58-17F-13. Sample contract forms to be filed with director--Material changes to be submitted--Certain changes not material--Director's inaction within certain time deemed approval--Contract copies to be provided upon request.
Any health carrier shall file with the director sample contract forms proposed for use with its participating providers and intermediaries. Any health carrier shall submit material changes to a sample contract that would affect a provision required by this chapter, or any rules promulgated pursuant to this chapter, to the director for approval thirty days prior to use. Changes in provider payment rates, coinsurance, copayments, or deductibles, or other plan benefit modifications are not considered material changes for the purpose of this section. If the director takes no action within sixty days after submission of a material change to a contract by a health carrier, the change is deemed approved. The health carrier shall maintain provider and intermediary contracts and provide copies to the division or department upon request. (SL 2012, ch 239, §1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.")
Source: SL 2011, ch 219, §13.
Structure South Dakota Codified Laws
Chapter 17F - Network Adequacy Standards
Section 58-17F-1 - Definitions.
Section 58-17F-2 - Health benefit plan defined.
Section 58-17F-3 - Medical director required for managed care plans.
Section 58-17F-7 - Health carrier to ensure provider proximity to covered persons.
Section 58-17F-9 - Factors to consider in determining network adequacy.
Section 58-17F-11 - Requirements for health carrier and providers in managed care plans.
Section 58-17F-14 - Contract does not relieve health carrier of liability.
Section 58-17F-15 - Remedies available to director against health carrier found not in compliance.
Section 58-17F-16 - Managed care contractor to register with director.
Section 58-17F-17 - Filing changes in registration information.
Section 58-17F-18 - Request for information from managed care contractor.
Section 58-17F-19 - Activities of nonregistered managed care contractor prohibited.
Section 58-17F-20 - Registration fee for managed care contractor.