Essential community providers are providers that serve predominantly low-income, medically underserved individuals, unless the provider lost its status as a result of a violation of Federal law:

1. (1) Health care providers defined in section 340B(a)(4) of the Public Health Service Act (Pub. L. 102-585), as amended by PPACA, Health Care and Education Reconciliation Act (Pub. L. 111-152), and Medicare and Medicaid Extenders Act of 2010 (Pub. L. 111-309); and

2. (2) Providers described in section 1927(c)(1)(D)(i)(IV) of the Public Health Service Act as set forth by section 221 of Pub. L. 111-8 (March 11, 2009).

   Nothing in this section shall be construed to require a qualified health plan issuer to contract with an essential community provider if such provider refuses to accept the generally applicable payment rates of such issuer.

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.