<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>p.sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText { margin-bottom: 0; text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; } span.sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } p.sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001 { margin-bottom: 0; text-align: center; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; } span.sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont-000002 { color: #0000FF; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont-000003 { font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont-000004 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } p.sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eNormal { line-height: 115.0%; margin-bottom: 10pt; font-family: Calibri; font-size: 11pt; margin-top: 0; margin-left: 0; margin-right: 0; } span.sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000005 { font-size: 11pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">DEPARTMENT OF LABOR AND REGULATION</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">DIVISION OF INSURANCE</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">GUIDELINES FOR LONG-TERM INDEPENDENT REVIEW ENTITIES</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">Chapter </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont-000002">20:06:21</span></a></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">APPENDIX M</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">SEE: § </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:100"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont-000002">20:06:21:100</span></a></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">    Source: 36 SDR 209, effective July 1, 2010.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText-000001"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont-000003"><br />&#x200e;</span><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont-000004">Guidelines for Long-Term Care Independent Review Entities</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">In order for an organization to qualify as an independent review organization for long-term care insurance benefit trigger decisions, the organization shall comply with all of the following:</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall ensure that all health care professionals on its staff and with whom it contracts to provide benefit trigger determination reviews hold a current unrestricted license or certification to practice a health care profession in the United States.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall ensure that any health care professional on its staff and with whom it contracts to provide benefit trigger determination reviews who is a physician holds a current certification by a recognized American medical specialty board in a specialty appropriate for determining an insured's functional or cognitive impairment.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall ensure that any health care professional on its staff and with whom it contracts to provide benefit trigger determination reviews who is not a physician holds a current certification in the specialty in which that person is licensed, by a recognized American specialty board in a specialty appropriate for determining an insured's functional or cognitive impairment.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall ensure that all health care professionals on its staff and with whom it contracts to provide benefit trigger determination reviews have no history of disciplinary actions or sanctions including the loss of staff privileges or any participation restriction taken or pending by any hospital or state or federal government regulatory agency.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall ensure that neither it, nor any of its employees, agents, or licensed health care professionals utilized for benefit trigger determination reviews receives compensation of any type that is dependent on the outcome of the review.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall ensure that neither it, nor any of its employees, agents, or licensed health care professionals it utilizes for benefit trigger determination reviews are in any manner related to, employed by, or affiliated with the insurer, insured, or with any person who previously provided medical care or long-term care services to the insured.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall provide a description of the qualifications of the reviewers retained to conduct independent review of long-term care insurance benefit trigger decisions, including the reviewer's current and past employment history, practice affiliations and a description of past experience with decisions relating to long-term care, functional capacity, dependency in activities of daily living, or in assessing cognitive impairment. Specifically, with regard to reviews of tax qualified long-term care insurance contracts, the organization must demonstrate the ability to assess the severity or cognitive impairment requiring substantial supervision to protect the individual from harm, or with assessing deficits in the ability to perform without substantial assistance from another person at least two activities of daily living for a period of at least 90 days due to a loss of functional capacity.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall provide a description of the procedures employed to ensure that reviewers conducting independent reviews are appropriately licensed, registered, or certified; trained in the principles, procedures, and standards of the independent review organization; and knowledgeable about the functional or cognitive impairments associated with the diagnosis and disease staging processes, including expected duration of such impairment, which is the subject of the independent review.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall provide the number of reviewers retained by the independent review organization and a description of the areas of expertise available from such reviewers and the types of cases such reviewers are qualified to review (e.g., assessment of cognitive impairment or inability to perform activities of daily living due to a loss of functional capacity).</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall provide a description of the policies and procedures employed to protect confidentiality of protected health information, in accordance with federal and state law.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall provide a description of its quality assurance program.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall provide the names of all corporations and organizations owned or controlled by the independent review organization or which own or control the organization, and the nature and extent of any such ownership or control.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall ensure that neither it, nor any of its employees, agents, or licensed health care professionals utilized are not a subsidiary of, or owned or controlled by, an insurer or by a trade association of insurers of which the insured is a member.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">The independent review organization shall provide the names and resumes of all directors, officers, and executives of the independent review organization.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000000"> </span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont-000004">    Source:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont"> 36 SDR 209, effective July 1, 2010.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont-000004">    General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont-000002">58-17B-4</span></a></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eBodyText"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont-000004">    Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont-000002">58-17B-4</span></a><span style="white-space: pre-wrap;" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eDefaultParagraphFont">.</span></p><p dir="ltr" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1eNormal"><span style="white-space: pre-wrap;" xml:space="preserve" class="sf65e7c66-f427-4af4-8b87-2f8b0ee6fd1e000005"> </span></p></div></body></html>