address prior authorization and reporting requirements by utilization review organizations and health carriers.

Fewer approval hurdles for South Dakota patients

South Dakota insurers and health review organizations must review each service requiring prior approval every year. They must remove approval rules when routine approvals show the rules do not improve care or save enough to justify administrative costs. These requirements exclude dental services, pharmaceutical services, and prescription drug products or supplies. Annual reports must show the previous calendar year's approval and denial counts and percentages, separately for urgent and nonurgent requests. They must also show average and median decision times for both groups. A second annual report must count the approval requirements reviewed and removed, with reasons for each removal. It must identify rules kept despite approval rates of at least 80%, with medical or scientific evidence supporting continued use. For each removed rule, it must report the previous year's request count and the number of providers submitting requests. It must also report changes of 10% or more in average claims per provider for affected services compared with the previous year. The South Dakota Division of Insurance must publish both reports online within 60 days after receiving them.