S.D. Admin. R. 20:06:53:39

Current through Register Vol. 51, page 71, January 6, 2025

Section 20:06:53:39 - Health carrier notification of eligibility for experimental or investigational treatment reviews

Whenever a request for external review is determined eligible for external review, the health carrier shall notify the director and the covered person and, if applicable, the covered person's authorized representative. Within one business day after the receipt of the notice from the health carrier that the external review request is eligible for external review pursuant to § 20:06:53:35 or this section, the director shall:

(1) Assign an independent review organization to conduct the external review from the list of approved independent review organizations compiled and maintained by the director pursuant to §§ 20:06:53:55 and 20:06:53:56 and notify the health carrier of the name of the assigned independent review organization; and

(2) Notify in writing the covered person and, if applicable, the covered person's authorized representative of the request's eligibility and acceptance for external review.

The director shall include in the notice provided to the covered person and, if applicable, the covered person's authorized representative a statement that the covered person or the covered person's authorized representative may submit in writing to the assigned independent review organization within five business days following the date of receipt of the notice provided pursuant to this section additional information that the independent review organization shall consider when conducting the external review. The independent review organization is not required to, but may, accept and consider additional information submitted after five business days.

S.D. Admin. R. 20:06:53:39

37 SDR 48, effective 9/22/2010; 37 SDR 241, effective 7/1/2011.

General Authority: SDCL 58-17-87, 58-17H-49, 58-17I-16, 58-18-79.

Law Implemented: SDCL 58-17-87, 58-18-79.