HB 1199

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:
26.648.18  2  1199
            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 authorization
   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 associated 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 retained 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:
HB1199 ENROLLED
26.648.18  3  1199
            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.
HB1199 ENROLLED
26.648.18  4  1199
An Act to address prior authorization and reporting requirements by utilization review
organizations and health carriers.
                                                     Received at this Executive Office
 I certify that the attached Act originated in       this _____ day of _____________,
 the:
                                                     2026 at ____________M.
 House as Bill No. 1199
                                                     By
                     Chief Clerk of the House  for the Governor
                                                                      The attached Act is hereby
                                                                  approved this ________ day of
                          Speaker of the House  ______________, A.D., 2026
 Attest:
                                                                                        Governor
                     Chief Clerk of the House
                                                     STATE OF SOUTH DAKOTA,
                                                                                               ss.
                                                     Office of the Secretary of State
                       President of the Senate
                                                                    Filed ____________, 2026
 Attest:  at _________ o'clock __M.
                       Secretary of the Senate  Secretary of State
 House Bill No. 1199  By
 File No. ____  Asst. Secretary of State
 Chapter No. ______
HB1199 ENROLLED