State Law

South Dakota Codified Laws-Title 58-Chapter. 17l. Grievance Procedure

08/24/2023 South Dakota Section 58-17I-14

Expedited review decision not initial determination for benefits–Notification–Time periods–Continuation of service involving concurrent review urgent care requests

State Medical Necessity Appeals-Deadlines

An expedited review decision, that is not an initial determination for benefits, shall be made and the covered person or, if applicable, the covered person’s authorized representative, shall be notified of the decision in accordance with § 58-17I-15 as expeditiously as the covered person’s medical condition requires, but in no event more than seventy-two hours after the date of receipt of the request for the expedited review. If the expedited review is of a grievance involving an adverse determination with respect to a concurrent review urgent care request, the service shall be continued without liability to the covered person until the covered person has been notified of the determination.

For purposes of calculating the time periods within which a decision is required to be made under this section, the time period within which the decision is required to be made shall begin on the date the request is filed with the health carrier in accordance with the health carrier’s procedures established pursuant to § 58-17I-6 for filing a request, without regard to whether all of the information necessary to make the determination accompanies the filing.