11-46.2 Source: SL 2004, ch 311, §8.
SD Codified L § 58-29E-8.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29E - Pharmacy Benefits Management|Section 58-29E-8.1 - Cost-sharing information not to be restricted.

58-29E-8.1. Cost-sharing information not to be restricted.A pharmacy benefits manager may neither prohibit nor penalize a pharmacist or pharmacy for providing cost-sharing information on the amount a covered individual may pay for a particular prescription drug. Source: SL 2018, ch 281, §1.
SD Codified L § 58-29E-9 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29E - Pharmacy Benefits Management|Section 58-29E-9 - Rules--Content.

58-29E-9. Rules--Content.The Division of Insurance shall promulgate rules, pursuant to chapter 1-26, to carry out the issuance of the license required by §58-29E-2 and the enforcement provisions of this chapter. The rules may include the following:(1)Definition of terms;(2)Use of prescribed forms;(3)Reporting requirements;(4)Enforcement procedures; and(5)Protection of proprietary information and trade secrets. Source: SL 2004, ch 311, §9.
SD Codified L § 58-29E-10 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29E - Pharmacy Benefits Management|Section 58-29E-10 - Civil action--Enforcement of chapter--Damages.

58-29E-10. Civil action--Enforcement of chapter--Damages.Any covered entity may bring a civil action to enforce the provisions of this chapter or to seek civil damages for the violation of its provisions. Source: SL 2004, ch 311, §10.
SD Codified L § 58-29E-11 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29E - Pharmacy Benefits Management|Section 58-29E-11 - Application of chapter to certain contracts.

58-29E-11. Application of chapter to certain contracts.The provisions of this chapter apply only to pharmacy benefits management services contracts entered into or renewed after June 30, 2004. Source: SL 2004, ch 311, §11.
SD Codified L § 58-29E-12 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29E - Pharmacy Benefits Management|Section 58-29E-12 - Requiring pharmacy to charge cost share that exceeds amount retained by pharmacy prohibited.

58-29E-12. Requiring pharmacy to charge cost share that exceeds amount retained by pharmacy prohibited.No pharmacy benefit manager shall contractually require a pharmacy, who is a participating provider in a health plan provided by a covered entity, to charge or collect from an insured a cost share for a prescription or pharmacy service that exceeds the amount retained by the pharmacist or pharmacy from all payment sources for the filling of the prescription or providing the pharmacy service. Source: SL 2019, ch 213, §1.
SD Codified L § 58-29E-13 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29E - Pharmacy Benefits Management|Section 58-29E-13 - Certain claims adjustments prohibited.

58-29E-13. Certain claims adjustments prohibited.No pharmacy benefit manager contracting with a covered entity shall retroactively adjust a claim for reimbursement submitted by a pharmacy for a prescription drug unless the adjustment is a result of either of the following:(1)A pharmacy audit conducted in accordance with chapter 58-29F; or(2)A technical billing error. Source: SL 2019, ch 213, §2.
SD Codified L § 58-29E-14 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29E - Pharmacy Benefits Management|Section 58-29E-14 - Adjustment of claim due to error in adjudication permitted.

58-29E-14. Adjustment of claim due to error in adjudication permitted.Nothing in §§58-29E-12 to 58-29E-15, inclusive, shall prohibit a pharmacy benefit manager from adjusting claim payment for the benefit of a covered individual if there was an error in the adjudication of a claim submitted by or on behalf of the covered individual. Source: SL 2019, ch 213, §3.
SD Codified L § 58-29E-15 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29E - Pharmacy Benefits Management|Section 58-29E-15 - Discrimination prohibited against pharmacy participating in health plan under Public Health Service Act.

58-29E-15. Discrimination prohibited against pharmacy participating in health plan under Public Health Service Act.No pharmacy benefit manager may discriminate against a pharmacy participating in a health plan as an entity authorized to participate under section 340B of the Public Health Service Act, as amended to January 1, 2019, or any pharmacy under contract with such an entity to provide prescriptions. For the purposes of this chapter, a retail pharmacy is any pharmacy licensed under the laws of this state, and no pharmacy benefit manager may, by contract, modify that definition. Source: SL 2019, ch 213, §4.
SD Codified L § 58-29F-1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29F - Pharmacy Audit Integrity Program|Section 58-29F-1 - Pharmacy audit integrity program established.

58-29F-1. Pharmacy audit integrity program established.The pharmacy audit integrity program is hereby established to provide standards for an audit of pharmacy records carried out by a pharmacy benefits manager or any entity that represents the pharmacy benefits manager. Source: SL 2013, ch 254, §1.
SD Codified L § 58-29F-2 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29F - Pharmacy Audit Integrity Program|Section 58-29F-2 - Definitions.

58-29F-2. Definitions.Term used in this chapter mean:(1)"Entity," a pharmacy benefits manager or any person or organization that represents these companies, groups, or organizations in any capacity;(2)"Plan sponsor," the employer in the case of an employee benefit plan established or maintained by a single employer or the employee organization in the case of a plan established or maintained by an employee organization, an association, joint board, trustee, committee, or other similar group that establishes or maintains the plan. Source: SL 2013, ch 254, §2.
SD Codified L § 58-29F-3 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29F - Pharmacy Audit Integrity Program|Section 58-29F-3 - Time for disclosing proposed change in pharmacy audit terms.

58-29F-3. Time for disclosing proposed change in pharmacy audit terms.The pharmacy benefits manager shall disclose an amendment to the pharmacy audit terms in a contract between a pharmacy and a pharmacy benefits manager to the pharmacy at least sixty days prior to the effective date of the proposed change. Source: SL 2013, ch 254, §3.
SD Codified L § 58-29F-4 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29F - Pharmacy Audit Integrity Program|Section 58-29F-4 - Requirements for conducting pharmacy audit.

58-29F-4. Requirements for conducting pharmacy audit.Unless otherwise prohibited by federal statutes or regulations, any entity conducting a pharmacy audit shall:(1)Give a pharmacy a minimum fourteen days written notice before conducting initial on-site audit;(2)Conduct an audit that involves clinical or professional judgment in consultation with a licensed pharmacist; and(3)Audit each pharmacy under the same standards and parameters as other similarly situated pharmacies. Source: SL 2013, ch 254, §4.
SD Codified L § 58-29F-5 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29F - Pharmacy Audit Integrity Program|Section 58-29F-5 - Audit terms.

58-29F-5. Audit terms.Unless otherwise prohibited by federal statutes or regulations, for any entity conducting a pharmacy audit the following audit items apply:(1)The period covered by the audit may not exceed twenty-four months from the date that the claim was submitted to or adjudicated by the entity, unless a longer period is required under state or federal law;(2)If an entity uses random sampling as a method for selecting a set of claims for examination, the sample size shall be appropriate for a statistically reliable sample. Notwithstanding any other provision, the auditing entity shall provide the pharmacy a masked list that provides a prescription number or date range that the auditing entity is seeking to audit;(3)An on-site audit may not take place during the first five business days of the months of December and January unless the pharmacy consents;(4)An auditor may not enter any portion of the pharmacy area where patient-specific information is available unless escorted, and to the extent possible shall remain out of sight and hearing range of the pharmacy patients;(5)Any recoupment may not be deducted against future remittances until final completion of any appeals process and both parties have received the results of the final audit;(6)A pharmacy benefits manager may not require information to be written on a prescription unless the information is required to be written on the prescription by state or federal law. Recoupment may be assessed for items not written on the prescription if:(a)Additional information is required in the provider manual; or(b)The information is required by the Food and Drug Administration; or(c)The information is required by the drug manufacturer's product safety program; and(d)The information in subsections (a), (b), or (c) is not readily available for the auditor at the time of the audit;(7)The auditing company or agent may not receive payment based on a percentage of the amount recovered. This section does not prevent the entity conducting the audit from charging or assessing the responsible party, directly or indirectly, based on amounts recouped if:(a)The plan sponsor and the entity conducting the audit have a contract that explicitly states the percentage charge or assessment to the plan sponsor; and(b)A commission to an agent or employee of the entity conducting the audit is not based, directly or indirectly, on amounts recouped. Source: SL 2013, ch 254, §5.
SD Codified L § 58-29F-6 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29F - Pharmacy Audit Integrity Program|Section 58-29F-6 - Recoupment or chargeback criteria.

58-29F-6. Recoupment or chargeback criteria.For recoupment or chargeback, the following criteria apply:(1)Audit parameters shall consider consumer-oriented parameters based on manufacturer listings;(2)A pharmacy's usual and customary price for compounded medications is considered the reimbursable cost unless the pricing methodology is outlined in the provider contract;(3)A finding of overpayment or underpayment can only be based on the actual overpayment or underpayment and not a projection based on the number of patients served having a similar diagnosis or on the number of similar orders or refills for similar drugs;(4)The entity conducting the audit may not use extrapolation in calculating the recoupment or penalties for audits unless required by state or federal law or regulation;(5)Calculations of overpayments may not include dispensing fees unless:(a)A prescription was not actually dispensed;(b)The prescriber denied authorization;(c)The prescription dispensed was a medication error by the pharmacy; or(d)The identified overpayment is solely based on an extra dispensing fee;(6)An entity may not consider any clerical or record-keeping error, such as a typographical error, scrivener's error, or computer error regarding a required document or record as fraud. However, such errors may be subject to recoupment;(7)In the case of errors that have no actual financial harm to the patient or plan, the pharmacy benefits manager may not assess any chargebacks. Errors that are a result of the pharmacy's failing to comply with a formal corrective action plan may be subject to recovery; and(8)Interest may not accrue during the audit period for either party. The audit period begins with the notice of the audit and ends with the final audit report. Source: SL 2013, ch 254, §6.
SD Codified L § 58-29F-7 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29F - Pharmacy Audit Integrity Program|Section 58-29F-7 - Validation of pharmacy record and delivery.

58-29F-7. Validation of pharmacy record and delivery.To validate the pharmacy record and delivery, the pharmacy may use authentic and verifiable statements or records including medication administration records of a nursing home, assisted living facility, hospital, physician, or other authorized practitioner or additional audit documentation parameters located in the provider manual. Any legal prescription that meets the requirements in this chapter may be used to validate claims in connection with prescriptions, refills, or changes in prescriptions, including medication administration records, faxes, e-prescriptions, or documented telephone calls from the prescriber or the prescriber's agents. Source: SL 2013, ch 254, §7.
SD Codified L § 58-29F-8 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29F - Pharmacy Audit Integrity Program|Section 58-29F-8 - Preliminary and final audit reports.

58-29F-8. Preliminary and final audit reports.A preliminary audit report shall be delivered to the pharmacy within sixty days after the conclusion of the audit. A pharmacy shall be allowed at least forty-five days following receipt of the preliminary audit, to provide documentation to address any discrepancy found in the audit. A final audit report shall be delivered to the pharmacy within one hundred twenty days after receipt of the preliminary audit report or final appeal, whichever is later. An entity shall remit any money due to a pharmacy or pharmacist as a result of an underpayment of a claim within forty-five days after the appeals process has been exhausted and the final audit report has been issued. Source: SL 2013, ch 254, §8.
SD Codified L § 58-29F-9 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29F - Pharmacy Audit Integrity Program|Section 58-29F-9 - Appeals process.

58-29F-9. Appeals process.The entity conducting the audit shall establish a written appeals process which shall include appeals of preliminary reports and final reports. Source: SL 2013, ch 254, §9.
SD Codified L § 58-29F-10 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29F - Pharmacy Audit Integrity Program|Section 58-29F-10 - Plan sponsor.

58-29F-10. Plan sponsor.If contractually required, an auditing entity shall provide a copy of the claims included in the audit to the plan sponsor, and any recouped money shall be returned to the plan sponsor. Source: SL 2013, ch 254, §10.
SD Codified L § 58-29F-11 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29F - Pharmacy Audit Integrity Program|Section 58-29F-11 - Chapter not applicable to investigative audits.

58-29F-11. Chapter not applicable to investigative audits.The provisions of this chapter do not apply to any investigative audit that involves fraud, willful misrepresentation, or on any audit completed by the State of South Dakota on health care programs operated by the state. Source: SL 2013, ch 254, §11.
SD Codified L § 58-29F-12 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 29F - Pharmacy Audit Integrity Program|Section 58-29F-12 - Civil action by pharmacy.

58-29F-12. Civil action by pharmacy.In addition to the remedies otherwise provided for in this chapter, in chapter 58-29E, or under general South Dakota law, any pharmacy subject to an audit procedure may bring a civil action to enforce the provisions of this chapter and to seek damages from the pharmacy benefits manager and any person or organization representing the entity during the audit process for the violation of the provisions of this chapter. Source: SL 2013, ch 254, §12.
SD Codified L § 58-30-1.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 30 - Insurance Producers|Section 58-30-1.1 - "Excess business" defined.

58-30-1.1. Excess business defined.Excess business is that portion of a risk which is in excess of the amount that an insurer then represented by the insurance producer will accept. Source: SL 1982, ch 365, §6; SL 2001, ch 286, §154.
SD Codified L § 58-30-6 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 30 - Insurance Producers|Section 58-30-6 - Appointment of insurance producer by insurer--Filing with director--Statement of kinds of insurance to be transacted--Payment of fee--Reasons for denying appointment.

58-30-6. Appointment of insurance producer by insurer--Filing with director--Statement of kinds of insurance to be transacted--Payment of fee--Reasons for denying appointment.The director may deny an appointment or withhold processing an appointment for reasons of protection of the public health, welfare, or safety including the following:(1)The insurance producer to be appointed is not properly licensed; or(2)A notice of hearing from the Division of Insurance seeking revocation or suspension of the insurance producer or insurer has been issued. Source: SL 1966, ch 111, ch 9, §20 (1); SL 1995, ch 289, §1; SL 2001, ch 286, §156.
SD Codified L § 58-30-8.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 30 - Insurance Producers|Section 58-30-8.1 - Notice required for termination of agency contract for fire and casualty lines--Extension of coverage on previous policies.

58-30-8.1. Notice required for termination of agency contract for fire and casualty lines--Extension of coverage on previous policies.No insurance company may terminate the agency contract of an insurance producer writing fire and casualty lines of insurance except upon ninety days' notice in writing given by the company to the insurance producer. The company shall, upon a terminated insurance producer's request, extend the coverage of any policy which has been written by the insurance producer in the company and which expires or has its anniversary date during the ninety-day period to the end of the ninety-day period if the insured pays the premium therefor. The company may terminate an insurance policy on its anniversary date if the anniversary date occurs after the expiration of the ninety-day period. Source: SL 1971, ch 271; SL 2001, ch 286, §158.
SD Codified L § 58-30-8.2 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 30 - Insurance Producers|Section 58-30-8.2 - Notice requirements inapplicable to exclusive agencies or termination for cause.

58-30-8.2. Notice requirements inapplicable to exclusive agencies or termination for cause.The provisions of §58-30-8.1 do not apply to those agency contracts in which the insurance producer agrees to represent exclusively one company or a group of companies under common management or to the termination of an insurance producer's contract for insolvency, abandonment, gross and willful misconduct, or failure to pay over to the company moneys due to the company after the insurance producer's receipt of a written demand therefor, or after revocation of the insurance producer's license by the director. Source: SL 1971, ch 271; SL 2001, ch 286, §159.
SD Codified L § 58-30-9 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 30 - Insurance Producers|Section 58-30-9 - Rights of insurance producer following termination of appointment.

58-30-9. Rights of insurance producer following termination of appointment.Following termination of an agency appointment as to property, casualty, or surety insurance, and subject to the terms of any agreement between the insurance producer and the insurer, the insurance producer may continue to service and receive from the insurer commissions or other compensation relative to business written by him the insurance producer during the existence of the appointment, so long as the insurance producer is licensed as an insurance producer. Source: SL 1966, ch 111, ch 9, §22 (1); SL 2001, ch 286, §160.
SD Codified L § 58-30-10 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 30 - Insurance Producers|Section 58-30-10 - Rights of insurance producer after termination of appointment inapplicable to employer and employee relationship.

58-30-10. Rights of insurance producer after termination of appointment inapplicable to employer and employee relationship.The provisions of §58-30-9 do not apply as to any insurer and insurance producer between whom the relationship of employer and employee exists. Source: SL 1966, ch 111, ch 9, §22 (2); SL 2001, ch 286, §161.
SD Codified L § 58-30-20 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 30 - Insurance Producers|Section 58-30-20 - Licensing provisions inapplicable to title insurance.

58-30-20. Licensing provisions inapplicable to title insurance.The provisions of §§58-30-12.1, 58-30-143, and 58-30-169 to 58-30-176, inclusive, do not apply to title insurance. Source: SL 1966, ch 111, ch 9, §7 (6); SL 2001, ch 286, §163.
SD Codified L § 58-30-23.6 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 30 - Insurance Producers|Section 58-30-23.6 - Criminal files check.

58-30-23.6. Criminal files check.For the purposes of §58-30-23.7 and §§58-30-170 and 58-30-180, the division may access the criminal files of any licensee convicted of a felony or crime of moral turpitude without any authorization from the licensee. Any law enforcement agency that possesses criminal records shall provide reasonable access by the division to the records. The provisions of this section do not affect the division's ability to otherwise exchange information or cooperate with any law enforcement agency or other authorized agency. Source: SL 1998, ch 297, §5; SL 2001, ch 286, §164.
SD Codified L § 58-30-23.7 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 30 - Insurance Producers|Section 58-30-23.7 - Joint issuance of waivers.

58-30-23.7.Joint issuance of waivers.The division may participate with the National Association of Insurance Commissioners and the insurance regulatory offices of other states regarding the issuance of waivers pursuant to 18 U.S. C. §§1033 and 1034 as amended to January 1, 1998. The issuance of a waiver by any state is not in any manner binding upon any licensing determination made or to be made by the division. Source: SL 1998, ch 297, §6.
SD Codified L § 58-30-27 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 30 - Insurance Producers|Section 58-30-27 - Licenses to insurance producers of domestic insurer insuring members of armed forces and dependents outside territorial limits.

58-30-27. Licenses to insurance producers of domestic insurer insuring members of armed forces and dependents outside territorial limits.If any domestic company is engaged in writing insurance on the lives or property of the members of the military forces of the United States, and dependents of the members while stationed outside the continental and territorial limits of the United States, the director, if otherwise satisfied as to the qualifications of applicants for licenses as insurance producers to write the business outside the continental and territorial limits of the United States, for the companies, may issue the same type of license to the insurance producers as to any resident insurance producer. Source: SL 1966, ch 111, ch 9, §9 (7); SL 2001, ch 286, §165.