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26.648.18 101st Legislative Session 1199
2026 South Dakota Legislature
House Bill 1199
ENROLLED
AN ACT
ENTITLED An Act to address prior authorization and reporting requirements by
utilization review organizations and health carriers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF SOUTH DAKOTA:
Section 1. That a NEW SECTION be added to chapter 58-17H:
A utilization review organization or health carrier shall conduct an annual review
and submit the findings in a report to the Division of Insurance, at the time and in the
manner directed by the division.
The report must contain the following information for the previous calendar year,
aggregated for all health care services or items:
(1) The number and percentage of urgent prior authorization requests that the
utilization review organization or health carrier approved;
(2) The number and percentage of urgent prior authorization requests that the
utilization review organization or health carrier denied;
(3) The number and percentage of nonurgent prior authorization requests that the
utilization review organization or health carrier approved;
(4) The number and percentage of nonurgent prior authorization requests that the
utilization review organization or health carrier denied;
(5) The average and median time that elapsed between the submission of a prior
authorization request and a determination by the utilization review organization or
health carrier; and
(6) The average and median time that elapsed between the submission of an urgent
prior authorization request and a determination by the utilization review
organization or health carrier.
The division shall publish the report required by this section, on the division's
website, within sixty days after receiving the report.
Section 2. That a NEW SECTION be added to chapter 58-17H:
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A utilization review organization or health carrier shall annually review each health
care service for which a health benefit plan requires prior authorization and shall eliminate
the prior authorization requirement for any health care service if prior autho rization
requests are routinely approved with such frequency as to demonstrate that the prior
authorization requirement does not promote health care quality or reduce health care
spending, to a degree that justifies the plan's administrative costs associ ated with the
prior authorization requirement.
Section 3. That a NEW SECTION be added to chapter 58-17H:
A utilization review organization or health carrier shall submit an annual report to
the Division of Insurance, at the time and in the manner requested by the division,
regarding the review required in accordance with section 2 of this Act. The report must
set forth:
(1) The number of prior authorizations evaluated in accordance with the review;
(2) The number of prior authorizations eliminated as a result of the review, and the
reason for the elimination;
(3) The list of prior authorizations that had at least eighty percent of all requests
approved, during the preceding calendar year, for a specific health care service
covered by the health benefit plan, but for which the prior authorization
requirement was re tained due to medical or scientific evidence that justified
continuation of the requirement; and
(4) The number of prior authorization requests that were submitted in the preceding
calendar year for each eliminated prior authorization and the number of health care
providers that had submitted a request for each eliminated prior authorization
requirement.
With respect to each health care service for which prior authorization was
eliminated under section 2 of this Act, the report must provide data regarding any increase
or decrease of ten percent or more, in the average number of claims submitted per health
care provider, for that service, compared to the calendar year preceding the elimination.
The division shall publish the report required by this section on the division's
website within sixty days after receiving the report.
Section 4. That a NEW SECTION be added to chapter 58-17H:
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For purposes of sections 1 to 3 of this Act, inclusive, “health care services” do not
include dental services, pharmaceutical services, or the provision of prescription drug
products or supplies.
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An Act to address prior authorization and reporting requirements by utilization review
organizations and health carriers.
I certify that the attached Act originated in
the:
House as Bill No. 1199
Chief Clerk of the House
Speaker of the House
Attest:
Chief Clerk of the House
President of the Senate
Attest:
Secretary of the Senate
House Bill No. 1199
File No. ____
Chapter No. ______
Received at this Executive Office
this _____ day of _____________,
2026 at ____________M.
By
for the Governor
The attached Act is hereby
approved this ________ day of
______________, A.D., 2026
Governor
STATE OF SOUTH DAKOTA,
ss.
Office of the Secretary of State
Filed ____________, 2026
at _________ o'clock __M.
Secretary of State
By
Asst. Secretary of State