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
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.