<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.sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal { 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.sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont-000000 { color: #0000FF; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont-000001 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28e000002 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont-000003 { 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="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">    </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:102"><span class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont-000000">20:06:21:102</span></a><span class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont-000001">.  Maintenance of records and reporting obligations by independent review organizations.</span><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont"> Each insurer contracting with an independent review organization doing business in this state shall contractually ensure that the independent review organization complies with the following:</span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28e000002"> </span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">    (1)  Maintain written documentation establishing the date it receives a request for independent review, the date each review is conducted, the resolution, the date such resolution was communicated to the insurer and the insured, the name and professional status of the reviewer conducting such review in an easily accessible and retrievable format for the year in which it received the information, plus two calendar years;</span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28e000002"> </span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">    (2)  Be able to document measures taken to appropriately safeguard the confidentiality of such records and prevent unauthorized use and disclosures in accordance with applicable federal and state law;</span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28e000002"> </span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">    (3)  Report annually to the director, by June 1, in the aggregate and for each long-term care insurer all of the following:</span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28e000002"> </span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">        (a)  The total number of requests received for independent review of long-term care benefit trigger decisions;</span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">        (b)  The total number of reviews conducted and the resolution of such reviews (i.e., the number of reviews which upheld or overturned the long-term care insurer's determination that the benefit trigger was not met);</span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">        (c)  The number of reviews withdrawn prior to review;</span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">        (d)  The percentage of reviews conducted within the prescribed timeframe set forth in § </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:99"><span class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont-000003">20:06:21:99</span></a><span class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">; and</span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">        (e)  Such other information the director may require.</span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28e000002"> </span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">    (4)  Report immediately to the director any change in its status which would cause it to cease meeting any of the qualifications required of an independent review organization performing independent reviews of long-term care benefit trigger decisions.</span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28e000002"> </span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">    </span><span class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont-000001">Source:</span><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont"> 36 SDR 209, effective July 1, 2010.</span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">    </span><span class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont-000001">General Authority:</span><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont-000003">58-17B-4</span></a><span class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">.</span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">    </span><span class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont-000001">Law Implemented:</span><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont-000003">58-17B-4</span></a><span class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eDefaultParagraphFont">.</span></p><p dir="ltr" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28eNormal"><span xml:space="preserve" class="sc5de3bbf-81c7-4036-8c4c-f5cda9a3e28e000002"> </span></p></div></body></html>