Court Opinion

ID: 9931212
Source: CourtListenerOpinion
Date Created: 2024-02-08 17:11:06.833743+00
Date Added: 2024-06-11T12:17:14.611857
License: Public Domain

#30207-a-SRJ
2024 S.D. 9

                      IN THE SUPREME COURT
                              OF THE
                     STATE OF SOUTH DAKOTA

                              ****

ORTHOPEDIC INSTITUTE, P.C.;
SIOUX FALLS SPECIALTY HOSPITAL,
LLP; SIOUX FALLS SPECIALTY
HOSPITAL, LLP d/b/a SIOUX FALLS
URGENT CARE; SIOUX FALLS
SPECIALTY HOSPITAL, LLP d/b/a
WORKFORCE OCCUPATIONAL HEALTH
AND MEDICAL SERVICES; SIOUX FALLS
SPECIALTY HOSPITAL, LLP d/b/a
MIDWEST PAIN SPECIALISTS; SIOUX
FALLS SPECIALTY HOSPITAL, LLP d/b/a
MIDWEST IMAGING; OPHTHALMOLOGY
LTD, INC.; and OPHTHALMOLOGY LTD,
EYE SURGERY CENTER, LLC,              Plaintiffs and Appellees,

     v.

SANFORD HEALTH PLAN, INC.,            Defendant and Appellant.

                              ****

                APPEAL FROM THE CIRCUIT COURT OF
                   THE SECOND JUDICIAL CIRCUIT
                MINNEHAHA COUNTY, SOUTH DAKOTA

                              ****

               THE HONORABLE RACHEL R. RASMUSSEN
                             Judge

                              ****

                                      ARGUED
                                      AUGUST 30, 2023
                                      OPINION FILED 02/07/24
                                      ****

MARK W. HAIGH
DELIA M. DRULEY of
Evans, Haigh & Arndt, LLP
Sioux Falls, South Dakota

MARTIN S. CHESTER
KATE E. MIDDLETON
JOSIAH D. YOUNG of
Faegre, Drinker, Biddle
  & Reath, LLP
Minneapolis, Minnesota                       Attorneys for defendant and
                                             appellant.

ANDREW DAMGAARD
JORDAN J. FEIST of
Woods, Fuller, Shultz & Smith, P.C.
Sioux Falls, South Dakota                    Attorneys for plaintiffs and
                                             appellees.
#30207

JENSEN, Chief Justice

[¶1.]        Several physician groups and health care facilities (Providers) sought a

declaratory judgment establishing their right to participate as panel providers in

each of the health benefit plans offered by Sanford Health Plan, Inc. (SHP),

pursuant to the “Any Willing Provider” law found in SDCL 58-17J-2. Providers and

SHP filed cross-motions for summary judgment asking the circuit court to interpret

the application of SDCL 58-17J-2. The circuit court granted Providers’ motion for

summary judgment and denied SHP’s motion. The court determined that SDCL 58-

17J-2 does not permit SHP to exclude a fully qualified and willing health care

provider from participating as a panel provider in every health benefit plan offered

by SHP. We affirm.

                      Factual and Procedural Background

[¶2.]        Providers are comprised of health care professionals licensed by the

State Boards of Medical and Osteopathic Examiners, Optometry, or Nursing. Each

health care professional employed by Providers is board certified within each of

their specialties. Additionally, each medical facility is licensed by the South Dakota

Department of Health.

[¶3.]        SHP is a taxable, non-profit corporation with its principal place of

business in Sioux Falls. SHP is a wholly owned subsidiary of Sanford Health, a

South Dakota health care system headquartered in Sioux Falls. SHP has been

authorized by the South Dakota Division of Insurance to provide health benefit

plans to South Dakota residents.

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[¶4.]         SHP currently offers its insureds four primary health benefit plans:

Simplicity Plan, Signature Series Plan, Sanford TRUE Plan, and Sanford PLUS

Plan. These plans are offered to individuals, as well as large and small employer

groups. While some of SHP’s plans include its entire panel of providers, others

include a smaller sub-panel of providers. Plans that do not include SHP’s entire

panel of providers are identified as “focused” plans, while those that include SHP’s

entire panel of providers are known as “broad” plans. 1 SHP represents that it

requires prospective insureds to be given the choice between a broad plan and a

focused plan prior to selecting a health benefit plan.

[¶5.]         The Sanford Simplicity Plan is offered to individuals and small

employers (50 or less employees) while the Signature Series Plan is offered to large

employers (50 or more employees). These broad plans provide insureds with the

largest number of panel providers. The Providers are panel providers within the

Sanford Simplicity and Signature Series plans.

[¶6.]         The TRUE Plan is a focused plan offered to both large and small

employers as well as individuals. The TRUE Plan’s panel of providers consists

primarily of Sanford Health providers as well as other providers necessary to meet

network adequacy requirements. The TRUE Plan provides no health insurance

benefits to insureds who receive non-emergency care from non-panel providers.

Thus, an insured covered by the TRUE Plan must pay the entire cost of medical

care received by a non-panel TRUE Plan provider. Providers are non-panel

1.      SHP’s broad plans include some 25,000 health care providers. In contrast,
        there are as few as 2,500 providers within its TRUE Plan, the smallest
        “focused” plan.
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providers under the TRUE Plan and claim to have turned away TRUE Plan

insureds who are unable to afford the entire cost of health care received by a non-

panel provider.

[¶7.]        The PLUS Plan, offered to large employers, includes SHP’s entire

panel of providers, however, the plan divides providers into two tiers. Tier 1 is

closely related to the panel of providers offered in the TRUE Plan, comprised

primarily of Sanford Health providers and facilities. Care received from Tier 1

providers results in the lowest out-of-pocket cost for the insured. Tier 2 has a

broader panel of health care providers that expands beyond the Sanford Health

system and has higher out-of-pocket costs for the insured. Providers are Tier 2

providers under the PLUS Plan.

[¶8.]        Providers claim they are fully qualified under SDCL 58-17J-2 and

willing to meet SHP’s terms and conditions to participate as panel providers in the

TRUE Plan, and as Tier 1 providers in the PLUS Plan. Prior to commencing this

action, Providers requested to participate as panel providers for both plans. SHP

denied Providers’ requests, maintaining that the focused plans allow insureds to

choose a less expensive health care plan as a tradeoff for a narrower choice of health

care providers.

[¶9.]        In response to SHP’s denial, Providers filed suit on September 21,

2021, seeking a declaratory judgment pursuant to SDCL 58-17J-2 to allow

Providers to participate as panel providers in the True Plans, and as Tier 1 panel

providers in the PLUS plan. Providers filed a motion for summary judgment

alleging that there was no genuine dispute as to any material fact relating to the

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application of SDCL 58-17J-2 and that SHP may not exclude them from

participating as panel providers in the TRUE Plans and Tier 1 of the PLUS Plan.

SHP filed an opposition to Providers’ motion for summary judgment as well as a

cross-motion for summary judgment alleging Providers lacked standing to assert a

declaratory judgment claim under SDCL 58-17J-2. In its cross-motion for summary

judgment, SHP alleged that it complied with the statute by offering prospective

insureds a choice between plans that include a broad panel of providers and a

focused panel of providers.

[¶10.]         The circuit court issued a memorandum opinion and order granting

Providers’ motion for summary judgment and denying SHP’s motion. The circuit

court held that Providers have standing to bring their suit, 2 and determined that

SDCL 58-17J-2 does not “allow a health insurer to exclude a health care provider

from a health benefit plan’s panel of providers who is (1) licensed under the laws of

South Dakota; (2) located within the geographic coverage area of the health benefit

plan; and (3) willing and fully qualified to meet the terms and conditions of

participation as established by the health insurer.”

[¶11.]         SHP filed a notice of appeal, raising two issues:

               1.    Whether SDCL 58-17J-2 allows a health insurer to
                     exclude a provider from participating as a panel provider
                     in a health benefits plan for any reason other than those
                     included within the statute.

               2.    Whether the circuit court erred in concluding there was
                     no genuine dispute of material fact precluding entry of
                     summary judgment in favor of Providers.

2.       SHP has not appealed the circuit court’s standing determination.
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                                Standard of Review

[¶12.]       This Court has routinely held that “[s]tatutory interpretation and

application are questions of law that we review de novo.” Krsnak v. S.D. Dep’t of

Env’t and Nat. Res., 2012 S.D. 89, ¶ 8, 824 N.W.2d 429, 433 (alteration in original)

(quoting State v. Goulding, 2011 S.D. 25, ¶ 5, 799 N.W.2d 412, 414). “We review a

circuit court’s entry of summary judgment under the de novo standard of review.”

Harvieux v. Progressive N. Ins. Co., 2018 S.D. 52, ¶ 9, 915 N.W.2d 697, 700 (citation

omitted). Our rules for reviewing the entry of summary judgment under SDCL 15-

6-56(c) are well settled:

             Summary judgment is proper where, the pleadings, depositions,
             answers to interrogatories, and admissions on file, together with
             the affidavits, if any, show that there is no genuine issue as to
             any material fact and that the moving party is entitled to
             judgment as a matter of law. We will affirm only when no
             genuine issues of material fact exist and the law was applied
             correctly. We make all reasonable inferences drawn from the
             facts in the light most favorable to the non-moving party. In
             addition, the moving party has the burden of clearly
             demonstrating an absence of any genuine issue of material fact
             and an entitlement to judgment as a matter of law.

Garrido v. Team Auto Sales, Inc., 2018 S.D. 41, ¶ 15, 913 N.W.2d 95, 100 (quoting

McKie Ford Lincoln, Inc. v. Hanna, 2018 S.D. 14, ¶ 8, 907 N.W.2d 795, 798).

                                       Analysis

             1.     South Dakota’s Any Willing Provider Law.

[¶13.]       In 2014, South Dakota voters approved Initiated Measure 17, also

referred to as the State’s “Any Willing Provider Law”. 2015 S.D. Sess. Laws ch.

278, § 1. Initiated Measure 17 is codified at SDCL 58-17J-2. The purpose of the

statute is to secure patient choice in the selection of health care, and provides:

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               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.

[¶14.]         SHP argues that SDCL 58-17J-2 does not require a health insurer to

include any “willing and fully qualified” health care provider in every plan it offers

as long as insureds have the ability to choose a broad plan that includes the

insurers’ entire panel of providers. SHP highlights that it offers both focused and

broad plans to insureds prior to selecting a plan, giving them the choice to select a

plan that includes every willing and fully qualified provider within SHP’s panel of

providers. SHP argues it complies with SDCL 58-17J-2 because it accepts any

willing and fully qualified provider into its overall panel of providers, creates plans

with both broad and focused panels of providers, and affords insureds a choice

between focused and broad plans. In other words, SHP contends that the statute is

“insurer specific” rather than “plan specific.” SHP also argues that the circuit

court’s plan-specific reading of SDCL 58-17J-2 would implicitly repeal or nullify

several statutory provisions by making both closed and tiered plans illegal.

[¶15.]         In contrast, Providers argue, consistent with the circuit court’s reading

of the statute, that SDCL 58-17J-2 is plan-specific. In their view, if a provider is

willing and fully qualified, an insurer may not exclude the provider from any plan

offered by the health insurer. Providers maintain that an insurer may only exclude

a willing provider from participating in a plan based upon the criteria established in

the statute.

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[¶16.]       “The purpose of statutory interpretation is to discover legislative

intent.” State v. Bryant, 2020 S.D. 49, ¶ 20, 948 N.W.2d 333, 338 (quoting State v.

Mundy-Geidd, 2014 S.D. 96, ¶ 5, 857 N.W.2d 880, 883). “[T]he starting point when

interpreting a statute must always be the language itself.” Id. (alteration in

original) (quoting State v. Livingood, 2018 S.D. 83, ¶ 31, 921 N.W.2d 492, 499).

This Court “give[s] words their plain meaning and effect, and read[s] statutes as a

whole.” Id. (quoting Reck v. S.D. Bd. of Pardons & Paroles, 2019 S.D. 42, ¶ 8, 932

N.W.2d 135, 138). Lastly, “[w]hen the language in a statute is clear, certain and

unambiguous, there is no reason for construction, and the Court’s only function is to

declare the meaning of the statute as clearly expressed.” State v. Bettelyoun, 2022

S.D. 14, ¶ 24, 972 N.W.2d 124, 131 (quoting State v. Armstrong, 2020 S.D. 6, ¶ 16,

939 N.W.2d 9, 13).

[¶17.]       The plain language of SDCL 58-17J-2 prohibits an insurer from

“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.” While the statutory prohibition is extended to health insurers,

the language is plan-specific by providing that an insurer may not exclude any

willing and fully qualified provider “located within the geographic coverage area of

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the health benefit plan.…” Id. (Emphasis added). When reading the statute as a

whole, a “health insurer’s panel of providers” is specific to each individual plan. 3

[¶18.]         SDCL 58-17J-2 clearly defines the grounds for which an insurer may

exclude a provider from a health benefit plan’s panel of providers. These include

providers who are not: (1) licensed under the laws of South Dakota; (2) located

within the geographic coverage area of the plan; or (3) willing and fully qualified to

meet the terms and conditions established by the health insurer. SDCL 58-17J-2.

Any other reason offered by an insurer for obstructing a health care provider from

joining a particular plan is impermissible under SDCL 58-17J-2. 4

[¶19.]         We also cannot accept SHP’s argument that a plan-specific

interpretation of SDCL 58-17J-2 will implicitly repeal or nullify several statutory

provisions by making both closed and tiered plans illegal. “Where conflicting

statutes appear, it is the responsibility of the court to give a reasonable construction

3.       This reading of the statute is consistent with other interpretations of
         similarly written statutes. See Idaho Cardiology Assocs., P.A. v. Idaho
         Physicians Network, Inc., 108 P.3d 370, 374–75 (Idaho 2005) (stating that
         “the Idaho Legislature’s primary purpose in enacting the any willing provider
         statute was to preserve, to the maximum extent possible, the right of a
         patient to select his own treatment provider, subject only to the provider’s
         willingness and ability to comply with the basic requirements of the managed
         care plan.”) (emphasis added).

4.       SHP in its briefs, and Avera Health Plans, Inc. in its amicus brief, assert
         policy concerns with a plan-specific reading of SDCL 58-17J-2. They argue
         the circuit court’s interpretation will increase health insurance premiums by
         requiring health insurers to maintain a broad panel of providers for every
         plan they offer. However, policy and economic implications of the statute are
         not at play in our interpretation of the statute. “[T]he Court’s only function is
         to declare the meaning of the statute as clearly expressed.” Bettelyoun, 2022
         S.D. 14, ¶ 24, 972 N.W.2d at 131 (quoting Armstrong, 2020 S.D. 6, ¶ 16, 939
         N.W.2d at 13).
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to both, and to give effect, if possible, to all provisions under consideration,

construing them together to make them harmonious and workable.” In re Approval

for Request for Amend. to Frawley Planned Unit Dev., 2002 S.D. 2, ¶ 17, 638 N.W.2d

552, 557 (quoting Karlen v. Janklow, 339 N.W.2d 322, 323 (S.D. 1983)). “Repeal by

implication will be indulged only where there is a manifest and total repugnancy.”

Id. (quoting Karlen, 339 N.W.2d at 323). “If, by any reasonable construction, both

acts can be reconciled, they should be.” Id. (quoting Karlen, 339 N.W.2d at 323).

[¶20.]        Closed plans are defined several times throughout Title 58. See SDCL

58-17F-1(1); 58-17G-1(1); 58-17I-1(8); 58-18A-53(3). A “closed plan” is defined as:

              a managed care plan or health carrier that requires covered
              persons to use participating providers under the terms of the
              managed care plan or health carrier and does not provide any
              benefits for out-of-network services except for emergency
              services.

SDCL 58-17F-1(1); 58-17G-1(1); and 58-17I-1. Whereas a “closed panel plan” is

defined as:

              a plan that provides health benefits to covered persons primarily
              in the form of services through a panel of providers that have
              contracted with or are employed by the plan and that excludes
              benefits for services provided by other providers, except in cases
              of emergency or referral by a panel member.

SDCL 58-18A-53(3). These definitions do not conflict with a plan-specific reading of

SDCL 58-17J-2. For instance, insurers are still permitted by SDCL 58-17J-2 to

exclude providers from plans if they do not meet the statutory requirements for

participation as a panel provider. Closed plans remain closed according to their

definitions because an insurer may still refuse to provide benefits to an insured

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seeking non-emergency health-care from a provider who is not a willing and fully

qualified provider within the meaning of SDCL 58-17J-2.

[¶21.]       Additionally, SDCL 58-17J-2 was passed by initiated measure on

behalf of South Dakota residents. See Brendtro v. Nelson, 2006 S.D. 71, ¶ 29, 720

N.W.2d 670, 680 (quoting Byre v. City of Chamberlain, 362 N.W.2d 69, 79 (S.D.

1985)) (“The purpose of the initiative is not to curtail or limit legislative power to

enact laws, but rather to compel enactment of measures desired by the people, and

to empower the people, in the event the legislature fails to act, or enact such

measures themselves.”). In general, “the drafters who frame an initiative statute

and the voters who enact it may be deemed to be aware of existing law.” 42 Am.

Jur. 2d Initiative and Referendum § 49 (2023). Furthermore, “[a]n initiative

petition may amend existing law by repealing parts of recent legislation along with

proposing new laws.” Id. Therefore, even if there are other statutes potentially in

conflict with SDCL 58-17J-2, the voters are presumed to have voted having

knowledge of all relevant statutes, and possess the authority to impliedly repeal

conflicting statutes.

[¶22.]       Providers’ complaint sought a judicial declaration that SHP’s TRUE

and PLUS plans are inconsistent with SDCL 58-17J-2. We conclude that because

the TRUE Plan excludes providers for reasons other than the three reasons

identified in the statute, the TRUE Plan is inconsistent with SDCL 58-17J-2.

[¶23.]       In turning to the PLUS Plan, although SDCL 58-17J-2 does not

specifically address excluding panel providers within tiers, the statute does

unambiguously provide that a health insurer may not exclude “a health care

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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[.]” SDCL 58-17J-2. Just as an insurer may not

exclude any willing and fully qualified provider from joining a plan, an insurer may

not exclude such a provider from participating as a panel provider in any tier within

a plan. Tier 1 of the PLUS Plan obstructs patient choice by excluding Providers for

reasons other those permitted by the statute. 5 See Northeast Ga. Cancer Care, LLC

v. Blue Cross Blue Shield of Ga., Inc., 726 S.E.2d 714, 720 (Ga. Ct. App. 2012)

(stating that although insurers are permitted to designate preferred providers

within a plan, providers “meeting the statutorily defined criteria ‘shall be given the

opportunity to apply and to become a preferred provider,’ and they cannot be

discriminated against for the specified improper reasons.”) (internal citations

omitted).

[¶24.]         SDCL 58-17J-2 is a plan-specific statute. By its plain terms, SDCL 58-

17J-2 does not permit SHP to exclude any statutorily qualified and willing health

care provider from its plans or exclude those same providers from any tier within a

plan.

5.       For example, an insured covered by the PLUS Plan could choose to receive
         care from a Tier 2 provider. However, due to financial barriers created by
         higher out-of-pocket costs for care received from a Tier 2 provider, the
         insured may be forced to stay with a Tier 1 provider.
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             2.    The circuit court’s summary judgment
                   determination.

[¶25.]       SHP argues that the circuit court erred in determining there was “no

genuine issue of material fact regarding [Providers’] qualifications and willingness

to accept SHP’s terms.” SHP maintains that the “unrebutted evidence shows that

the terms and conditions for participating in a health benefit plan are negotiated

individually and vary between providers.” As a result, it claims, reimbursement

rates may differ between providers. SHP also points to the deposition testimony of

Stan Gebhart, the corporate representative of a Provider, that he could not predict

all the terms, conditions, and contract provisions that might arise in contract

negotiations with SHP and that some of these could be “deal breakers”.

[¶26.]       SHP agrees with the circuit court that Providers are “fully qualified”

within the meaning of SDCL 58-17J-2. However, SHP claims that questions of fact

remain as to whether Providers are “willing” within the meaning of the statute

because Providers may not consent to the “terms and conditions of participation [in

a particular plan] as established by [SHP].” This misapprehends the issues

presented and resolved on summary judgment. In their complaint and motion for

summary judgment, Providers sought a judicial declaration, pursuant to SDCL 58-

17J-2, that they were entitled to participate as panel providers in each health care

plan offered by SHP. This case does not concern the specific terms and conditions

that SHP has offered Providers to participate in the TRUE plan and Tier 1 of the

PLUS plan. SHP acknowledges it has not offered Providers an agreement with

terms and conditions to participate in each plan. Instead, the dispute involves the

interpretation of SDCL 58-17J-2 and whether SHP may exclude Providers from

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their plans for reasons not set forth in this statute. As Providers alleged in their

complaint, a “controversy exists between [Providers] and [SHP] with respect to the

interpretation of SDCL 58-17J-1 and SDCL 58-17J-2.”

[¶27.]       In ruling on the cross-motions for summary judgment, the circuit court

recognized the possibility that a dispute may arise concerning the terms SHP offers

Providers, stating that “[e]ven if there is a dispute between the parties about the

specific terms and conditions of any one plan, such a dispute would not preclude

summary judgment because it is not a material fact that would change the outcome

of the court’s interpretation of [SDCL 58-17J-2].” In ruling on the cross-motions for

summary judgment, the court interpreted the statute and held that “South Dakota

does not allow a health insurer to exclude a health care provider from a health

benefit plan’s panel of providers who is (1) licensed under the laws of South Dakota;

(2) located within the geographic coverage area of the health benefit plan; and (3)

willing and fully qualified to meet the terms and conditions of participation as

established by the health insurer.” We agree with the circuit court’s resolution of

the summary judgment motion. While Providers have generally stated their

willingness to participate as panel providers in each of SHP’s plans, the specific

terms and conditions of any agreement allowing Providers to participate as panel

providers was not presented to the circuit court.

[¶28.]       Furthermore, the record does not reflect that Providers have been

offered specific terms and conditions to participate as a panel provider in the TRUE

plan or Tier 1 of the Plus plan. Given SHP’s refusal to consider Providers’ requests

to be included on each plan’s panel of providers, any potential dispute concerning

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the specific “terms and conditions of participation as established by the health

insurer” is not appropriate for resolution at this time. See MacKaben v. MacKaben,

2015 S.D. 86, ¶ 14, 871 N.W.2d 617, 623 (quoting Boever v. S.D. Bd. of Acct., 526

N.W.2d 747, 750 (S.D. 1995) (“A matter is sufficiently ripe if the facts indicate

imminent conflict.”). An issue that is dependent upon “the future occurrence of

conduct and events that [are] uncertain and unknown” present no real controversy

and are thus not ripe for review. See Boever, 526 N.W.2d at 750 (holding that an

accountant’s constitutional challenge of the South Dakota Board of Accountancy’s

quality review was not ripe because “his constitutional challenge to that statute was

dependent upon the future occurrence of conduct and events that were uncertain

and unknown.” As such, there was “was no real, present or imminent controversy

presented[.]”). However, once Providers request to participate as panel providers of

the TRUE Plan and Tier 1 of the PLUS Plan, they must be considered and offered

terms and conditions for participation.

[¶29.]       The circuit court did not err in granting Providers’ motion for summary

judgment and declaring that pursuant to SDCL 58-17J-2, SHP may not exclude a

qualified and willing provider from participating as a panel provider in either the

TRUE Plan or Tier 1 of the PLUS Plan. The possibility that SHP or a particular

Provider are unable to agree to the specific terms and conditions to provide health

services under SHP’s plans do not, on this record, preclude a judicial declaration

concerning the meaning of SDCL 58-17J-2. SHP may not exclude Providers from

participating in their plans except for the reasons specified in the statute. The

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circuit court did not err in granting summary judgment on the application of SDCL

58-17J-2 to the SHP’s TRUE Plan and PLUS Plan.

[¶30.]       We affirm.

[¶31.]       KERN, DEVANEY, and MYREN, Justices, and LOVRIEN, Circuit

Court Judge, concur.

[¶32.]       LOVRIEN, Circuit Court Judge, sitting for SALTER, Justice, who

recused himself and did not participate.

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