§ 58-17F-1 Definitions
§ 58-17F-2 Health benefit plan defined
§ 58-17F-3 Medical director required for managed care plans
§ 58-17F-4 Health carrier to provide written information to prospective enrollees–Specific information required
§ 58-17F-5 Health carrier to maintain provider network sufficient to assure services without unreasonable delay–Emergency services–Determination of sufficiency
§ 58-17F-6 Where provider network is insufficient, covered benefit to be made available at no greater cost
§ 58-17F-7 Health carrier to ensure provider proximity to covered persons
§ 58-17F-8 Health carrier to monitor provider ability, capacity, and authority–Financial capability to be monitored in capitated plans
§ 58-17F-9 Factors to consider in determining network adequacy
§ 58-17F-10 Access plan required for managed care plans–Annual update–Contents–Exemptions for discounted fee-for-service networks
§ 58-17F-11 Requirements for health carrier and providers in managed care plans
§ 58-17F-12 Provisions governing contractual arrangements between health carriers and intermediaries
§ 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
§ 58-17F-14 Contract does not relieve health carrier of liability
§ 58-17F-15 Remedies available to director against health carrier found not in compliance
§ 58-17F-16 Managed care contractor to register with director
§ 58-17F-17 Filing changes in registration information
§ 58-17F-18 Request for information from managed care contractor
§ 58-17F-19 Activities of nonregistered managed care contractor prohibited
§ 58-17F-20 Registration fee for managed care contractor
§ 58-17F-21 Promulgation of rules
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Terms Used In South Dakota Codified Laws > Title 58 > Chapter 17F - Network Adequacy Standards

  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Oversight: Committee review of the activities of a Federal agency or program.
  • Person: includes natural persons, partnerships, associations, cooperative corporations, limited liability companies, and corporations. See South Dakota Codified Laws 2-14-2
  • Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
  • Recourse: An arrangement in which a bank retains, in form or in substance, any credit risk directly or indirectly associated with an asset it has sold (in accordance with generally accepted accounting principles) that exceeds a pro rata share of the bank's claim on the asset. If a bank has no claim on an asset it has sold, then the retention of any credit risk is recourse. Source: FDIC
  • State: when used in context signifying a jurisdiction other than the State of South Dakota, a state, the District of Columbia, a territory, commonwealth, or possession of the United States of America, or a province of the Dominion of Canada. See South Dakota Codified Laws 58-1-2
  • written: include typewriting and typewritten, printing and printed, except in the case of signatures, and where the words are used by way of contrast to typewriting and printing. See South Dakota Codified Laws 2-14-2