Network Adequacy Standards

  1. Law
  2. South Dakota Codified Laws
  3. Insurance
  4. Network Adequacy Standards

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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-4

Health carrier to provide written information to prospective enrollees--Specific information required.

Section
58-17F-5

Health carrier to maintain provider network sufficient to assure services without unreasonable delay--Emergency services--Determination of sufficiency.

Section
58-17F-6

Where provider network is insufficient, covered benefit to be made available at no greater cost.

Section
58-17F-7

Health carrier to ensure provider proximity to covered persons.

Section
58-17F-8

Health carrier to monitor provider ability, capacity, and authority--Financial capability to be monitored in capitated plans.

Section
58-17F-9

Factors to consider in determining network adequacy.

Section
58-17F-10

Access plan required for managed care plans--Annual update--Contents--Exemptions for discounted fee-for-service networks.

Section
58-17F-11

Requirements for health carrier and providers in managed care plans.

Section
58-17F-12

Provisions governing contractual arrangements between health carriers and intermediaries.

Section
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.

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.

Section
58-17F-21

Promulgation of rules.