§ 58-17H-22 Health carrier oversight of delegated activities--Requirements.

SD Codified L § 58-17H-22 (2019) (N/A)

Copy with citation

Copy as parenthetical citation

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;

(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. (SL 2012, ch 239, § 1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub.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, § 47.

Previous Section

§ 58-17H-21 Data systems to support program activities and generate management reports.

Next Section

§ 58-17H-23 Utilization review to be coordinated with other medical management activity of health carrier.