South Dakota Codified Laws 58-17H-22. Health carrier oversight of delegated activities–Requirements
If a health carrier delegates any utilization review activities to a utilization review organization, the health carrier shall maintain adequate oversight, which shall include:
(1) A written description of the utilization review organization’s activities and responsibilities, including reporting requirements;
Terms Used In South Dakota Codified Laws 58-17H-22
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
- Oversight: Committee review of the activities of a Federal agency or program.
- written: include typewriting and typewritten, printing and printed, except in the case of signatures, and where the words are used by way of contrast to typewriting and printing. See South Dakota Codified Laws 2-14-2
(2) Evidence of formal approval of the utilization review organization program by the health carrier; and
(3) A process by which the health carrier evaluates the performance of the utilization review organization.
Source: SL 2011, ch 219, § 47.
Commission Note: SL 2012, ch 239, § 1 provides: “The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub.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.”