58-17H-51. Reclassification of benefits with respect to cancer treatment medications.
A health carrier may not reclassify benefits with respect to cancer treatment medications or increase a copayment, deductible, or coinsurance amount for covered cancer treatment medications that are injected or intravenously administered unless:
(1)The increase is applied generally to other medical or pharmaceutical benefits covered under the plan and is not done to circumvent §58-17H-50;
(2)The reclassification of benefits with respect to cancer treatment medications is done in a manner that is consistent with §§58-17H-50 to 58-17H-52, inclusive; or
(3)A health carrier is applying cost-sharing increases consistent with the annual increases in the cost of health care.
Source: SL 2015, ch 252, §2, eff. Jan. 1, 2016.
Structure South Dakota Codified Laws
Chapter 17H - Utilization Review And Benefit Determinations
Section 58-17H-1 - Definitions.
Section 58-17H-2 - Health benefit plan defined.
Section 58-17H-3 - Urgent care request defined.
Section 58-17H-4 - Applicability of chapter.
Section 58-17H-6 - In-network emergency services.
Section 58-17H-7 - Cost-sharing requirements for out-of-network emergency services.
Section 58-17H-9 - Exceptions for payments by capitated and other plans without negotiated fees.
Section 58-17H-10 - Negotiated amounts for in-network providers for a particular emergency service.
Section 58-17H-11 - General cost-sharing requirements allowed.
Section 58-17H-12 - Access to representative for post-evaluation or post-stabilization services.
Section 58-17H-14 - Health carrier responsibility for utilization review activities.
Section 58-17H-16 - Written utilization review program required--Contents of program document.
Section 58-17H-18 - Program to be administered by qualified licensed health care professionals.
Section 58-17H-19 - Determinations to be issued in timely manner--Process to ensure consistency.
Section 58-17H-20 - Effectiveness and efficiency of program to be routinely reviewed.
Section 58-17H-21 - Data systems to support program activities and generate management reports.
Section 58-17H-22 - Health carrier oversight of delegated activities--Requirements.
Section 58-17H-24 - Health carrier to provide free access to review staff.
Section 58-17H-25 - Only information necessary for review or determination to be collected.
Section 58-17H-26 - Independence and impartiality required for utilization review.
Section 58-17H-27 - Written procedures required for making determinations--Notification.
Section 58-17H-29 - Concurrent review determinations--Timing--Notification requirements.
Section 58-17H-30 - Retrospective review determinations--Timing--Notification requirements.
Section 58-17H-32 - Notification of adverse determination--Contents.
Section 58-17H-35 - Registration of utilization review organizations--Required information.
Section 58-17H-36 - Filing changes in registration information.
Section 58-17H-37 - Requests for information from utilization review organizations.
Section 58-17H-38 - Activities of nonregistered utilization review organizations prohibited.
Section 58-17H-39 - Registration fee for utilization review organizations.
Section 58-17H-42 - Insufficient information for determination of prospective urgent care requests.
Section 58-17H-43 - Urgent care requests--Timely notification of determination.
Section 58-17H-44 - Time within which to submit necessary information.
Section 58-17H-47 - Calculation of time periods for determination.
Section 58-17H-48 - Notification of adverse determination--Requirements.
Section 58-17H-49 - Promulgation of rules.
Section 58-17H-50 - Coverage for cancer treatment medication.
Section 58-17H-51 - Reclassification of benefits with respect to cancer treatment medications.
Section 58-17H-52 - Medical management practices complying with chapter.
Section 58-17H-53 - Step therapy protocols.
Section 58-17H-54 - Step therapy protocols--Process--Transparency.