ARSD 20:06:58 – Mental Health Parity | Midpage

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Administrative Rules of South Dakota

Chapter 20:06:58

ARSD 20:06:58

Mental Health Parity

20:06:58:01Definitions.20:06:58:02Parity requirements with respect to aggregate lifetime and annual dollar limits.20:06:58:03Plan with no limit or limits on less than one-third of all medical or surgical benefits.20:06:58:04Plan with a limit on at least two-thirds of all medical or surgical benefits.20:06:58:05Determining one-third and two-thirds of all medical or surgical benefits.20:06:58:06Plan not described in sections 20:06:58:03 or 20:06:58:04 of this chapter.20:06:58:07Parity requirements with respect to financial requirements and treatment limitations -- Clarification of classification of benefits.20:06:58:08Parity requirements with respect to financial requirements and treatment limitations -- Clarification of type of financial requirement or treatment limitation.20:06:58:09Parity requirements with respect to financial requirements and treatment limitations -- Clarification of level of a type of financial requirement or treatment limitation.20:06:58:10Parity requirements with respect to financial requirements and treatment limitations -- Clarification of coverage unit.20:06:58:11General parity requirement.20:06:58:12Classifications of benefits used for applying rules.20:06:58:13Application to out-of-network providers.20:06:58:14Financial requirements and quantitative treatment limitations -- Determining substantially all.20:06:58:15Financial requirements and quantitative treatment limitations -- Determining predominant.20:06:58:16Financial requirements and quantitative treatment imiitations -- Determining portion based on plan payments.20:06:58:17Financial requirements and quantitative treatment limitations -- Determining clarifications for certain threshold requirements and dollar amount of plan payments.20:06:58:18Application to different coverage units.20:06:58:19Special rule for multi-tiered prescription drug benefits.20:06:58:20Special rule for multiple network tiers.20:06:58:21Special rule for sub-classifications permitted for office visits, separate from other outpatient services.20:06:58:22No separate cumulative financial requirements or cumulative quantitative treatment limitations.20:06:58:23Nonquantitive treatment limitations.20:06:58:24Illustrative list of nonquantitative treatment limitations.20:06:58:25Exemptions.20:06:58:26Availability of plan information -- Criteria for medical necessity determinations.20:06:58:27Availability of plan information -- Reasons for denial.20:06:58:28Applicability and effective dates -- Group health plans.20:06:58:29Applicability and effective dates -- Health insurance issuers.20:06:58:30Scope.20:06:58:31Coordination with EHB requirements.20:06:58:32Small employer exemption.20:06:58:33Determining employer size.20:06:58:34Increased cost exemption.20:06:58:35Applicable percentage.20:06:58:36Determinations by actuaries.20:06:58:37Formula.20:06:58:38Six-month determination.20:06:58:39Notification.20:06:58:40Participants and beneficiaries -- Content of notice.20:06:58:41Use of summary of material reductions in covered services of benefits.20:06:58:42Delivery.20:06:58:43Availability of documentation.20:06:58:44Sale of nonparity health insurance coverage.20:06:58:45Special effective date for certain collective-bargained plans.