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          20:06:53:52.  Health carrier requirement upon notice of decision reversing adverse determination for experimental or investigational treatment reviews. Upon receipt of a notice of a decision pursuant to ยงยง 20:06:53:48 and 20:06:53:49 reversing the adverse determination or final adverse determination, the health carrier immediately shall approve coverage of the recommended or requested health care service or treatment that was the subject of the adverse determination or final adverse determination.

 

          Source: 37 SDR 48, effective September 22, 2010; 37 SDR 241, effective July 1, 2011.

          General Authority: SDCL 58-17-87, 58-17H-49, 58-17I-16, 58-18-79.

          Law Implemented: SDCL 58-17-87, 58-18-79.

 


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