State Law

South Dakota Codified Laws-Title 58-Chapter. 17H. Utilization Review and Benefit Determinations

08/24/2023 South Dakota Section 58-17H-9

Exceptions for payments by capitated and other plans without negotiated fees

OON-Payment Issues

For capitated or other health benefit plans that do not have a negotiated per-service amount for in-network providers, subdivision 58-17H-8(1) does not apply. (SL 2012, ch 239, § 1 provides: “The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub.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.”)