<html> <head> <title>Rule 44:18:01:04 Statistical reports.</title> <META NAME="Keywords" Content="Administrative Rules 44:18:01:04"> <META NAME="Description" Content="Administrative Rules 44:18:01:04 Statistical reports."> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Originator content="Microsoft Word 10"> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>44:18:01:04.&nbsp;&nbsp;Statistical reports.</b> Each HMO shall continually develop, compile, and evaluate statistics. The following statistics, consisting of at least 12 months of information, shall be submitted to the secretary by March 1 in the annual report required by SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-41-63">58-41-63</A>:</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;Average income per enrollee per month and expense per enrollee per month;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;Cost statistics reflecting the cost required to provide services by the 20 most frequently occurring primary diagnoses;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;Gross utilization totals, including use by the 20 most frequently occurring primary diagnoses, hospital discharges, surgical hospital discharges, hospital bed days, outpatient visits, laboratory tests and X rays, physician encounters, and nonmedical encounters;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp;Service area demographic characteristics, including the age, sex, and geographic residence of enrollees who use HMO services;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (5)&nbsp;&nbsp;Statistics indicating the number of total enrollees whose source of premium payment is by medicare, medicaid, employer paid, and private pay;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (6)&nbsp;&nbsp;A list of personnel and office hours revealing the availability of services; and</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (7)&nbsp;&nbsp;Enrollee disease-specific and age-specific mortality rates.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 12 SDR 50, effective September 29, 1985.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>General Authority:</b>SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-41-12">58-41-12</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-41-67">58-41-67.</A></p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Law Implemented:</b>SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-41-12">58-41-12</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-41-63">58-41-63.</A></p> </div> </body> </html>