A qualified health plan issuer must ensure that the provider network of each of its qualified health plans meets the following standards:

1. (1) Includes essential community providers in accordance with §§ 20:06:55:38 and 20:06:55:39;
2. (2) Maintains a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance abuse services, to assure that all services are accessible without unreasonable delay; and

3. (3) Is consistent with the network adequacy provisions of SDCL chapter 58-17F.

   A qualified health plan issuer must make its provider directory for a qualified health plan available for publication online to potential enrollees in hard copy upon request. In the provider directory, a qualified health plan issuer must identify providers that are not accepting new patients.

Source: 39 SDR 203, adopted June 10, 2013, effective January 1, 2014.

General Authority: SDCL 58-17-87 , 58-18-79.

Law Implemented: SDCL 58-17-87 , 58-18-79 , 58-18-80.