20:06:56:12.  Accreditation. A qualified health plan must be accredited in the following categories by an accrediting entity recognized by HHS prior to certification:

            (1)  Clinical quality measures, such as the healthcare effectiveness Data and Information Set;

            (2)  Patient experience ratings on a standardized Consumer Assessment of Healthcare Providers and Systems survey;

            (3)  Consumer access;

            (4)  Utilization management;

            (5)  Quality assurance;

            (6)  Provider credentialing;

            (7)  Complaints and appeals;

            (8)  Network adequacy and access; and

            (9)  Patient information programs.

            Source: 39 SDR 203, effective June 10, 2013.

            General Authority: SDCL 58-17-87, 58-18-79.

            Law Implemented: SDCL 58-17-87, 58-18-79, 58-18-80.