47:03:04:07. Access to all health care disciplines. The department may deny certification or may revoke or suspend the certification of a case management plan that unfairly restricts access within the case management plan to any medical provider. A plan unfairly restricts access when access is denied to a medical provider and the treatment or service sought is within the scope of practice of the profession and is proper under the treatment standards adopted by the plan and approved by the department. The plan must give employees convenient access to all categories of providers and flexibility to choose medical providers from among those who provide services under the plan.
Source: 20 SDR 45, effective October 6, 1993; 21 SDR 225, effective July 5, 1995; 26 SDR 10, effective August 3, 1999.
