S.D. Admin. R. 44:18:01:04

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

Section 44:18:01:04 - Statistical reports

Each HMO shall continually develop, compile, and evaluate statistics. The following statistics, consisting of at least 12 months of information, shall be submitted to the secretary by March 1 in the annual report required by SDCL 58-41-63:

(1) Average income per enrollee per month and expense per enrollee per month;

(2) Cost statistics reflecting the cost required to provide services by the 20 most frequently occurring primary diagnoses;

(3) Gross utilization totals, including use by the 20 most frequently occurring primary diagnoses, hospital discharges, surgical hospital discharges, hospital bed days, outpatient visits, laboratory tests and X rays, physician encounters, and nonmedical encounters;

(4) Service area demographic characteristics, including the age, sex, and geographic residence of enrollees who use HMO services;

(5) Statistics indicating the number of total enrollees whose source of premium payment is by medicare, medicaid, employer paid, and private pay;

(6) A list of personnel and office hours revealing the availability of services; and

(7) Enrollee disease-specific and age-specific mortality rates.

S.D. Admin. R. 44:18:01:04

12 SDR 50, effective 9/29/1985.

General Authority: SDCL 58-41-12, 58-41-67.

Law Implemented: SDCL 58-41-12, 58-41-63.