S.D. Admin. R. 44:18:01:02

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

Section 44:18:01:02 - Availability and accessibility

An application for a certificate of authority must demonstrate that the following availability and accessibility standards are met:

(1) Comprehensive health maintenance services, as described in SDCL 58-41-1(5), 58-41-35.1, and 58-41-35.3, shall be provided by the applicant or through contractual arrangements with other providers;

(2) The ratio of potential enrollees to staff, including health professionals, administrative, and other supporting staff, directly or through referrals, shall assure that all services offered by the plan are accessible to enrollees and meet their anticipated needs without delays detrimental to the health of the enrollees. There shall be at least one full-time equivalent primary care physician to each 2,500 enrollees;

(3) Provision shall be made for emergency and out-of-area health care services;

(4) The geographical location or locations and hours of operation of the HMO or the HMO providers shall facilitate the delivery of health care services to enrollees considering the utilization patterns of the existing health care delivery system in the proposed geographic area; and

(5) A documented system for monitoring and evaluating accessibility of care shall be maintained, including a system for addressing problems that develop, including but not limited to waiting time and appointments.

S.D. Admin. R. 44:18:01:02

12 SDR 50, effective 9/29/1985.

General Authority: SDCL 58-41-67.

Law Implemented: SDCL 58-41-12.