HB 1292

26.170.37  101st Legislative Session  1292
                                      2026 South Dakota Legislature
                                                House Bill 1292
                                                    ENROLLED
                                                AN ACT
ENTITLED An Act to limit the ability of a health carrier to recoup, recover, or
         retroactively deny previously paid claims.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF SOUTH DAKOTA:
Section 1. That a NEW SECTION be added to chapter 58-17H:
            Except as otherwise provided in this section, a previously paid claim may be
   recouped, recovered, or retroactively denied by the health carrier only within eighteen
   months from the date the claim payment was made, if the health carrier has provided
   written notice of the reason to the provider. This limitation does not apply to a previously
   paid claim that:
   (1)      Was determined by the health carrier to have been submitted fraudulently or to
            involve waste or abuse;
   (2)      Is the subject of an adjustment with a different health carrier, administrator, or
            payor, and the adjustment is not affected by a contractual relationship, association,
            or affiliation involving claims payment, processing, or pricing;
   (3)      Was for medical services covered by casualty insurance, as defined by §§ 58-9-11
            to 58-9-27, inclusive;
   (4)      Was for medical services covered by a self-insured health plan governed by the
            Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001 to
            1461, inclusive (July 6, 2012);
   (5)      Was for medical services covered under medicare, 42 U.S.C. §§ 1395-1395lll,
            inclusive (March 15, 2025), medicaid, 42 U.S.C. §§ 1396 to 1396w-6, inclusive
            (July 4, 2025), or any other federal law;
   (6)      Was for medical services covered by workers' compensation, as provided for in title
            62; or
   (7)      Was incorrect because the provider or the member was already paid for the medical
            services identified in the claim.
26.170.37  2  1292
            A violation of this section is subject to enforcement by the Division of Insurance
   under title 58.
            For purposes of this section, "medical services," do not include dental services,
   pharmaceutical services, or the provision of prescription drug products or supplies.
            For purposes of this section, "retroactively deny a previously paid claim" means to
   retroactively collect claim payments made to a provider by requiring repayment of the
   payments, reducing other payments currently owed to the provider, withholding or setting
   off against future payments, or reducing or affecting the future claim payments to the
   provider in any other manner.
Section 2. That a NEW SECTION be added to chapter 58-17H:
            A payment remitted by the provider to the health carrier, as provided for in section
   1 of this Act, must be in the amount originally paid by the carrier and may not include any
   additional fees, penalties, or interest.
Section 3. This Act is applicable to claims for medical services provided on or after July 1,
2026.
HB1292 ENROLLED
26.170.37  3  1292
An Act to limit the ability of a health carrier to recoup, recover, or retroactively deny previously
paid claims.
                                                     Received at this Executive Office
 I certify that the attached Act originated in       this _____ day of _____________,
 the:
                                                     2026 at ____________M.
 House as Bill No. 1292
                                                     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. 1292  By
 File No. ____  Asst. Secretary of State
 Chapter No. ______
HB1292 ENROLLED