Current Status Bill Number:4708 Type of Legislation:General Bill GB Introducing Body:House Introduced Date:19960306 Primary Sponsor:Seithel All Sponsors:Seithel, Loftis, S. Whipper, Sheheen, Clyburn, Tripp, Littlejohn, Thomas, Vaughn, Wofford, R. Smith, Cooper, Harvin and Martin Drafted Document Number:pt\2325ac.96 Residing Body:House Current Committee:Labor, Commerce and Industry Committee 26 HLCI Subject:Patient Protection Act
Body Date Action Description Com Leg Involved
______ ________ _______________________________________ _______ ____________
House 19960306 Introduced, read first time, 26 HLCI
referred to Committee
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TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-272 SO AS TO ENACT THE SOUTH CAROLINA PATIENT PROTECTION ACT TO ALLOW A PERSON RECEIVING HEALTH CARE SERVICES UNDER A MANAGED CARE ORGANIZATION TO RECEIVE CARE FROM A PROVIDER WHO HAS NOT CONTRACTED WITH THE ORGANIZATION TO PROHIBIT PENALIZING THE PERSON FOR SELECTING SUCH A PROVIDER; TO PROHIBIT A MANAGED CARE ORGANIZATION FROM TERMINATING ITS AGREEMENT WITH A PROVIDER WITHOUT CAUSE; AND TO DECLARE NULL AND VOID CLAUSES IN MANAGED CARE CONTRACTS WHICH ALLOW INDEMNIFICATION FROM PROVIDERS FOR LIABILITY OF THE ORGANIZATION.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. This act may be cited as the "South Carolina Patient Protection Act".
SECTION 2. The 1976 Code is amended by adding:
"Section 38-71-272. (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) `Nonparticipating 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 nonparticipating providers. If a patient elects to receive health care services from a nonparticipating provider, the managed care organization may not penalize the patient by reducing benefits and must reimburse the nonparticipating 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 acts or omission, 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."
SECTION 3. This act takes effect July 1, 1996.