S.D. Admin. R. 20:06:53:41

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

Section 20:06:53:41 - Independent review organization clinical reviewer written opinion for experimental or investigational treatment reviews

In accordance with §§ 20:06:53:45 and 20:06:53:46, each clinical reviewer shall provide a written opinion to the assigned independent review organization on whether the recommended or requested health care service or treatment should be covered. In reaching an opinion, clinical reviewers are not bound by any decisions or conclusions reached during the health carrier's utilization review process as set forth in SDCL 58-17H-1 to 58-17H-49, inclusive.

S.D. Admin. R. 20:06:53:41

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.