2014 South Dakota Codified Laws
Title 58 - INSURANCE
Chapter 17 - Health Insurance Policies
§ 58-17-143 Preferred provider contracts with out-of-state providers--Limitations on payments byrisk pool.

58-17-143. Preferred provider contracts with out-of-state providers--Limitations on payments by risk pool. The board may, directly or indirectly, enter into preferred provider contracts to obtain discounts on goods or services from out-of-state providers. If health care goods or services are provided pursuant to a preferred provider contract and the goods or services are either not readily available in this state or are emergency services as defined by § 58-17H-1, the provisions of that contract shall govern the reimbursement rate. The payment by the risk pool for any services received from out-of-network providers in other states, other than emergency treatment as defined in § 58-17H-1, is limited to one hundred fifteen percent of South Dakota's medicaid reimbursement. Emergency treatment, as defined in § 58-17H-1, that is from an out-of-state provider that is an out-of-network provider, to the extent that such services are payable under the plan, may be reimbursed by the risk pool at an amount that does not exceed the amount determined to be reasonable by the plan administrator. (SL 2012, ch 239, § 1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub.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.")

Source: SL 2005, ch 266, § 1, eff. Feb. 8, 2005; SL 2011, ch 219, § 96.