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Rule 20:06:33:02 Form and content of access plans.

            20:06:33:02.  Form and content of access plans. Each initial filing of an access plan pursuant to SDCL 58-17F-10 must contain the following:

 

            (1)  A complete copy of the entire access plan;

 

            (2)  A complete copy of the current provider network in place listed by specialty and location;

 

            (3)  Any formalized steps that a covered person must utilize to obtain a referral;

 

            (4)  An annual survey, or other method approved by the director, to assess the satisfaction of covered persons that includes, at a minimum, questions designed to elicit how the covered person is generally satisfied and how the covered person feels the managed care plan meets the covered person's health care needs;

 

            (5)  In addition to the description of the method for informing covered persons required pursuant to SDCL subdivision 58-17F-10(5), a copy of the disclosure required by SDCL 58-17F-4, a copy of the health carrier's grievance procedures, a summary of utilization review procedures provided to prospective covered persons, and a copy of the membership card pursuant to SDCL 58-17H-33;

 

            (6)  A copy of any written materials provided to covered persons that would generally inform such persons of the systems or processes that may be used to change primary care professionals as required by SDCL subdivision 58-17F-10(7);

 

            (7)  In conjunction with the plan for providing continuity of care as required by SDCL subdivision 58-17F-10(8), a copy of the language used in any provider contract that pertains to continuity of care; and

 

            (8)  A specimen copy of all provider contracts.

 

            Discounted fee for service plans are not required to comply with subdivisions (3), (4), and (7). Discounted fee for service plans are not required to comply with subdivision (6) if the plan does not use or require the use of primary care professionals. Stand-alone dental plans are not required to comply with subdivisions (3), (4), (6), and (7).

 

            Source: 26 SDR 64, effective November 14, 1999; 37 SDR 241, effective July 1, 2011; 38 SDR 59, effective October 19, 2011; 39 SDR 203, effective June 10, 2013.

            General Authority: SDCL 58-17F-10, 58-17F-21.

            Law Implemented: SDCL 58-17F-4, 58-17F-10, 58-17F-21.

 


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