<html> <head> <title>Rule 20:06:13:68 Network restrictions.</title> <META NAME="Keywords" Content="Administrative Rules 20:06:13:68"> <META NAME="Description" Content="Administrative Rules 20:06:13:68 Network restrictions."> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Originator content="Microsoft Word 10"> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>20:06:13:68.&nbsp;&nbsp;Network restrictions.</b> A Medicare select policy or certificate may not restrict payment for covered services provided by providers outside the network if:</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;The services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury, or a condition; and</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;It is not appropriate given specific circumstances, such as time or distance, to obtain such services through a network provider.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 22 SDR 107, effective February 18, 1996; 23 SDR 236, effective July 13, 1997.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-17A-2">58-17A-2(5)</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-17A-2">58-17A-2.</A></p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-17A-2">58-17A-2.</A></p> </div> </body> </html>