South Dakota Administrative Rules
Title 47 - Department of Labor And Regulation
Article 47:03 - Workers' compensation
Chapter 47:03:04 - Case management plans for workers' compensation
Section 47:03:04:02 - Application

(1) The names and addresses of any officers or directors of the case management plan;

(2) The name and title of the day-to-day administrator of the plan;

(3) The address of the place of business where the plan will be administered and records kept;

(4) The name, address, and phone number of a contact person for the plan;

(5) The names, addresses, and specialties of all participating medical providers who will provide services under the case management plan, together with a statement declaring that the providers have complied with any licensing or certification requirements for those providers to practice in South Dakota;

(6) A copy of the standard agreement that participating medical providers sign and a description of any other arrangements with medical providers who may deliver services to an employee;

(7) The names and credentials of the individuals who will be making final utilization review or medical case management decisions for the plan. The individuals must be licensed, registered, or certified health care providers under SDCL title 36;

(8) A description of the times, places, and manner of providing services under the plan to demonstrate that the case management plan meets the certification requirements of § 47:03:04:03;

(9) The treatment standards the plan has developed for medical services that the plan intends to use in reviewing medical services, including reference to the source of the treatment standards. No plan may be certified without comprehensive treatment standards developed for workers' compensation injuries and disabilities. Treatment standards developed by the plan are subject to review and approval by the department; and

(10) Any other materials requested by the department.