S.D. Admin. R. 20:06:56:12

Current through Register Vol. 51, page 67, December 16, 2024

Section 20:06:56:12 - Accreditation

A qualified health plan must be accredited in the following categories by an accrediting entity recognized by HHS prior to certification:

(1) Clinical quality measures, such as the healthcare effectiveness Data and Information Set;

(2) Patient experience ratings on a standardized Consumer Assessment of Healthcare Providers and Systems survey;

(3) Consumer access;

(4) Utilization management;

(5) Quality assurance;

(6) Provider credentialing;

(7) Complaints and appeals;

(8) Network adequacy and access; and

(9) Patient information programs.

S.D. Admin. R. 20:06:56:12

39 SDR 203, effective 6/10/2013.

General Authority: SDCL 58-17-87, 58-18-79.

Law Implemented: SDCL 58-17-87, 58-18-79, 58-18-80.