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26.922.9 101st Legislative Session 211 South Dakota Legislature Senate Bill 211 Introduced by:
26.922.10 101st Legislative Session 211 South Dakota Legislature Senate Bill 211 SENATE HEALTH AND HUMAN SERVICES ENGROSSED Introduced by:
For the purposes of §§ 58-17-64, sections 2 to 8 inclusive, of this Act, §§ 58-18-63, 58-38-36, and 58-40-33, a health benefit plan is any hospital or medical policy or certificate, hospital or medical service plan, or health maintenance organization subscriber contract.
For the purposes of §§ 58-17-64, sections 2 to 5 inclusive, of this Act, §§ 58-18-63, 58-38-36, and 58-40-33, a health benefit plan is any hospital or medical policy or certificate, hospital or medical service plan, or health maintenance organization subscriber contract.
26.922.9 2 211 of-network basis, except for any coinsurance, copayment, or deductible amount, required under the terms of the patient’s health benefit plan.
26.922.10 2 211 of-network basis, except for any coinsurance, copayment, or deductible amount, required under the terms of the patient’s health benefit plan.
or (2) Three hundred twenty-five percent of the medicare allowable rate for the same service.
or (2) Two hundred seventy-five percent of the medicare allowable rate for the same service.
A health benefit plan shall provide the reimbursement directly to the out-of- network ambulance service provider no later than thirty days after receipt of a claim, unless otherwise agreed to in writing by the plan and the provider.
A health benefit plan shall provide the reimbursement for emergency medical services rendered on an out-of-network basis directly to the ambulance service provider in accordance with the provisions set forth in chapter 58-12, unless otherwise agreed to in writing by the plan and the provider.
On or before January 1, 2027, the Division of Insurance shall compile and post on the division's website, ambulance reimbursement rates from any political subdivision that has effectuated rates.
The division shall update the posted rates annually.
If a political subdivision fails to submit its rates, as required by this section, an ambulance service provider located in the political subdivision must be reimbursed at the lesser of:
(1) The provider’s billed charge;
or (2) Three hundred twenty-five percent of the medicare allowable rate for the same service.
Section 6.
That a NEW SECTION be added to chapter 58-17:
Overstrikes indicate deleted language.
Section 6.
26.922.9 3 211 Section 7.
Any person aggrieved by a violation of sections 3 to 6, inclusive, of this Act may file a complaint with the Division of Insurance for appropriate relief.
Sections 2 to 5, inclusive, of this Act do not apply to a self-funded employer health plan, medicaid, medicare, or any other federally regulated program.
The division may investigate any violation of sections 3 to 6, inclusive, and impose administrative penalties or sanctions in accordance with chapter 58-4.
Section 8.
That a NEW SECTION be added to chapter 58-17:
Sections 3 to 6, inclusive, of this Act do not apply to a self-funded employer health plan, medicaid, medicare, or any other federally regulated program.
Underscores indicate new language.
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