76th Legislative Session _ 2001

Committee: Senate Health and Human Services
Wednesday, February 14, 2001

                                            P - Present
                                            E - Excused
                                            A - Absent

Roll Call
P    Diedtrich (Elmer)
P    Ham
P    McIntyre
P    Staggers
P    Sutton (Dan)
P    Olson (Ed), Vice-Chair
P    Albers, Chair

OTHERS PRESENT: See Original Minutes

The meeting was called to order by Senator Ken Albers, Chair.

MOTION:     TO APPROVE THE MINUTES OF FEBRUARY 12, 2001.

Moved by:    Sutton (Dan)
Second by:    Diedtrich (Elmer)
Action:    Prevailed by voice vote.

          SB 231: ensure that covered persons of managed care plans receive certain health care services.

Presented By:    Senator Ed Olson
Proponents:    Dean Krogman, Brookings, SD State Medical Assn.
        Tony Tiefenthaler, Sioux Falls, SDMGMA
        Randy Moses, Pierre, Div. of Insurance
Opponents:    Dick Tieszen, Pierre, State Farm Insurance/Self-Insured Employers of SD
        Kris O'Connell, Sioux Falls, Wellmark BCBS (Attachment “A”)
        Darla Pollman Rogers, Pierre, HIAA
        Mike Shaw, Pierre, American Family Insurance

MOTION:     AMEND SB 231

231ja
     On the printed bill, delete everything after the enacting clause and insert:

"      Section 1. That chapter 58-12 be amended by adding thereto a NEW SECTION to read as follows:

     As used in this Act, the term, clean claim, means a claim for payment of health care expenses that is submitted to a health carrier on the carrier's standard claim form with all required fields completed with correct and complete information in accordance with the carrier's published filing requirements. The term, clean claim, does not include a claim for payment of expenses incurred during a period of time for which premiums are delinquent, except to the extent otherwise required by law.

     Section 2. That chapter 58-12 be amended by adding thereto a NEW SECTION to read as follows:

     Every health carrier shall provide a copy of its filing requirements upon request to:

             (1)    Every enrollee or insured upon enrollment in the carrier's plan or upon issuance of the policy if applicable;

             (2)    Every enrollee or insured, upon request, within fifteen calendar days;

             (3)    Every participating provider upon acceptance of the provider into the carrier's network; and

             (4)    Every enrollee, insured, and participating provider within fifteen calendar days after any change in the standard form or the accompanying instructions or requirements if applicable.

     Section 3. That chapter 58-12 be amended by adding thereto a NEW SECTION to read as follows:

     Each clean claim shall be paid to the person entitled thereto, denied, or settled within thirty calendar days after receipt by the carrier if submitted electronically and within forty-five calendar days after receipt by the carrier. If the resolution of an otherwise clean claim requires additional information, the carrier shall, within thirty calendar days after receipt of the claim, give the provider, policyholder, insured, or patient, as appropriate, a full explanation of what additional information is needed. The person receiving a request for additional information shall submit all additional information requested by the carrier within thirty calendar days after receipt of such request.
     Section 4. That chapter 58-12 be amended by adding thereto a NEW SECTION to read as follows:

     Notwithstanding any provision of any indemnity or health policy or certificate to the contrary, if a provider fails to timely submit additional information requested under section 3 of this Act, the health carrier may deny an otherwise clean claim or continue to process the claim beyond the time frames contained in section 3 of this Act.

     Section 5. That chapter 58-12 be amended by adding thereto a NEW SECTION to read as follows:

     Absent suspected fraud, all clean claims, except those described in section 3 of this Act shall be paid, denied, or settled within ninety calendar days after receipt by the carrier.

     Section 6. That chapter 58-12 be amended by adding thereto a NEW SECTION to read as follows:

     This Act applies to any health insurer or health maintenance organization that issues health insurance coverage pursuant to chapters 58-17A, 58-17B, 58-17, 58-18, 58-18B, 58-19, 58-37A, 58- 38, 58-39, 58-40, and 58-41."

Moved by:    Olson (Ed)
Second by:    Ham
Action:    Prevailed by voice vote.

 MOTION:     DO PASS SB 231 AS AMENDED

Moved by:    Olson (Ed)
Second by:    McIntyre
Action:    Prevailed by roll call vote.(4-2-1-0)

Voting Yes:    Ham, McIntyre, Olson (Ed), Albers

Voting No:    Staggers, Sutton (Dan)

Excused:    Diedtrich (Elmer)

 MOTION:     TO AMEND TITLE OF SB 231

231jta
     On page 1, line 1 of the printed bill, delete everything after " to " and insert "provide for the prompt

payment of certain uncontested health care claims.".


     On page 1 , delete line 2 .

Moved by:    Olson (Ed)
Second by:    Ham
Action:    Prevailed by voice vote.

 MOTION:     ADJOURN

Moved by:    Olson (Ed)
Second by:    Ham
Action:    Prevailed by voice vote.

Beverly Jennings

____________________________

Committee Secretary
Kenneth D. Albers, Chair

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