S*0200(Rat #0191, Act #0121 of 1997)  General Bill, By Courtney, Alexander, 
Anderson, Elliott, Fair, Ford, Glover, Holland, Land, Lander, Martin, McGill, 
O'Dell, Peeler, Rankin, Reese, M.T. Rose, Thomas and Waldrep

Similar(H 3279)
 A BILL TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION
 38-71-440 SO AS TO ENACT THE SOUTH CAROLINA EYE CARE SERVICES ACT AND TO
 PROHIBIT HEALTH MAINTENANCE ORGANIZATIONS (HMO) AND HEALTH BENEFIT PLANS
 OFFERING MEDICAL EYE CARE OR VISION CARE BENEFITS FROM UNNECESSARILY
 RESTRICTING THE PRACTICE OF OPTOMETRISTS PARTICIPATING IN THE HMO OR PLAN; TO
 PROHIBIT DISCRIMINATION AGAINST OPTOMETRISTS OR OPTHALMOLOGISTS IN THE
 OPPORTUNITY TO PARTICIPATE OR WITH REGARD TO THE TERMS AND CONDITIONS OF THE
 HMO OR PLAN; TO REQUIRE AN HMO OR PLAN TO CONTRACT WITH OPTHALMOLOGISTS FOR
 EYE SURGERY ONLY SERVICES; AND TO PROVIDE PROCEDURES FOR GRIEVANCES RESULTING
 FROM VIOLATIONS.-AMENDED TITLE

   01/21/97  Senate Introduced and read first time SJ-9
   01/21/97  Senate Referred to Committee on Banking and Insurance SJ-9
   04/10/97  Senate Recalled from Committee on Banking and Insurance SJ-5
   04/15/97  Senate Amended SJ-40
   04/15/97  Senate Read second time SJ-40
   04/15/97  Senate Unanimous consent for third reading on next
                     legislative day SJ-40
   04/16/97  Senate Read third time and sent to House SJ-27
   04/17/97  House  Introduced and read first time HJ-20
   04/17/97  House  Referred to Committee on Labor, Commerce and
                     Industry HJ-20
   05/27/97  House  Committee report: Favorable with amendment Labor,
                     Commerce and Industry HJ-94
   05/29/97  House  Amended HJ-27
   05/29/97  House  Read second time HJ-29
   05/29/97  House  Unanimous consent for third reading on next
                     legislative day HJ-30
   05/30/97  House  Read third time and returned to Senate with
                     amendments HJ-3
   06/04/97  Senate Concurred in House amendment and enrolled
   06/09/97         Ratified R 191
   06/13/97         Signed By Governor
   06/13/97         Effective date This Act takes effect 180 days
                     after signature by Governor; however, existing
                     contracts may comply with the requirements of
                     this Act at their next renewal date
   06/26/97         Copies available
   06/26/97         Act No. 121

AN ACT TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-440 SO AS TO ENACT THE SOUTH CAROLINA EYE CARE SERVICES ACT AND TO PROHIBIT HEALTH MAINTENANCE ORGANIZATIONS (HMO) AND HEALTH BENEFIT PLANS OFFERING MEDICAL EYE CARE OR VISION CARE BENEFITS FROM UNNECESSARILY RESTRICTING THE PRACTICE OF OPTOMETRISTS PARTICIPATING IN THE HMO OR PLAN; TO PROHIBIT DISCRIMINATION AGAINST OPTOMETRISTS OR OPTHALMOLOGISTS IN THE OPPORTUNITY TO PARTICIPATE OR WITH REGARD TO THE TERMS AND CONDITIONS OF THE HMO OR PLAN; TO REQUIRE AN HMO OR PLAN TO CONTRACT WITH OPTHALMOLOGISTS FOR EYE SURGERY ONLY SERVICES; AND TO PROVIDE PROCEDURES FOR GRIEVANCES RESULTING FROM VIOLATIONS.

Be it enacted by the General Assembly of the State of South Carolina:

Act citation

SECTION 1. This act may be cited as the 'South Carolina Eye Care Services Act'.

Prohibitions for health maintenance organizations and health benefit plans offering eye and vision services

SECTION 2. The 1976 Code is amended by adding:

"Section 38-71-440. (A) As used in this section:

(1) 'Health benefit plan' means any public or private health plan implemented in this State that provides medical eye care or vision care benefits, or both, to covered persons including payments and reimbursements.

(2) 'Ophthalmologist' means a physician licensed pursuant to Title 40, Chapter 47 who practices in South Carolina and who specializes in the medical and surgical care of the eye and visual system and routine vision care.

(3) 'Optometrist' means a doctor of optometry licensed pursuant to Title 40, Chapter 37 who is engaged in the practice of optometry in South Carolina.

(B) No health maintenance organization or health benefit plan which maintains or contracts with a network of ophthalmologists or optometrists, or both, to provide medical eye care or vision care benefits, or both, shall prohibit a participating optometrist from performing medical services within that optometrist's scope of practice set forth in Title 40, Chapter 37, in accordance with the terms of the health maintenance organization or health benefit plan and in accordance with subsections (C) and (I).

(C) No health maintenance organization or health benefit plan which maintains or contracts with a network of ophthalmologists or optometrists, or both, to provide medical eye care or vision care benefits, or both, excepting all self-funded health benefit plans as defined under the Federal Employee Retirement Income Security Act (ERISA) of 1974, shall discriminate against optometry, as a class, or ophthalmology, as a class, with respect to the terms, conditions, privileges, and opportunity of participation or compensation for the same eye care services provided in this section.

(D) No health benefit plan or health maintenance organization shall impose on optometry, as a class, any condition or restriction which is not necessary for the delivery of services or materials, or both, in accordance with and subject to Chapter 37, Title 40.

(E) Any health maintenance organization or health benefit plan may contract for vision care benefits or medical eye care benefits, or both. A health maintenance organization or health benefit plan may contract for surgery only services with ophthalmologists. A health maintenance organization or health benefit plan must be authorized to contract with optometrists and ophthalmologists as either individual panelists or network panelists.

(F) Nothing in this section may be construed to limit, expand, or otherwise affect the scope of practice of optometrists and therapeutically certified optometrists as provided for in Chapter 37, Title 40.

(G) Nothing in this section may be construed to preclude a covered person from receiving emergency medical eye care or to preclude a primary care physician from providing treatment for covered services in accordance with the terms of a health maintenance organization or health benefit plan.

(H) Nothing in this section may be construed to mandate coverage of any service.

(I) Nothing in this plan may be construed to prohibit a health maintenance organization or health benefit plan from professionally credentialing and evaluating all individual optometrists or ophthalmologists within a network or plan in a nondiscriminatory manner. Nothing in this section may be construed to prohibit any health maintenance organization or health benefit plan from limiting the number of optometrists or ophthalmologists in a nondiscriminatory manner or to prohibit a health maintenance organization or health benefit plan from negotiating individually with optometrists or ophthalmologists for individual rates and eye care services in a nondiscriminatory manner.

(J) Any person aggrieved by a violation of this section may file a complaint with the Department of Insurance. After notice to the health maintenance organization or health benefit plan and an opportunity for it to submit a written response to the complaint, the director of the department may make a written determination regarding the complaint. Any party aggrieved by the director's determination is entitled to administrative and judicial review pursuant to Article 3, Chapter 23, Title 1. The director or the administrative law judge, if a hearing before the Administrative Law Judge Division is requested, may impose sanctions that are authorized under current insurance laws if a violation of this section is found to have occurred."

Time effective

SECTION 3. This act takes effect 180 days after signature by the Governor; however, existing contracts may comply with the requirements of this act at their next renewal date.

Approved the 13th day of June, 1997.