S.D. Admin. R. 20:06:21:102
Current through Register Vol. 51, page 67, December 16, 2024
Section 20:06:21:102 - Maintenance of records and reporting obligations by independent review organizationsEach insurer contracting with an independent review organization doing business in this state shall contractually ensure that the independent review organization complies with the following:
(1) Maintain written documentation establishing the date it receives a request for independent review, the date each review is conducted, the resolution, the date such resolution was communicated to the insurer and the insured, the name and professional status of the reviewer conducting such review in an easily accessible and retrievable format for the year in which it received the information, plus two calendar years;(2) Be able to document measures taken to appropriately safeguard the confidentiality of such records and prevent unauthorized use and disclosures in accordance with applicable federal and state law;(3) Report annually to the director, by June 1, in the aggregate and for each long-term care insurer all of the following:(a) The total number of requests received for independent review of long-term care benefit trigger decisions;(b) The total number of reviews conducted and the resolution of such reviews (i.e., the number of reviews which upheld or overturned the long-term care insurer's determination that the benefit trigger was not met);(c) The number of reviews withdrawn prior to review;(d) The percentage of reviews conducted within the prescribed timeframe set forth in § 20:06:21:99; and(e) Such other information the director may require.(4) Report immediately to the director any change in its status which would cause it to cease meeting any of the qualifications required of an independent review organization performing independent reviews of long-term care benefit trigger decisions.S.D. Admin. R. 20:06:21:102
36 SDR 209, effective 7/1/2010.General Authority: SDCL 58-17B-4.
Law Implemented: SDCL 58-17B-4.