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South Dakota Laws > Title 58 > Chapter 17C - Standards For Managed Care Plans

^{Current as of: 2010}

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§ 58-17C-1	Definitions
§ 58-17C-10	Health carrier to ensure provider proximity to covered persons
§ 58-17C-13	Access plan required for managed care plans--Annual update--Contents--Discounted fee-for-service networks exempt
§ 58-17C-15	Provisions governing contractual arrangements between health carriers and intermediaries
§ 58-17C-16	Sample contract forms to be filed with director--Material changes to be submitted to director--Certain changes not material--Director's inaction within certain time deemed approval--Contract copies to be provided director, department upon request
§ 58-17C-17	Contract does not relieve health carrier of liability
§ 58-17C-24	If private accrediting body satisfies requirements of §§ 58-17C-7 to 58-17C-26, inclusive, carrier may be deemed to have done so
§ 58-17C-26	Division of Insurance to monitor complaints against individual policies
§ 58-17C-34	Applicability of chapter 17C
§ 58-17C-36	Director to hold health carrier responsible for utilization review performance of contractor
§ 58-17C-40	Determinations to be issued in a timely manner--Process to ensure consistency
§ 58-17C-45	Health carrier to provide free access to review staff
§ 58-17C-49	Prospective review determinations--Timing--Notification of requirements--Extension of time
§ 58-17C-50	Concurrent review determinations--Timing--Notification requirements
§ 58-17C-54	Information required to be provided to covered persons and prospective covered persons
§ 58-17C-58	Establishment of grievance system by managed care plan or utilization review organization
§ 58-17C-59	Record of grievances--Report
§ 58-17C-60	Maintenance of grievance records--Accessibility
§ 58-17C-63	Promulgation of rules for grievance system
§ 58-17C-67	Activities of nonregistered utilization review organizations prohibited
§ 58-17C-68	Registration fee for utilization review organizations
§ 58-17C-70	Urgent care request defined
§ 58-17C-75	Time within which to submit necessary information
§ 58-17C-77	Concurrent review urgent care requests--Requests for extended care--Time to make determination and provide notice
§ 58-17C-83	Review of adverse determinations--Time for filing--Designation and notice of reviewers--Scope of review
§ 58-17C-84	Review of adverse determinations--Rights of covered person or authorized representative--Access to documentation
§ 58-17C-85	Review of adverse determinations--Time for issuing decisions and providing notice--Calculation of time periods
§ 58-17C-86	Issuance of decision--Required contents
§ 58-17C-87	Health carrier to establish review procedures for grievances not involving adverse determinations
§ 58-17C-88	Standard review--Covered persons or authorized representatives entitled to submit written material only
§ 58-17C-92	Additional voluntary review--Right of covered person to appear--Required notice--Not applicable to health indemnity plans
§ 58-17C-96	Procedures for appearance before voluntary review panel--Legal representation--Time for issuance of decision
§ 58-17C-99	Expedited review for adverse determinations involving urgent care requests--Appointment of peers for review
§ 58-17C-102	Expedited review decision--Notification--Required contents
§ 58-17C-103	Promulgation of rules--Consistency with federal requirements

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South Dakota Laws: Long-Term Care Insurance

South Dakota Laws > Title 58 > Chapter 17B - Standards For Long-Term Care Insurance

South Dakota Laws > Title 58 > Chapter 17C - Standards For Managed Care Plans

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