This bill introduces a new section to chapter 58-17H of South Dakota law, which limits the ability of health carriers to recoup, recover, or retroactively deny previously paid claims. Under the new provisions, health carriers can only take such actions within eighteen months from the date of payment, provided they have given written notice to the provider regarding the reason for the action. However, this limitation does not apply to claims that are found to be fraudulent, involve adjustments with other payors, or pertain to specific types of insurance such as casualty, self-insured health plans under ERISA, Medicare, Medicaid, or workers' compensation. Additionally, claims that were incorrectly paid due to prior payments to the provider or member are also exempt from this limitation.

The bill also stipulates that any payment made by a provider to a health carrier in relation to a recouped claim must be for the original amount paid by the carrier, without any added fees, penalties, or interest. The enforcement of these provisions will fall under the jurisdiction of the Division of Insurance. Furthermore, the bill clarifies that "medical services" do not include dental services, pharmaceuticals, or prescription drug products. The new regulations will apply to claims for medical services provided on or after July 1, 2026.