South Dakota 2025 Regular Session

South Dakota House Bill HB1102 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	25.87.9 100th Legislative Session 1102
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4	4	2025 South Dakota Legislature
5	5	House Bill 1102
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11	11
12	12	Introduced by: Representative Aylward
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14	14	Underscores indicate new language.
15	15	Overstrikes indicate deleted language.
16	16	An Act to require the submission of medical, dental, and pharmaceutical claims data 1
17	17	to the Division of Insurance and to establish a health care data system. 2
18	18	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF SOUTH DAKOTA: 3
19	19	Section 1. That a NEW SECTION be added to chapter 58-17K: 4
20	20	For the purposes of sections 2 to 4, inclusive, of this Act, the following terms mean: 5
21	21	(1) "Insurer," any person that provides health or dental insurance in this state and is 6
22	22	subject to the insurance laws of this state; and 7
23	23	(2) "Third-party administrator," any person required to be licensed or registered in 8
24	24	accordance with chapter 58-29D. 9
25	25	Section 2. That a NEW SECTION be added to chapter 58-17K: 10
26	26	The division shall coordinate the establishment and maintain oversight of a health 11
27	27	care data system that stores medical, dental, and pharmaceutical claims data for the 12
28	28	purposes of: 13
29	29	(1) Health care planning, policy development, policy evaluation, and research by 14
30	30	federal, state, and local governments; 15
31	31	(2) Monitoring payments for health services by the federal and state governments; 16
32	32	(3) Assessing and improving the quality of health care; 17
33	33	(4) Measuring and optimizing access to health care; 18
34	34	(5) Supporting public health functions and objectives; 19
35	35	(6) Improving the ability of insurers, health care providers, and consumers to 20
36	36	coordinate, improve, and make choices about health care; 21
37	37	(7) Monitoring costs at provider and plan levels; and 22
38	38	(8) Providing transparency for health care utilization, expenditures, and performance. 23
39	39	Section 3. That a NEW SECTION be added to chapter 58-17K: 24 25.87.9 2 1102
40	40	Underscores indicate new language.
41	41	Overstrikes indicate deleted language.
42	42	An insurer or a third-party administrator shall submit medical, dental, and 1
43	43	pharmaceutical claims data to the division, at the time and in the manner determined by 2
44	44	the division, for all individuals covered by: 3
45	45	(1) A fully insured health or dental plan in any market in this state; 4
46	46	(2) A self-funded health or dental plan for state or municipal employees; or 5
47	47	(3) A health plan offered or administered by or on behalf of the federal government. 6
48	48	Section 4. That a NEW SECTION be added to chapter 58-17K: 7
49	49	Claims data from a self-funded, employer-sponsored plan must be included in the 8
50	50	health data system, if the employer has agreed, on a form prescribed by the division, to 9
51	51	the submission of data. 10
52	52	An insurer or third-party administrator of a self-funded, employer-sponsored plan 11
53	53	shall notify the employer of the option to authorize the submission of the claims data to 12
54	54	the division for inclusion in the health care data system. 13
55	55	Nothing in this section otherwise imposes any reporting obligation on any self -14
56	56	funded, employer sponsored plan, or any requirement as to administration of the 15
57	57	sponsored plan. 16
58	58	This section does not apply to a self-funded health or dental plan for state or 17
59	59	municipal employees. 18
60	60	Section 5. That a NEW SECTION be added to chapter 58-17K: 19
61	61	The division and the Department of Social Services shall enter a contract for the 20
62	62	inclusion of medical, dental, and pharmaceutical claims data from the state medicaid 21
63	63	program in the health care data system. 22
64	64	Section 6. That a NEW SECTION be added to chapter 58-17K: 23
65	65	The division may impose a civil penalty against any person who fails to submit 24
66	66	claims data in accordance with sections 3, 4, and 8 of this Act . The penalty may not 25
67	67	exceed one thousand dollars per occurrence. The division shall forward any civil penalty 26
68	68	collected under this section to the state treasurer, for deposit in the state general fund. 27
69	69	Section 7. That a NEW SECTION be added to chapter 58-17K: 28
70	70	The division may contract with any person for the establishment and maintenance 29
71	71	of the health care data system. 30 25.87.9 3 1102
72	72	Underscores indicate new language.
73	73	Overstrikes indicate deleted language.
74	74	Section 8. That a NEW SECTION be added to chapter 58-17K: 1
75	75	The division shall promulgate rules pursuant to chapter 1-26 to provide for the 2
76	76	establishment, maintenance, and use of the health care data system. The rules must 3
77	77	establish: 4
78	78	(1) Specific data elements to be reported; 5
79	79	(2) Criteria for authorizing persons to undertake claims data collection; 6
80	80	(3) Criteria and procedures for maintaining confidentiality; 7
81	81	(4) Procedures and requirements governing the structure of the health care data 8
82	82	system and the reporting, collections, analysis, and quality assurance of claims 9
83	83	data and information related to the health care data system; 10
84	84	(5) Procedures and requirements for the dissemination of claims data from the health 11
85	85	care data system through limited and public use data sets; and 12
86	86	(6) The form and procedure for an employer to authorize the submission of data in 13
87	87	accordance with section 4 of this Act. 14
88	88	Section 9. That a NEW SECTION be added to chapter 58-17K: 15
89	89	To the extent allowed under the Health Insurance Portability and Accountability 16
90	90	Act, 42. U.S.C. § 1320 et seq., (January 1, 2025), the division shall make claims data in 17
91	91	the health care data system available to the public through limited and public use data 18
92	92	sets. 19
93	93	The public use data sets must be available on the division's website and must 20
94	94	contain comparative data sets based on: 21
95	95	(1) Geography; and 22
96	96	(2) Demographics. 23
97	97	Any claims data released must be presented in a manner that no individual may 24
98	98	be identified. 25
99	99	Section 10. That a NEW SECTION be added to chapter 58-17K: 26
100	100	Nothing in sections 2 to 9, inclusive, of this Act, or in any rules promulgated 27
101	101	thereunder, requires any health care facility, as defined in § 34-12-1.1, to provide any 28
102	102	information that would violate the provisions of § 36-4-26.1. 29
103	103	Section 11. That a NEW SECTION be added to chapter 58-17K: 30 25.87.9 4 1102
104	104	Underscores indicate new language.
105	105	Overstrikes indicate deleted language.
106	106	The data submission requirements in sections 3, 4, and 8 of this Act do not apply 1
107	107	to: 2
108	108	(1) Accident insurance; 3
109	109	(2) Coverage issued as a supplement to liability insurance; 4
110	110	(3) Credit insurance; 5
111	111	(4) Disability income insurance; 6
112	112	(5) Hospital income or indemnity insurance; 7
113	113	(6) Liability insurance; 8
114	114	(7) Long-term care insurance; 9
115	115	(8) A medical payment under automobile or homeowner's insurance; 10
116	116	(9) A short-term limited duration plan; 11
117	117	(10) Workers compensation or similar insurance; or 12
118	118	(11) Vision insurance. 13
119	119	Section 12. That § 1-43-19 be REPEALED. 14
120	120	The Department of Health shall coordinate the establishment and maintain 15
121	121	oversight of a comprehensive health data system for the purposes of: 16
122	122	(1) Health care planning, policy development, policy evaluation, and research by 17
123	123	federal, state, and local governments; 18
124	124	(2) Monitoring payments for health services by the federal and state governments; 19
125	125	(3) Assessing and improving the quality of health care; 20
126	126	(4) Measuring and optimizing access to health care; 21
127	127	(5) Supporting public health functions and objectives; 22
128	128	(6) Improving the ability of health plans, health care providers, and consumers to 23
129	129	coordinate, improve, and make choices about health care; and 24
130	130	(7) Monitoring costs at provider and plan levels. 25
131	131	Section 13. That § 1-43-20 be REPEALED. 26
132	132	In establishing a health care data system pursuant to § 1-43-19, the Department 27
133	133	of Health may by contract or agreement authorize any person or any public or private 28
134	134	entity or any combination of persons or entities to implement and maintain any portion of 29
135	135	the health care data system. 30
136	136	Section 14. That § 1-43-21 be REPEALED. 31 25.87.9 5 1102
137	137	Underscores indicate new language.
138	138	Overstrikes indicate deleted language.
139	139	The Department of Health shall promulgate rules pursuant to chapter 1-26 to 1
140	140	provide for the establishment, maintenance, and use of a health care data system 2
141	141	pursuant to §§ 1-43-19 and 1-43-20. The rules shall include: 3
142	142	(1) A listing of specific data elements to be reported; 4
143	143	(2) Criteria for authorizing persons or entities to undertake health care data collection; 5
144	144	(3) Criteria and procedures for maintaining confidentiality; and 6
145	145	(4) Procedures and requirements governing the structure and objectives of the health 7
146	146	care data system and the reporting, collections, analysis, quality assurance, and 8
147	147	dissemination of data and information related to the health care data system. 9
148	148	Section 15. That § 1-43-24 be REPEALED. 10
149	149	Annual reports of data collected pursuant to §§ 1-43-19 to 1-43-21, inclusive, shall 11
150	150	be available to the public. Any data released shall be presented in a manner such that no 12
151	151	person may be identified. 13
152	152	Section 16. That § 1-43-31 be REPEALED. 14
153	153	Nothing established in §§ 1-43-19 and 1-43-33, or in any rules promulgated 15
154	154	pursuant thereto requires any health facility as defined in chapter 34-12 to provide any 16
155	155	information which would violate the provisions of § 36-4-26.1. 17
156	156	Section 17. That § 1-43-32 be REPEALED. 18
157	157	Implementation of the comprehensive health data system shall be contingent upon 19
158	158	the receipt of federal or other funds by the Department of Health or other relevant state 20
159	159	agencies to the extent necessary to carry out the provisions of §§ 1-43-19 and 1-43-33. 21
160	160	Section 18. That § 1-43-33 be REPEALED. 22
161	161	The Department of Health shall promulgate rules, pursuant to chapter 1-26, to 23
162	162	specify criteria, procedures, and forms for submitting health related data and to establish 24
163	163	standards for information collection. 25