S.D. Admin. R. 20:06:53:51

Current through Register Vol. 50, page 159, June 17, 2024

Section 20:06:53:51 - Notice of written decision by independent review organization for experimental or investigational treatment reviews

The independent review organization shall include in the notice provided pursuant to §§ 20:06:53:48 and 20:06:53:49:

(1) A general description of the reason for the request for external review;

(2) The written opinion of each clinical reviewer, including the recommendation of each clinical reviewer as to whether the recommended or requested health care service or treatment should be covered and the rationale for the reviewer's recommendation:

(3) The date the independent review organization was assigned by the director to conduct the external review;

(4) The date the external review was conducted;

(5) The date of its decision;

(6) The principal reason or reasons for its decision; and

(7) The rationale for its decision.

S.D. Admin. R. 20:06:53:51

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.