This bill introduces new requirements for utilization review organizations and health carriers in South Dakota regarding prior authorization processes. It mandates that these organizations conduct an annual review and submit a report to the Division of Insurance, detailing the approval and denial rates for both urgent and nonurgent prior authorization requests, as well as the average and median times for determinations. The Division of Insurance is required to publish these reports on its website within sixty days of receipt. Additionally, the bill requires organizations to review health care services that require prior authorization and eliminate such requirements if they are routinely approved, indicating that they do not effectively promote health care quality or reduce costs.

Furthermore, the bill stipulates that organizations must submit another annual report regarding the review of prior authorizations, including the number evaluated, eliminated, and the reasons for elimination. It also requires data on the impact of eliminating prior authorization on claims submitted by health care providers. Notably, the bill specifies that dental services, pharmaceutical services, and prescription drug products are excluded from these reporting requirements.

Statutes affected:
Introduced, 01/29/2026: 58-17H-1