Bill 384

                    Current Status

Bill Number:                       384
Type of Legislation:               General Bill GB
Introducing Body:                  Senate
Introduced Date:                   19950118
Primary Sponsor:                   McConnell 
All Sponsors:                      McConnell 
Drafted Document Number:           jic\5172ac.95
Companion Bill Number:             4460
Residing Body:                     Senate
Subject:                           Health insurance, insurer or
                                   payor

Body    Date      Action Description                       Com     Leg Involved
______  ________  _______________________________________  _______ ____________

Senate  19960326  Committee report: majority               02 SBI
                  favorable, with amendment,
                  minority unfavorable
Senate  19950118  Introduced, read first time,             02 SBI
                  referred to Committee

COMMITTEE REPORT

March 26, 1996

S. 384

S. Printed 3/26/96--S.

Read the first time January 18, 1995.

To whom was referred a Bill (S. 384), to amend the Code of Laws of South Carolina, 1976, by adding Section 38-71-270 so as to provide that nothing in Title 38 may limit an insurer, etc., respectfully

That they have duly and carefully considered the same, and recommend that the same do pass with amendment:

Amend the bill, as and if amended, by striking all after the enacting words and inserting:

/SECTION 1. This act may be cited as the "South Carolina Patient Freedom of Choice Act".

SECTION 2. The 1976 Code is amended by adding:

"Section 38-71-270. (A) As used in this section:

(1) `Participating provider' means a health care provider who has been accepted by and has signed a managed care provider contract with a managed care organization.

(2) `Non-participating provider' means a health care provider who has not signed a managed care provider contract with the managed care organization.

(3) `Patient' means an individual covered under a health care services plan designed by a managed care organization.

(B) A person has the right to receive health care from the provider chosen by the person. A person enrolled in a managed care plan may not be denied access to treatment by participating or non-participating providers. If an enrollee in a managed care plan elects to receive health care services from a non-participating provider, the managed care organization may not penalize the patient by reducing benefits and must reimburse the non-participating provider, when assigned by the patient, at the same reimbursement rate as it reimburses similar participating providers. Any deductible stated in the insurance contract must remain the same. Terms and conditions may not discriminate against or among health care providers.

(C) It is unlawful for a managed care organization to terminate or cancel its agreement with any provider without cause.

(D) A clause existing in a managed care contract, whether executed before or after July 1, 1996, containing language, expressed or implied, which operates to or may operate to have the legal liability of the managed care organization, its processes and procedures, and act or omissions, including those of its agents, committees, assigns, or directors, indemnified by the participating providers is declared null and void as a matter of public policy.

(E) The provisions of this section take precedence over terms, conditions, and provisions of an existing contract.

(F) If any provision of this act or the application of a provision thereof either to any person or under any circumstances, is held to be invalid, then that determination does not affect provisions or applications of this act which can be given effect without the invalid provision or application. To that end, the provisions of this act are severable."

SECTION 3. This act takes effect July 1, 1996./

Renumber sections to conform.

Amend title to conform.

Majority favorable. Minority unfavorable.

EDWARD E. SALEEBY LARRY A. MARTIN

For Majority. For Minority.

A BILL

TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-270 SO AS TO PROVIDE THAT NOTHING IN TITLE 38 MAY LIMIT AN INSURER OR OTHER THIRD PARTY PAYOR FROM DETERMINING THE SCOPE OF ITS BENEFITS AND OTHER TERMS OF ITS CONTRACTS WITH PROVIDERS EXCEPT THAT THE CONTRACT PROVIDING COVERAGE TO AN INSURED MAY NOT EXCLUDE THE RIGHT OF ASSIGNMENT OF BENEFITS TO A PROVIDER AT THE SAME BENEFIT RATE AS PAID TO A CONTRACT PROVIDER.

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

SECTION 1. The 1976 Code is amended by adding:

"Section 38-71-270. Nothing in this title may be construed to limit an insurer, health maintenance organization, preferred provider organization, health care service corporation, or other third party payor from determining the scope of its benefits or services or any other terms of its group or individual insured, or both, subscriber or enrollee contracts nor from negotiating contracts with licensed providers on reimbursement rates or any other lawful provisions, except that the contract providing coverage to an insured may not exclude the right of assignment of benefits to a provider at the same benefit rate as paid to a contract provider."

SECTION 2. This act takes effect July 1, 1995.