A qualified health plan must be accredited in the following categories by an accrediting entity recognized by HHS prior to certification:
- (1) Clinical quality measures, such as the healthcare effectiveness Data and Information Set;
- (2) Patient experience ratings on a standardized Consumer Assessment of Healthcare Providers and Systems survey;
- (3) Consumer access;
- (4) Utilization management;
- (5) Quality assurance;
- (6) Provider credentialing;
- (7) Complaints and appeals;
- (8) Network adequacy and access; and
- (9) Patient information programs.
Source: 39 SDR 203, effective June 10, 2013.
General Authority: SDCL 58-17-87 , 58-18-79.
Law Implemented: SDCL 58-17-87 , 58-18-79 , 58-18-80.