Section 58-17-143 - Preferred provider contracts with out-of-state providers--Limitations onpayments by risk pool. - South Dakota Statutes

58-17-143. Preferred provider contracts with out-of-state providers--Limitations on payments by risk pool. The board may, directly or indirectly, enter into preferred provider contracts to obtain discounts on goods or services from out-of-state providers. If health care goods or services are provided pursuant to a preferred provider contract and the goods or services are either not readily available in this state or are emergency services as defined by § 58-17C-27, the provisions of that contract shall govern the reimbursement rate. The payment by the risk pool for any services received from out-of-network providers in other states, other than emergency treatment as defined in § 58-17C-27, is limited to one hundred fifteen percent of South Dakota's medicaid reimbursement. Emergency treatment, as defined in § 58-17C-27, that is from an out-of-state provider that is an out-of-network provider, to the extent that such services are payable under the plan, may be reimbursed by the risk pool at an amount that does not exceed the amount determined to be reasonable by the plan administrator.

Source: SL 2005, ch 266, § 1.