<html xmlns="http://www.w3.org/1999/xhtml" lang="en-US"><head><meta charset="UTF-8"><meta http-equiv='content-language' content='en-us'/><title>SDLRC - Codified Law 58-17H-26 - Independence and impartiality required for utilization review.</title><meta name="Generator" content="PowerTools for Open XML"><style>span { white-space: pre-wrap; } p.sad4a11e63292424a9df295a6da4833d3Normal { 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.sad4a11e63292424a9df295a6da4833d3SENU { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sad4a11e63292424a9df295a6da4833d3CL { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } p.sad4a11e63292424a9df295a6da4833d3Normal-000000 { text-indent: 0.50in; text-align: justify; font-family: 'Times New Roman', 'serif'; 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} span.sad4a11e63292424a9df295a6da4833d3DefaultParagraphFont-000004 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } body { text-decoration-skip-ink: none; } </style><meta name="viewport" content="width=device-width, initial-scale=1"><meta name="twitter:card" content="summary"><meta property="og:title" content="SD 58-17H-26 - Independence and impartiality required for utilization review."><meta property="og:description" content="SDLRC Codified Law 58-17H-26 - Independence and impartiality required for utilization review."><meta property="og:type" content="website"><meta property="og:url" content="https://sdlegislature.gov/Statutes/58-17H-26"><meta property="og:image" content="https://lawmakerdocuments.blob.core.usgovcloudapi.net/photos/logoshape.webp"><meta property="og:site_name" content="South Dakota Legislature"></head><body><div><p dir="ltr" class="sad4a11e63292424a9df295a6da4833d3Normal"><a href="https://sdlegislature.gov/Statutes?Statute=58-17H-26" rel="noopener"><span class="sad4a11e63292424a9df295a6da4833d3SENU">58-17H-26</span></a><span xml:space="preserve" class="sad4a11e63292424a9df295a6da4833d3SENU">. </span><span class="sad4a11e63292424a9df295a6da4833d3CL">Independence and impartiality required for utilization review.</span></p><p dir="ltr" class="sad4a11e63292424a9df295a6da4833d3Normal-000000"><span class="sad4a11e63292424a9df295a6da4833d3DefaultParagraphFont">In conducting utilization review, the health carrier shall ensure that the review is conducted in a manner to ensure the independence and impartiality of the individuals involved in making the utilization review or benefit determination.</span></p><p dir="ltr" class="sad4a11e63292424a9df295a6da4833d3Normal-000001"><span class="sad4a11e63292424a9df295a6da4833d3DefaultParagraphFont">In ensuring the independence and impartially of individuals involved in making the utilization review or benefit determination, no health carrier may make decisions regarding hiring, compensation, termination, promotion, or other similar matters based upon the likelihood that the individual will support the denial of benefits.</span></p><p dir="ltr" class="sad4a11e63292424a9df295a6da4833d3Normal"><span xml:space="preserve" class="sad4a11e63292424a9df295a6da4833d3000002"> </span></p><p dir="ltr" class="sad4a11e63292424a9df295a6da4833d3Normal"><span class="sad4a11e63292424a9df295a6da4833d3SCL">Source:</span><span xml:space="preserve" class="sad4a11e63292424a9df295a6da4833d3SCL-000003"> SL 2011, ch 219, § 51.</span></p><p dir="ltr" class="sad4a11e63292424a9df295a6da4833d3Normal"><span xml:space="preserve" class="sad4a11e63292424a9df295a6da4833d3000002"> </span></p><p dir="ltr" class="sad4a11e63292424a9df295a6da4833d3Normal"><span xml:space="preserve" class="sad4a11e63292424a9df295a6da4833d3DefaultParagraphFont-000004">Commission Note: </span><span class="sad4a11e63292424a9df295a6da4833d3DefaultParagraphFont">SL 2012, ch 239, § 1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed."</span></p></div></body></html>