S.D. Admin. R. 20:06:56:13
During certification for an issuer's initial year of qualified health plan certification a qualified health plan issuer without existing commercial, Medicaid, or Exchange health plan accreditation granted by a recognized accrediting entity for the same state in which the issuer is applying to offer coverage must have scheduled or plan to schedule a review of qualified health plan policies and procedures of the applying qualified health plan issuer with a recognized accrediting entity.
Prior to a qualified health plan issuer's second year and third year of qualified health plan certification, a qualified health plan issuer must be accredited by a recognized accrediting entity on the policies and procedures that are applicable to their Exchange products, or a qualified health plan issuer must have commercial or Medicaid health plan accreditation granted by a recognized accrediting entity for the same state in which the issuer is offering Exchange coverage and the administrative policies and procedures underlying that accreditation must be the same or similar to the administrative policies and procedures used in connection with the qualified health plan.
Prior to the qualified health plan issuer's fourth year of qualified health plan certification and in every subsequent year of certification, a qualified health plan issuer must be accredited in accordance with § 20:06:56:12.
S.D. Admin. R. 20:06:56:13
General Authority: SDCL 58-17-87, 58-18-79.
Law Implemented: SDCL 58-17-87, 58-18-79, 58-18-80.