South Dakota Administrative Rules
Title 44 - Department of Health
Article 44:18 - Health maintenance organizations
Chapter 44:18:01 - Health care qualifications
Section 44:18:01:04 - Statistical reports
Current through Register Vol. 51, page 43, September 23, 2024
Each HMO shall continually develop, compile, and evaluate statistics. The following statistics, consisting of at least 12 months of information, shall be submitted to the secretary by March 1 in the annual report required by SDCL 58-41-63:
(1) Average income per enrollee per month and expense per enrollee per month;
(2) Cost statistics reflecting the cost required to provide services by the 20 most frequently occurring primary diagnoses;
(3) Gross utilization totals, including use by the 20 most frequently occurring primary diagnoses, hospital discharges, surgical hospital discharges, hospital bed days, outpatient visits, laboratory tests and X rays, physician encounters, and nonmedical encounters;
(4) Service area demographic characteristics, including the age, sex, and geographic residence of enrollees who use HMO services;
(5) Statistics indicating the number of total enrollees whose source of premium payment is by medicare, medicaid, employer paid, and private pay;
(6) A list of personnel and office hours revealing the availability of services; and
(7) Enrollee disease-specific and age-specific mortality rates.
General Authority: SDCL 58-41-12, 58-41-67.
Law Implemented: SDCL 58-41-12, 58-41-63.
