(SB 201)
The risk pool reimbursement method for health care providers revised.
Section
1.
That
§
58-17-123
be amended to read as follows:
58-17-123.
An enrollee shall notify any health care provider or any provider of pharmacy goods
or services prior to receiving goods or services or as soon as reasonably possible that the enrollee
is qualified to receive comprehensive coverage under the risk pool. Any health care provider or
provider of pharmacy goods or services who provides goods or services to an enrollee and requests
payment is deemed to have agreed to the reimbursement system as provided for in §§ 58-17-68,
58-17-70, 58-17-85, and 58-17-113 to 58-17-142, inclusive. Each health care provider shall be
reimbursed using medicare reimbursement methodologies at a rate that is designed to achieve a
payment that is equivalent to one hundred
fifteen
thirty-five
percent of South Dakota's medicaid
reimbursement for the goods or services delivered. Each provider of pharmacy goods or services
shall be reimbursed at one hundred fifteen percent of South Dakota's medicaid reimbursement for
any goods or services provided. Any reimbursement rate to a provider is limited to the lesser of
billed charges or the rates as provided by this section. In no event may a provider collect or attempt
to collect from an enrollee any money owed to the provider by the risk pool nor may the provider
have any recourse against an enrollee for any covered charges in excess of the copayment,
coinsurance, or deductible amounts specified in the coverage. However, the provider may bill the
enrollee for noncovered services.