25.87.9 100th Legislative Session 1102
2025 South Dakota Legislature
House Bill 1102
Introduced by: Representative Aylward
Underscores indicate new language.
Overstrikes indicate deleted language.
An Act to require the submission of medical, dental, and pharmaceutical claims data 1
to the Division of Insurance and to establish a health care data system. 2
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF SOUTH DAKOTA: 3
Section 1. That a NEW SECTION be added to chapter 58-17K: 4
For the purposes of sections 2 to 4, inclusive, of this Act, the following terms mean: 5
(1) "Insurer," any person that provides health or dental insurance in this state and is 6
subject to the insurance laws of this state; and 7
(2) "Third-party administrator," any person required to be licensed or registered in 8
accordance with chapter 58-29D. 9
Section 2. That a NEW SECTION be added to chapter 58-17K: 10
The division shall coordinate the establishment and maintain oversight of a health 11
care data system that stores medical, dental, and pharmaceutical claims data for the 12
purposes of: 13
(1) Health care planning, policy development, policy evaluation, and research by 14
federal, state, and local governments; 15
(2) Monitoring payments for health services by the federal and state governments; 16
(3) Assessing and improving the quality of health care; 17
(4) Measuring and optimizing access to health care; 18
(5) Supporting public health functions and objectives; 19
(6) Improving the ability of insurers, health care providers, and consumers to 20
coordinate, improve, and make choices about health care; 21
(7) Monitoring costs at provider and plan levels; and 22
(8) Providing transparency for health care utilization, expenditures, and performance. 23
Section 3. That a NEW SECTION be added to chapter 58-17K: 24 25.87.9 2 1102
Underscores indicate new language.
Overstrikes indicate deleted language.
An insurer or a third-party administrator shall submit medical, dental, and 1
pharmaceutical claims data to the division, at the time and in the manner determined by 2
the division, for all individuals covered by: 3
(1) A fully insured health or dental plan in any market in this state; 4
(2) A self-funded health or dental plan for state or municipal employees; or 5
(3) A health plan offered or administered by or on behalf of the federal government. 6
Section 4. That a NEW SECTION be added to chapter 58-17K: 7
Claims data from a self-funded, employer-sponsored plan must be included in the 8
health data system, if the employer has agreed, on a form prescribed by the division, to 9
the submission of data. 10
An insurer or third-party administrator of a self-funded, employer-sponsored plan 11
shall notify the employer of the option to authorize the submission of the claims data to 12
the division for inclusion in the health care data system. 13
Nothing in this section otherwise imposes any reporting obligation on any self -14
funded, employer sponsored plan, or any requirement as to administration of the 15
sponsored plan. 16
This section does not apply to a self-funded health or dental plan for state or 17
municipal employees. 18
Section 5. That a NEW SECTION be added to chapter 58-17K: 19
The division and the Department of Social Services shall enter a contract for the 20
inclusion of medical, dental, and pharmaceutical claims data from the state medicaid 21
program in the health care data system. 22
Section 6. That a NEW SECTION be added to chapter 58-17K: 23
The division may impose a civil penalty against any person who fails to submit 24
claims data in accordance with sections 3, 4, and 8 of this Act . The penalty may not 25
exceed one thousand dollars per occurrence. The division shall forward any civil penalty 26
collected under this section to the state treasurer, for deposit in the state general fund. 27
Section 7. That a NEW SECTION be added to chapter 58-17K: 28
The division may contract with any person for the establishment and maintenance 29
of the health care data system. 30 25.87.9 3 1102
Underscores indicate new language.
Overstrikes indicate deleted language.
Section 8. That a NEW SECTION be added to chapter 58-17K: 1
The division shall promulgate rules pursuant to chapter 1-26 to provide for the 2
establishment, maintenance, and use of the health care data system. The rules must 3
establish: 4
(1) Specific data elements to be reported; 5
(2) Criteria for authorizing persons to undertake claims data collection; 6
(3) Criteria and procedures for maintaining confidentiality; 7
(4) Procedures and requirements governing the structure of the health care data 8
system and the reporting, collections, analysis, and quality assurance of claims 9
data and information related to the health care data system; 10
(5) Procedures and requirements for the dissemination of claims data from the health 11
care data system through limited and public use data sets; and 12
(6) The form and procedure for an employer to authorize the submission of data in 13
accordance with section 4 of this Act. 14
Section 9. That a NEW SECTION be added to chapter 58-17K: 15
To the extent allowed under the Health Insurance Portability and Accountability 16
Act, 42. U.S.C. § 1320 et seq., (January 1, 2025), the division shall make claims data in 17
the health care data system available to the public through limited and public use data 18
sets. 19
The public use data sets must be available on the division's website and must 20
contain comparative data sets based on: 21
(1) Geography; and 22
(2) Demographics. 23
Any claims data released must be presented in a manner that no individual may 24
be identified. 25
Section 10. That a NEW SECTION be added to chapter 58-17K: 26
Nothing in sections 2 to 9, inclusive, of this Act, or in any rules promulgated 27
thereunder, requires any health care facility, as defined in § 34-12-1.1, to provide any 28
information that would violate the provisions of § 36-4-26.1. 29
Section 11. That a NEW SECTION be added to chapter 58-17K: 30 25.87.9 4 1102
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Overstrikes indicate deleted language.
The data submission requirements in sections 3, 4, and 8 of this Act do not apply 1
to: 2
(1) Accident insurance; 3
(2) Coverage issued as a supplement to liability insurance; 4
(3) Credit insurance; 5
(4) Disability income insurance; 6
(5) Hospital income or indemnity insurance; 7
(6) Liability insurance; 8
(7) Long-term care insurance; 9
(8) A medical payment under automobile or homeowner's insurance; 10
(9) A short-term limited duration plan; 11
(10) Workers compensation or similar insurance; or 12
(11) Vision insurance. 13
Section 12. That § 1-43-19 be REPEALED. 14
The Department of Health shall coordinate the establishment and maintain 15
oversight of a comprehensive health data system for the purposes of: 16
(1) Health care planning, policy development, policy evaluation, and research by 17
federal, state, and local governments; 18
(2) Monitoring payments for health services by the federal and state governments; 19
(3) Assessing and improving the quality of health care; 20
(4) Measuring and optimizing access to health care; 21
(5) Supporting public health functions and objectives; 22
(6) Improving the ability of health plans, health care providers, and consumers to 23
coordinate, improve, and make choices about health care; and 24
(7) Monitoring costs at provider and plan levels. 25
Section 13. That § 1-43-20 be REPEALED. 26
In establishing a health care data system pursuant to § 1-43-19, the Department 27
of Health may by contract or agreement authorize any person or any public or private 28
entity or any combination of persons or entities to implement and maintain any portion of 29
the health care data system. 30
Section 14. That § 1-43-21 be REPEALED. 31 25.87.9 5 1102
Underscores indicate new language.
Overstrikes indicate deleted language.
The Department of Health shall promulgate rules pursuant to chapter 1-26 to 1
provide for the establishment, maintenance, and use of a health care data system 2
pursuant to §§ 1-43-19 and 1-43-20. The rules shall include: 3
(1) A listing of specific data elements to be reported; 4
(2) Criteria for authorizing persons or entities to undertake health care data collection; 5
(3) Criteria and procedures for maintaining confidentiality; and 6
(4) Procedures and requirements governing the structure and objectives of the health 7
care data system and the reporting, collections, analysis, quality assurance, and 8
dissemination of data and information related to the health care data system. 9
Section 15. That § 1-43-24 be REPEALED. 10
Annual reports of data collected pursuant to §§ 1-43-19 to 1-43-21, inclusive, shall 11
be available to the public. Any data released shall be presented in a manner such that no 12
person may be identified. 13
Section 16. That § 1-43-31 be REPEALED. 14
Nothing established in §§ 1-43-19 and 1-43-33, or in any rules promulgated 15
pursuant thereto requires any health facility as defined in chapter 34-12 to provide any 16
information which would violate the provisions of § 36-4-26.1. 17
Section 17. That § 1-43-32 be REPEALED. 18
Implementation of the comprehensive health data system shall be contingent upon 19
the receipt of federal or other funds by the Department of Health or other relevant state 20
agencies to the extent necessary to carry out the provisions of §§ 1-43-19 and 1-43-33. 21
Section 18. That § 1-43-33 be REPEALED. 22
The Department of Health shall promulgate rules, pursuant to chapter 1-26, to 23
specify criteria, procedures, and forms for submitting health related data and to establish 24
standards for information collection. 25