Current Status Bill Number:1156 Type of Legislation:General Bill GB Introducing Body:Senate Introduced Date:19960221 Primary Sponsor:Hayes All Sponsors:Hayes Drafted Document Number:bbm\10558jm.96 Residing Body:Senate Current Committee:Banking and Insurance Committee 02 SBI Subject:Health care utilization review, before service denied
Body Date Action Description Com Leg Involved
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Senate 19960221 Introduced, read first time, 02 SBI
referred to Committee
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TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-70-70 SO AS TO REQUIRE IN THE PERFORMANCE OF UTILIZATION REVIEW, BEFORE ANY HEALTH CARE RESOURCE OR SERVICE IS DENIED, THAT A PHYSICIAN LICENSED IN SOUTH CAROLINA AND PRACTICING IN THE SAME SPECIALTY AREA AS THE PATIENT'S OR INSURED'S TREATING HEALTH CARE PROVIDER REVIEWS THE PATIENT FILE AND AGREES WITH THE DENIAL AND TO PROVIDE THAT COMPLIANCE WITH THIS SECTION IS A CONDITION FOR DOING BUSINESS IN THIS STATE OR FOR BEING CERTIFIED UNDER CHAPTER 70 OF TITLE 38.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. The 1976 Code is amended by adding:
"Section 38-70-70. Notwithstanding any other provision of this chapter or other provision of law, every private review agent operating subject to the provisions of this chapter, as well as every insurance company, administrator of an insurance benefit plan, health maintenance organization, hospital, hospital service corporation, preferred provider organization, or other similar entity or organization which does business in this State and which performs utilization review, as defined in Section 38-70-10(1), whether or not any such entity or organization employs utilization review staff to perform its own utilization review, shall ensure, before any health care resource or service given or proposed to be given to a patient or group of patients is denied, that a physician licensed in this State and practicing in the same specialty area as the treating health care provider reviews the patient file and agrees with the decision to deny the health care resource or service.
Compliance with the provisions of this section constitutes a condition for doing business in this State or for being certified under this chapter, as may be applicable under the circumstances."
SECTION 2. This act takes effect upon approval by the Governor.