S.D. Admin. R. 20:06:55:40
If an item or service covered by a qualified health plan is provided by a federally-qualified health center to an enrollee of a qualified health plan, the qualified health plan issuer must pay the federally-qualified health center for the item or service an amount that is not less than the amount of payment that would be required to be paid to the center under section 1902(bb) of PPACA for such item or service. Nothing in this section would preclude a qualified health plan issuer and federally-qualified health center from mutually agreeing upon payment rates other than those that would be paid to the center under section 1902(bb) of PPACA, as long as such mutually agreed upon rates are at least equal to the generally applicable payment rates of the issuer.
S.D. Admin. R. 20:06:55:40
General Authority: SDCL 58-17-87, 58-18-79.
Law Implemented: SDCL 58-17-87, 58-18-79, 58-18-80.