S.D. Admin. R. 20:06:58:26

Current through Register Vol. 51, page 57, November 12, 2024
Section 20:06:58:26 - Availability of plan information - Criteria for medical necessity determinations

The criteria for medical necessity determinations made under a group health plan with respect to mental health or substance use disorder benefits, or health insurance coverage offered in connection with the plan with respect to such benefits, must be made available by the plan administrator, or health insurance issuer offering such coverage, to any current or potential participant, beneficiary, or contracting provider upon request.

S.D. Admin. R. 20:06:58:26

41 SDR 93, effective 12/3/2014.

General Authority: SDCL 58-17-87, 58-18-79, 58-18-79(15).

Law Implemented: SDCL 58-17-87, 58-18-79, 58-18-80.