Current Status Bill Number:3279 Type of Legislation:General Bill GB Introducing Body:House Introduced Date:19970121 Primary Sponsor:Meacham All Sponsors:Meacham, Allison, Altman, Bailey, Barfield, Barrett, Battle, Baxley, Boan, G. Brown, H. Brown, J. Brown, T. Brown, Byrd, Campsen, Canty, Cato, Cave, Chellis, Cobb-Hunter, Cooper, Dantzler, Davenport, Delleney, Easterday, Hamilton, Harvin, Haskins, Hawkins, J. Hines, M. Hines, Hinson, Inabinett, Jennings, Jordan, Kelley, Kennedy, Kinon, Kirsh, Klauber, Law, Leach, Lee, Limehouse, Littlejohn, Lloyd, Martin, Mason, McCraw, McKay, McMahand, Miller, Moody-Lawrence, Neal, Neilson, Parks, Phillips, Pinckney, Rhoad, Rice, Riser, Robinson, Sandifer, Seithel, Sharpe, Sheheen, Simrill, J. Smith, R. Smith, Spearman, Stille, Stoddard, Stuart, Tripp, Trotter, Vaughn, Walker, Webb, Whatley, Whipper, Wilkes, Wilkins, Witherspoon, Woodrum, and Young-Brickell Drafted Document Number:egm\18540ac.97 Companion Bill Number:200 Residing Body:Senate Current Committee:Medical Affairs Committee 13 SMA Date of Last Amendment:19970424 Subject:Patient Access to Optometric Primary Eye Care Act, Optometry, Insurance, medical and health
Body Date Action Description Com Leg Involved ______ ________ _______________________________________ _______ ____________ Senate 19970429 Introduced, read first time, 13 SMA referred to Committee House 19970425 Read third time, sent to Senate House 19970424 Amended, read second time, unanimous consent for third reading on Friday, 19970425 House 19970416 Committee report: Favorable with 26 HLCI amendment House 19970121 Introduced, read first time, 26 HLCI referred to CommitteeView additional legislative information at the LPITS web site.
AMENDED
April 24, 1997
H. 3279
Introduced by Reps. Meacham, Allison, Altman, Bailey, Barfield, Barrett, Battle, Baxley, Boan, G. Brown, H. Brown, J. Brown, T. Brown, Byrd, Campsen, Canty, Cato, Cave, Chellis, Cobb-Hunter, Cooper, Dantzler, Davenport, Delleney, Easterday, Hamilton, Harvin, Haskins, Hawkins, J. Hines, M. Hines, Hinson, Inabinett, Jennings, Jordan, Kelley, Kennedy, Kinon, Kirsh, Klauber, Law, Leach, Lee, Limehouse, Littlejohn, Lloyd, Martin, Mason, McCraw, McKay, McMahand, Miller, Moody-Lawrence, Neal, Neilson, Parks, Phillips, Pinckney, Rhoad, Rice, Riser, Robinson, Sandifer, Seithel, Sharpe, Sheheen, Simrill, J. Smith, R. Smith, Spearman, Stille, Stoddard, Stuart, Tripp, Trotter, Vaughn, Walker, Webb, Whatley, Whipper, Wilkes, Wilkins, Witherspoon, Woodrum, and Young-Brickell
S. Printed 4/24/97--H.
Read the first time January 21, 1997.
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-440 SO AS TO ENACT THE "PATIENT ACCESS TO OPTOMETRIC PRIMARY EYE CARE ACT" BY ESTABLISHING PARAMETERS WITHIN WHICH HEALTH CARE INSURERS THAT OFFER PRIMARY EYE CARE MUST PROVIDE THIS COVERAGE AND TO PROVIDE AN EQUITABLE REMEDY WHEN THERE ARE VIOLATIONS.
Amend Title To Conform
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. This act may be cited as the "South Carolina Eye Care Services Act."
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 non-discriminatory 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 non-discriminatory 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 non-discriminatory 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 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."
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.