<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.sb9bff53c-548f-47b2-90f0-847fafad61d2Normal { text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } span.sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont-000000 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sb9bff53c-548f-47b2-90f0-847fafad61d2000001 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont-000002 { color: #0000FF; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="sb9bff53c-548f-47b2-90f0-847fafad61d2Normal"><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont">    </span><span class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont-000000">20:06:21:73.  Providers in a different state.</span><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont"> No long-term care issuer may deny a claim because services are provided in a state other than the state of policy issue if the following conditions are met:</span></p><p dir="ltr" class="sb9bff53c-548f-47b2-90f0-847fafad61d2Normal"><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2000001"> </span></p><p dir="ltr" class="sb9bff53c-548f-47b2-90f0-847fafad61d2Normal"><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont">    (1)  If the state other than the state of policy issue does not have the provider licensing, certification, or registration required in the policy, but the provider satisfies the policy requirements outlined for providers in lieu of licensure, certification, or registration; or</span></p><p dir="ltr" class="sb9bff53c-548f-47b2-90f0-847fafad61d2Normal"><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2000001"> </span></p><p dir="ltr" class="sb9bff53c-548f-47b2-90f0-847fafad61d2Normal"><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont">    (2)  If the state other than the state of policy issue licenses, certifies, or registers the provider under another classification.</span></p><p dir="ltr" class="sb9bff53c-548f-47b2-90f0-847fafad61d2Normal"><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2000001"> </span></p><p dir="ltr" class="sb9bff53c-548f-47b2-90f0-847fafad61d2Normal"><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont">    For purposes of this section, "state of policy issue" means the state in which the individual policy or certificate was originally issued.</span></p><p dir="ltr" class="sb9bff53c-548f-47b2-90f0-847fafad61d2Normal"><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2000001"> </span></p><p dir="ltr" class="sb9bff53c-548f-47b2-90f0-847fafad61d2Normal"><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont">    </span><span class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont-000000">Source:</span><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont"> 33 SDR 230, effective </span><span class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont">July 2, 2007.</span></p><p dir="ltr" class="sb9bff53c-548f-47b2-90f0-847fafad61d2Normal"><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont">    </span><span class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont-000000">General Authority:</span><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont-000002">58-17B-4</span></a><span class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont">.</span></p><p dir="ltr" class="sb9bff53c-548f-47b2-90f0-847fafad61d2Normal"><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont">    </span><span class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont-000000">Law Implemented:</span><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont-000002">58-17B-4</span></a><span class="sb9bff53c-548f-47b2-90f0-847fafad61d2DefaultParagraphFont">.</span></p><p dir="ltr" class="sb9bff53c-548f-47b2-90f0-847fafad61d2Normal"><span xml:space="preserve" class="sb9bff53c-548f-47b2-90f0-847fafad61d2000001"> </span></p></div></body></html>