20:06:53:34.  Notifications upon request for external review of experimental or investigational treatment adverse determinations. Upon receipt of a request for an expedited external review, the director immediately shall notify the health carrier. Upon notice of the request for expedited external review, the health carrier immediately shall determine whether the request meets the reviewability requirements of § 20:06:53:36. The health carrier shall immediately notify the director and the covered person and, if applicable, the covered person's authorized representative of its eligibility determination.

          The notice of initial determination by the health carrier under this section shall include a statement informing the covered person and, if applicable, the covered person's authorized representative that a health carrier's initial determination that the external review request is ineligible for review may be appealed to the director.

          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.