S.D. Admin. R. 20:06:13:68

Current through Register Vol. 51, page 57, November 12, 2024

Section 20:06:13:68 - Network restrictions

A Medicare select policy or certificate may not restrict payment for covered services provided by providers outside the network if:

(1) The services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury, or a condition; and

(2) It is not appropriate given specific circumstances, such as time or distance, to obtain such services through a network provider.

S.D. Admin. R. 20:06:13:68

22 SDR 107, effective 2/18/1996; 23 SDR 236, effective 7/13/1997.

General Authority: SDCL 58-17A-2(5), 58-17A-2.

Law Implemented: SDCL 58-17A-2.