reglab/housing_qa huggingface dataset:
SD Codified L § 58-17H-29 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-29 - Concurrent review determinations--Timing--Notification requirements.

58-17H-29. Concurrent review determinations--Timing--Notification requirements.For concurrent review determinations, if a health carrier has certified an ongoing course of treatment to be provided over a period of time or number of treatments:(1)Any reduction or termination by the health carrier during the course of treatment before the end of the period or number treatments, other than by health benefit plan amendment or termination of the health benefit plan, shall constitute an adverse determination; and(2)The health carrier shall notify the covered person of the adverse determination in accordance with §58-17H-32 at a time sufficiently in advance of the reduction or termination to allow the covered person or, if applicable, the covered person's authorized representative, to file a grievance to request a review of the adverse determination pursuant to chapter 58-17I, and obtain a determination with respect to that review of the adverse determination before the benefit is reduced or terminated.The health care service or treatment that is the subject of the adverse determination shall be continued without liability to the covered person until the covered person has been notified of the determination by the health carrier with respect to the internal review request made pursuant to chapter 58-17I. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub.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, §54.
SD Codified L § 58-17H-30 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-30 - Retrospective review determinations--Timing--Notification requirements.

58-17H-30. Retrospective review determinations--Timing--Notification requirements.For retrospective review determinations, the health carrier shall make the determination within a reasonable period of time, but in no event later than thirty days after the date of receiving the benefit request.In the case of a certification, the health carrier may notify in writing the covered person and the provider rendering the service.If the determination is an adverse determination, the health carrier shall provide notice of the adverse determination to the covered person or, if applicable, the covered person's authorized representative, in accordance with §58-17H-32. The time period for making a determination and notifying the covered person or, if applicable, the covered person's authorized representative, of the determination pursuant to this section may be extended once by the health carrier for up to fifteen days, if the health carrier:(1)Determines that an extension is necessary due to matters beyond the health carrier's control; and(2)Notifies the covered person or, if applicable, the covered person's authorized representative, prior to the expiration of the initial thirty-day time period, of the circumstances requiring the extension of time and the date by which the health carrier expects to make a determination.If the extension under this section is necessary due to the failure of the covered person or, if applicable, the covered person's authorized representative to submit information necessary to reach a determination on the request, the notice of extension shall specifically describe the required information necessary to complete the request and give the covered person or, if applicable, the covered person's authorized representative at least forty-five days from the date of receipt of the notice to provide the specified information. (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, §55.
SD Codified L § 58-17H-31 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-31 - Calculation of time period for determination for prospective and retrospective reviews.

58-17H-31. Calculation of time period for determination for prospective and retrospective reviews.For purposes of calculating the time periods within which a determination is required to be made for prospective and retrospective reviews, the time period within which the determination is required to be made begins on the date the request is received by the health carrier in accordance with the health carrier's procedures established pursuant to §58-17H-16. If the time period for making the determination for a prospective or retrospective review is extended due to the covered person or, if applicable, the covered person's authorized representative's failure to submit the information necessary to make the determination, the time period for making the determination shall be tolled from the date on which the health carrier sends the notification of the extension to the covered person or, if applicable, the covered person's authorized representative, until the earlier of: the date on which the covered person or, if applicable, the covered person's authorized representative, responds to the request for additional information or the date on which the specified information was to have been submitted. If the covered person or the covered person's authorized representative fails to submit the information before the end of the period of the extension, as specified in §§58-17H-28 and 58-17H-30, the health carrier may deny the certification of the requested benefit. (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, §56.
SD Codified L § 58-17H-33 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-33 - Information required to be provided to covered persons and prospective covered persons.

58-17H-33. Information required to be provided to covered persons and prospective covered persons.In the certificate of coverage or member handbook provided to covered persons, a health carrier shall include a clear and comprehensive description of its utilization review procedures, including the procedures for obtaining review of adverse determinations, and a statement of rights and responsibilities of covered persons with respect to those procedures. A health carrier shall include a summary of its utilization review and benefit determination procedures in materials intended for prospective covered persons. A health carrier shall print on its membership cards a toll-free telephone number to call for utilization review and benefit decisions. (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, §58.
SD Codified L § 58-17H-34 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-34 - Health carrier may be deemed to meet utilization review requirements if met by private accrediting body.

58-17H-34. Health carrier may be deemed to meet utilization review requirements if met by private accrediting body.If the director and the secretary find that the requirements of any private accrediting body meet the requirements of utilization review as set forth in this chapter, the health 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, §59.
SD Codified L § 58-17H-35 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-35 - Registration of utilization review organizations--Required information.

58-17H-35. Registration of utilization review organizations--Required information.Any utilization review organization which engages in utilization review activities in this state shall register with the Division of Insurance prior to conducting business in this state. The registration shall be in a format prescribed by the director. In prescribing the form or in carrying out other functions required by §§58-17H-35 to 58-17H-39, inclusive, the director shall consult with the secretary if applicable. The director or the secretary may require that the following information be submitted:(1)Information relating to its actual or anticipated activities in this state;(2)The status of any accreditation designation it holds or has sought;(3)Information pertaining to its place of business, officers, and directors;(4)Qualifications of review staff; and(5)Any other information reasonable and necessary to monitor its 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, §60.
SD Codified L § 58-17H-36 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-36 - Filing changes in registration information.

58-17H-36. Filing changes in registration information.Any utilization review organization which has previously registered in this state shall, on or before July first of each year, file with the Division of Insurance any changes to the initial or subsequent annual registration for the utilization review organization. (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, §61.
SD Codified L § 58-17H-37 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-37 - Requests for information from utilization review organizations.

58-17H-37. Requests for information from utilization review organizations.The director or the secretary may request information from any utilization review organization at any time pertaining to its activities in this state. The utilization review organization 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, §62.
SD Codified L § 58-17H-38 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-38 - Activities of nonregistered utilization review organizations prohibited.

58-17H-38. Activities of nonregistered utilization review organizations prohibited.A utilization review organization may not engage in utilization review in this state unless the utilization review organization is properly registered. The director may issue a cease and desist order against any utilization review organization which fails to comply with the requirements of §§58-17H-35 to 58-17H-39, inclusive, prohibiting the utilization review organization from engaging in utilization review 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, §63.
SD Codified L § 58-17H-39 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-39 - Registration fee for utilization review organizations.

58-17H-39. Registration fee for utilization review organizations.The director may require the payment of a fee in conjunction with the initial or annual registration of a utilization review organization 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, §64.
SD Codified L § 58-17H-40 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-40 - Urgent care requests--Written procedures required for receipt and determination of requests.

58-17H-40. Urgent care requests--Written procedures required for receipt and determination of requests.Each health carrier shall establish written procedures, in accordance with §§58-17H-40 to 58-17H-48, inclusive, for receiving benefit requests from covered persons or their authorized representatives and for making and notifying covered persons or their authorized representatives of expedited utilization review and benefit determinations with respect to urgent care requests and concurrent review urgent care requests. (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, §65.
SD Codified L § 58-17H-41 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-41 - Insufficient information for determination--Notice and statement of necessary information.

58-17H-41. Insufficient information for determination--Notice and statement of necessary information.If the covered person or, if applicable, the covered person's authorized representative has failed to provide sufficient information for the health carrier to make a determination, the health carrier shall notify the covered person or, if applicable, the covered person's authorized representative, either orally or, if requested by the covered person or the covered person's authorized representative, in writing of this failure and state what specific information is needed as soon as possible, but in no event later than twenty-four hours after receipt of the 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, §66.
SD Codified L § 58-17H-42 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-42 - Insufficient information for determination of prospective urgent care requests.

58-17H-42. Insufficient information for determination of prospective urgent care requests.If the benefit request involves a prospective review urgent care request, the provisions of §58-17H-41 apply only in the case of a failure that:(1)Is a communication by a covered person or, if applicable, the covered person's authorized representative, that is received by a person or organizational unit of the health carrier responsible for handling benefit matters; and(2)Is a communication that refers to a specific covered person, a specific medical condition or symptom, and a specific health care service, treatment, or provider for which approval is being 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, §67.
SD Codified L § 58-17H-43 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-43 - Urgent care requests--Timely notification of determination.

58-17H-43. Urgent care requests--Timely notification of determination.For an urgent care request, unless the covered person or the covered person's authorized representative has failed to provide sufficient information for the health carrier to determine whether, or to what extent, the benefits requested are covered benefits or payable under the health carrier's health benefit plan, the health carrier shall notify the covered person or, if applicable, the covered person's authorized representative of the health carrier's determination with respect to the request, whether or not the determination is an adverse determination, as soon as possible, taking into account the medical condition of the covered person, but in no event later than twenty-fours hours after the date of the receipt of the request by the health carrier. If the health carrier's determination is an adverse determination, the health carrier shall provide notice of the adverse determination in accordance with §58-17H-48. (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, §68.
SD Codified L § 58-17H-44 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 17H - Utilization Review And Benefit Determinations|Section 58-17H-44 - Time within which to submit necessary information.

58-17H-44. Time within which to submit necessary information.The health carrier shall provide the covered person or, if applicable, the covered person's authorized representative, a reasonable period of time to submit the necessary information, taking into account the circumstances, but in no event less than forty-eight hours after the date of notifying the covered person or the covered person's authorized representative of the failure to submit sufficient information, as provided in §§58-17H-41 and 58-17H-42. (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, §69.