To provide medical services under subdivisions 47:03:04:05(1), (2), and (3), the medical provider must comply with the following requirements:

1. (1) Agree to examine the employee within 48 hours of the employee's request for treatment or consultation unless it is impracticable under the circumstances of the case;
2. (2) Agree to supply the reports required by SDCL 62-4-44 and 62-4-45 to the case management plan;
3. (3) Agree to receive approval from the case management plan before any referral for other treatment the employee may require or before any diagnostic testing the employee may require, other than minor diagnostic testing exempted from the approval requirement under the plan's treatment standards; and

4. (4) Agree to abide by the provisions of this chapter and the terms and conditions of the case management plan.

   The employee must notify the medical provider that the employee is covered by a case management plan before treatment is rendered. A medical provider who has been informed that an employee is covered by a case management plan and who fails to comply with the requirements of this section is subject to denial of payment for the services rendered to the employee. An employee who desires to change the initial selection of medical provider must receive written approval from the case management plan. A medical provider initially selected by an employee who refers the employee for specialized treatment or testing may continue to treat the employee if continued treatment is appropriate. The employer may assign to the case management plan its rights to notification, to approve a change in medical provider, and to receive reports under SDCL 62-4-43, 62-4-44, and 62-4-45.

Source: 20 SDR 45, effective October 6, 1993; 21 SDR 225, effective July 5, 1995; 26 SDR 10, effective August 3, 1999.

General Authority: SDCL 58-20-24 , 62-5-21.

Law Implemented: SDCL 58-20-24 , 62-4-45 , 62-5-21.