S.D. Admin. R. 47:03:04:04

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

Section 47:03:04:04 - Access to medical providers and other case management services

The case management plan satisfies the requirements of subdivisions 47:03:04:03(1) and (2) by either of the following methods or through a combination of both methods:

(1) The plan establishes a network of participating medical providers who agree to provide medical services to the plan; or

(2) The plan establishes a procedure for an employee to receive medical services through a referral to a medical provider who is not a member of the case management plan, in accordance with § 47:03:04:05, in cases where the services are not available or reasonably accessible within the case management plan.

For the purpose of this chapter, access to a medical provider within a reasonable distance from the employee's home or place of employment requires consideration of the geographic area involved, the number of medical providers in the area, and the normal patterns of travel for medical care. The employer must notify the case management plan of any compensable injury or disability that requires medical treatment other than minor first aid within 24 hours after obtaining knowledge of the injury or disability. An employee who requests treatment for a compensable injury or disability from the case management plan must receive treatment by a participating medical provider or by referral to a qualified medical provider who is not a member of the managed plan within 48 hours after the employee's request for treatment unless it is impracticable considering the circumstances of the case.

S.D. Admin. R. 47:03:04:04

20 SDR 45, effective 10/6/1993; 21 SDR 225, effective 7/5/1995; 26 SDR 10, effective 8/3/1999.

General Authority: SDCL 58-20-24, 62-5-21.

Law Implemented: SDCL 58-20-24, 62-5-21.