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Rule 20:06:53:29 Expedited review decision.

          20:06:53:29.  Expedited review decision. As expeditiously as the covered person's medical condition or circumstances requires, but in no event more than 72 hours after the date of receipt of the request for an expedited external review that meets the reviewability requirements set forth in § 20:06:53:12, the assigned independent review organization shall:

 

          (1)  Make a decision to uphold or reverse the adverse determination or final adverse determination; and

 

          (2)  Notify the covered person, if applicable, the covered person's authorized representative, the health carrier, and the director of the decision. If the notice provided was not in writing, within 48 hours after the date of providing that notice, the assigned independent review organization shall:

 

              (a)  Provide written confirmation of the decision to the covered person, if applicable, the covered person's authorized representative, the health carrier, and the director; and

              (b)  Include the information set forth in § 20:06:53:21.

 

          Source: 37 SDR 48, effective September 22, 2010; 37 SDR 241, effective July 1, 2011.

          General Authority: SDCL 58-17-87, 58-17H-49, 58-17I-16, 58-18-79.

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

 


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