State of South Dakota  

256U0442   HOUSE ENGROSSED    NO.  HB 1142 -  02/20/2013  

Introduced by:    Representatives Wick, Campbell, Conzet, Gibson, Gosch, Greenfield, Haggar (Jenna), Hawks, Heinemann (Leslie), Heinert, Hickey, Lust, Magstadt, Munsterman, Novstrup (David), Rounds, Sly, and Steele and Senators Brown, Begalka, Frerichs, Jensen, Kirkeby, Lederman, Lucas, Maher, Monroe, Olson (Russell), Rampelberg, and Rhoden

        FOR AN ACT ENTITLED, An Act to promote patient choice in selecting health care providers.
    Section 1. No health insurer, including the South Dakota Medicaid program and Medicare, may obstruct patient choice by excluding a health care provider licensed under the laws of this state from participating on the health insurer's panel of providers if the provider is located within the geographic coverage area of the health benefit plan and is willing to meet the terms and conditions of participation as established by the health insurer.
    Section 2. Terms used in this Act mean:
            (1)    "Health benefit plan," any hospital or medical expense policy or certificate, hospital or medical service plan, nonprofit hospital, medical-surgical health service corporation contract or certificate, provider sponsored integrated health delivery network, self-insured plan or plan provided by multiple employer welfare arrangements, health maintenance organization subscriber contract of more than

six-month duration, or any health benefit plan that affects the rights of a South Dakota insured and bears a reasonable relation to South Dakota, whether delivered or issued for delivery in South Dakota. The term does not include specified disease, hospital indemnity, fixed indemnity, accident only, credit, dental, vision, Medicare supplement, long-term care or disability income insurance, coverage issued as a supplement to liability insurance, workers' compensation or similar insurance, automobile medical payment insurance, or any plan or coverage exempted from state regulation by ERISA;

            (2)    "Health insurer," any entity within the definitions set forth in subdivisions 58-17F-1(11), (12), and (15), any entity offering a health benefit plan as defined by § 58-17F-2, all self-insurers or multiple employer welfare arrangements, and self-insured employer-organized associations. The term does not include any entity exempted from state regulation by ERISA;
            (3)    "Health care provider," any individual or entity within the scope of the definition of health care provider as defined by subdivision 58-17F-1(9).