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Current Status Bill Number:View additional legislative information at the LPITS web site.4212 Type of Legislation:General Bill GB Introducing Body:House Introduced Date:19990602 Primary Sponsor:Pinckney All Sponsors:Pinckney, Cobb-Hunter and Lloyd Drafted Document Number:l:\council\bills\psd\7481ac99.doc Residing Body:House Current Committee:Medical, Military, Public and Municipal Affairs Committee 27 H3M Subject:Children's Health Act, Medical, Minors, Insurance, Hospitals, Kidcare, Healthy Kids Corporation History Body Date Action Description Com Leg Involved ______ ________ ______________________________________ _______ ____________ House 19990602 Introduced, read first time, 27 H3M referred to Committee Versions of This Bill
TO AMEND TITLE 44, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO HEALTH, BY ADDING CHAPTER 82 SO AS TO ENACT THE "CHILDREN'S HEALTH ACT" WHICH CREATES THE CHILDREN'S MEDICAL SERVICES PROGRAM TO PROVIDE CHILDREN WITH SPECIAL HEALTH CARE NEEDS A COMPREHENSIVE MANAGED SYSTEM OF CARE; TO CREATE THE SOUTH CAROLINA KIDCARE PROGRAM TO PROVIDE HEALTH BENEFITS TO UNINSURED, LOW-INCOME CHILDREN THROUGH AFFORDABLE HEALTH BENEFITS COVERAGE OPTIONS TO WHICH FAMILIES MAY CONTRIBUTE FINANCIALLY TO THE HEALTH CARE OF THEIR CHILDREN; TO CREATE THE SOUTH CAROLINA HEALTHY KIDS CORPORATION PROGRAM TO ORGANIZE SCHOOL CHILDREN GROUPS TO FACILITATE THE PROVISION OF COMPREHENSIVE HEALTH INSURANCE COVERAGE TO CHILDREN; TO PROVIDE FOR THE POWERS AND DUTIES OF STATE AGENCIES TO CARRY OUT THESE PROGRAMS, AND TO PROVIDE ELIGIBILITY CRITERIA AND PROGRAM COMPONENTS AND BENEFITS; AND TO REQUIRE THE ESTABLISHMENT OF DEVELOPMENTAL EVALUATION AND INTERVENTION SERVICES AT EACH HOSPITAL THAT PROVIDES LEVEL II OR LEVEL III NEONATAL INTENSIVE CARE SERVICES AND TO STATE WHAT SERVICES MUST BE PROVIDED.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. This act may be cited as the "Children's Health Act".
SECTION 2. Title 44 of the 1976 Code is amended by adding:
Section 44-82-5. The General Assembly intends that the Children's Medical Services program:
(1) provide to children with special health care needs a family-centered, comprehensive, and coordinated statewide managed system of care that links community-based health care with multidisciplinary, regional, and tertiary pediatric specialty care. The program may provide for the coordination and maintenance of consistency of the medical home for children in families with a Children's Medical Services program participant, in order to achieve family-centered care;
(2) provide essential preventive, evaluative, and early intervention services for children at risk for or having special health care needs, in order to prevent or reduce long term disabilities;
(3) serve as a principal provider for children with special health care needs under Titles XIX and XXI of the Social Security Act; and
(4) be complementary to children's health training programs essential for the maintenance of a skilled pediatric health care workforce for all South Carolinians.
Section 44-82-10. When used in this article, unless the context clearly indicates otherwise:
(1) 'Children's Medical Services network' or 'network' means a statewide managed care service system that includes health care providers, as defined in this section.
(2) 'Children with special health care needs' means those children under age twenty-one years whose serious or chronic physical or developmental conditions require extensive preventive and maintenance care beyond that required by typically healthy children. Health care utilization by these children exceeds the statistically expected usage of the normal child adjusted for chronological age. These children often need complex care requiring multiple providers, rehabilitation services, and specialized equipment in a number of different settings.
(3) 'Department' means the Department of Health and Human Services.
(4) 'Eligible individual' means a child with a special health care need or a female with a high-risk pregnancy, who meets the financial and medical eligibility standards established in regulation.
(5) 'Health care provider' means a health care professional, health care facility, or entity licensed or certified to provide health services in this State that meets the criteria as established by the department.
(6) 'Health services' includes the prevention, diagnosis, and treatment of human disease, pain, injury, deformity, or disabling conditions.
(7) 'Participant' means an eligible individual who is enrolled in the Children's Medical Services program.
(8) 'Program' means the Children's Medical Services program established in the department.
(9) 'Program director' means the director of the Children's Medical Services program appointed by the director of the department pursuant to Section 44-82-25.
Section 44-82-15. (A) This article applies to health services provided to eligible individuals who are:
(1) enrolled in the Medicaid program;
(2) enrolled in the South Carolina Kidcare program established pursuant to Section 44-82-315; and
(3) uninsured or underinsured, provided that they meet the financial eligibility requirements established in this article, and to the extent that resources are appropriated for their care.
(B) The Children's Medical Services program consists of the following components:
(1) the infant metabolic screening program established in Section 44-82-30;
(2) a federal or state program authorized by the General Assembly;
(3) the developmental evaluation and intervention program established pursuant to Article 7;
(4) the Children's Medical Se1rvices network.
(C) The Children's Medical Services program shall not be deemed an insurer and is not subject to the licensing requirements of the South Carolina Insurance Department or the regulations of the Department of Insurance, when providing services to children who receive Medicaid benefits, other Medicaid-eligible children with special health care needs, and children participating in the South Carolina Kidcare program. This exemption shall not extend to contractors.
Section 44-82-20. The department shall have the following powers, duties, and responsibilities to:
(1) provide or contract for the provision of health services to eligible individuals;
(2) determine the medical and financial eligibility standards for the program and to determine the medical and financial eligibility of individuals seeking health services from the program;
(3) recommend priorities for the implementation of comprehensive plans and budgets;
(4) coordinate a comprehensive delivery system for eligible individuals to take maximum advantage of all available funds;
(5) promote, establish, and coordinate programs relating to children's medical services in cooperation with other public and private agencies and to coordinate funding of health care programs with federal, state, or local indigent health care funding mechanisms;
(6) initiate, coordinate, and request review of applications to federal and state agencies for funds, services, or commodities relating to children's medical programs;
(7) sponsor or promote grants for projects, programs, education, or research in the field of medical needs of children, with an emphasis on early diagnosis and treatment;
(8) oversee and operate the Children's Medical Services network;
(9) establish reimbursement mechanisms for the Children's Medical Services network;
(10) establish Children's Medical Services network standards and credentialing requirements for health care providers and health care services;
(11) serve as a provider and principal case manager for children with special health care needs under Titles XIX and XXI of the Social Security Act;
(12) monitor the provision of health services in the program, including the utilization and quality of health services;
(13) administer the Children with Special Health Care Needs program in accordance with Title V of the Social Security Act;
(14) establish and operate a grievance resolution process for participants and health care providers;
(15) maintain program integrity in the Children's Medical Services program;
(16) receive and manage health care premiums, capitation payments, and funds from federal, state, local, and private entities for the program;
(17) appoint health care consultants for the purpose of providing peer review and making recommendations to enhance the delivery and quality of services in the Children's Medical Services program;
(18) make rules to carry out the provisions of this act.
Section 44-82-25. (A) The Children's Medical Services program shall have a central office and area offices. The director of the program must be a licensed physician appointed by the director of the department who has specialized training and experience in the provision of health care to children and who has recognized skills in leadership and the promotion of children's health programs.
(B) The director of the department, in consultation with the program director, shall designate Children's Medical Services area offices to perform operational activities including, but not limited to:
(1) providing case management services for the network;
(2) providing local oversight of the program;
(3) determining an individual's medical and financial eligibility for the program;
(4) participating in the determination of a level of care and medical complexity for long-term care services;
(5) authorizing services in the program and developing spending plans;
(6) participating in the development of treatment plans;
(7) taking part in the resolution of complaints and grievances from participants and health care providers.
(C) Each Children's Medical Services area office shall be directed by a licensed physician who has specialized training and experience in the provision of health care to children. The director of a Children's Medical Services area office shall be appointed by the director of the program.
Section 44-82-30. (A) The department shall establish the medical criteria to determine if an applicant for the Children's Medical Services program is an eligible individual.
(B) The following individuals are financially eligible for the program:
(1) a high-risk pregnant female who is eligible for Medicaid;
(2) a child with special health care needs from birth to age twenty-one years who is eligible for Medicaid;
(3) a child with special health care needs from birth to age nineteen years who is eligible for a program under Title XXI of the Social Security Act;
(4) a child with special health care needs from birth to age twenty-one years whose projected annual cost of care adjusts the family income to Medicaid financial criteria. In cases where the family income is adjusted based on a projected annual cost of care, the family shall participate financially in the cost of care based on criteria established by the department;
(5) a child with special health care needs as defined in Title V of the Social Security Act relating to children with special health care needs.
(C) The department shall determine the financial and medical eligibility of children for the program. The department shall also determine the financial ability of the parents, or persons or other agencies having legal custody over such individuals, to pay the costs of health services under the program. The department may pay reasonable travel expenses related to the determination of eligibility for or the provision of health services.
(D) Any child who has been provided with surgical or medical care or treatment under this article prior to being adopted shall continue to be eligible to be provided with such care or treatment after his or her adoption, regardless of the financial ability of the persons adopting the child.
Section 44-82-35. Benefits provided under the program shall the same benefits provided to children as specified in the mandatory and optional Medicaid Services in the State Medicaid Plan. The department may offer additional benefits for early intervention services, respite services, genetic testing, genetic and nutritional counseling, and parent support services, if such services are determined to be medically necessary. No child or person determined eligible for the program who is eligible under Title XIX or Title XXI of the Social Security Act shall receive any service other than an initial health care screening or treatment of an emergency medical condition until such child or person is enrolled in Medicaid or a Title XXI program.
Section 44-82-40. (A) The department shall establish the criteria to designate health care providers to participate in the Children's Medical Services network. The department shall follow, whenever available, national guidelines for selecting health care providers to serve children with special health care needs.
(B) The department shall require that all health care providers under contract with the program be duly licensed in the State, if such licensure is available, and meet such criteria as may be established by the department.
(C) The department may initiate agreements with other state or local governmental programs or institutions for the coordination of health care to eligible individuals receiving services from such programs or institutions.
Section 44-82-45. (A) The department shall reimburse health care providers for services rendered through the Children's Medical Services network using cost-effective methods, including, but not limited to, capitation, discounted fee-for-service, unit costs, and cost reimbursement. Medicaid reimbursement rates shall be utilized to the maximum extent possible, where applicable.
(B) Reimbursement to the Children's Medical Services program for services provided to children with special health care needs who participate in the South Carolina Kidcare program pursuant to Article 3 and who are not Medicaid recipients shall be on a capitated basis.
Section 44-82-50. (A) The program shall apply managed care methods to ensure the efficient operation of the Children's Medical Services network. Such methods include, but are not limited to, capitation payments, utilization management and review, prior authorization, and case management.
(B) The components of the network are:
(1) qualified primary care physicians who shall serve as the gatekeepers and who shall be responsible for the provision or authorization of health services to an eligible individual who is enrolled in the Children's Medical Services network;
(2) comprehensive specialty care arrangements to provide acute care, specialty care, long-term care, and chronic disease management for eligible individuals;
(3) case management services.
(C) The Children's Medical Services network may contract with school districts for the provision of school-based services, where available, for Medicaid-eligible children who are enrolled in the Children's Medical Services network.
Section 44-82-55. The department is authorized to establish health care provider agreements for participation in the Children's Medical Services program.
Section 44-82-60. The Children's Medical Services program shall develop quality of care and service integration standards and reporting requirements for health care providers that participate in the Children's Medical Services program. The program shall ensure that these standards are not duplicative of other standards and requirements for health care providers.
Section 44-82-65. The department shall adopt and implement a system to provide assistance to eligible individuals and health care providers to resolve complaints and grievances. To the greatest extent possible, the department shall use existing grievance reporting and resolution processes. The department shall ensure that the system developed for the Children's Medical Services program does not duplicate existing grievance reporting and resolution processes.
Section 44-82-70. The department shall operate a system to oversee the activities of Children's Medical Services program participants, and health care providers and their representatives, to prevent fraudulent and abusive behavior, overutilization and duplicative utilization, and neglect of participants and to recover overpayments as appropriate. The department shall refer incidents of suspected fraud and abuse, and overutilization and duplicative utilization, to the appropriate regulatory agency.
Section 44-82-75. (A) The department may initiate, fund, and conduct research and evaluation projects to improve the delivery of children's medical services. The department may cooperate with public and private agencies engaged in work of a similar nature. (B) The Children's Medical Services network shall be included in any evaluation conducted in accordance with the provisions of Title XXI of the Social Security Act.
Section 44-82-80. (A) The director of the department shall appoint a Statewide Children's Medical Services Network Advisory Council for the purpose of acting as an advisory body to the department. The duties of the council include, but are not be limited to:
(1) recommending standards and credentialing requirements for health care providers rendering health services to Children's Medical Services network participants;
(2) making recommendations to the Director of the Children's Medical Services program concerning the selection of health care providers for the Children's Medical Services network;
(3) reviewing and making recommendations concerning network health care provider or participant disputes that are brought to the attention of the advisory council;
(4) providing input to the Children's Medical Services program on the policies governing the Children's Medical Services network;
(5) reviewing the financial reports and financial status of the network and making recommendations concerning the methods of payment and cost controls or the network;
(6) reviewing and recommending the scope of benefits for the network;
(7) reviewing network performance measures and outcomes and making recommendations for improvements to the network and its maintenance and collection of data and information.
(B) The council shall be composed of twelve members representing the private health care provider sector, families with children who have special health care needs, the Department of Health and Human Services, the Department of Insurance, the South Carolina Chapter of the American Academy of Pediatrics, an academic health center pediatric program, and the health insurance industry. Members shall be appointed for four-year, staggered terms. In no case shall an employee of the Department of Health serve as a member or as an ex officio member of the advisory council. A vacancy shall be filled for the remainder of the unexpired term in the same manner as the original appointment. A member may not be appointed to more than two consecutive terms. However, a member may be reappointed after being off the council for at least two years.
(C) Members shall receive no compensation, but shall be reimbursed for per diem, mileage and subsistence as provided by law for members of State boards, committees, and commissions.
Section 44-82-85. The director of the department may establish technical advisory panels to assist in developing specific policies and procedures for the Children's Medical Services program.
SECTION 2. The 1976 Code is amended by adding:
Section 44-82-305. This article may be cited as the 'South Carolina Kidcare Act'.
Section 44-82-310. As used in this article:
(1) 'Actuarially equivalent' means that:
(a) the aggregate value of the benefits included in health benefits coverage is equal to the value of the benefits in the benchmark benefit plan; and
(b) the benefits included in health benefits coverage are substantially similar to the benefits included in the benchmark benefit plan, except that preventive health services must be the same as in the benchmark benefit plan.
(2) 'Applicant' means a parent who applies for determination of eligibility for health benefits coverage.
(3) 'Benchmark benefit plan' means the form and level of health benefits coverage established in Section 44-82-335 .
(4) 'Child' means any person under nineteen years of age.
(5) 'Child with special health care needs' means a child whose serious or chronic physical or developmental condition requires extensive preventive and maintenance care beyond that required by typically healthy children. Health care utilization by such a child exceeds the statistically expected usage of the normal child adjusted for chronological age, and such a child often needs complex care requiring multiple providers, rehabilitation services, and specialized equipment in a number of different settings.
(6) 'Children's Medical Services network' or 'network' means a statewide managed care service system as defined in Section 44-82-15.
(7) 'Community rate' means a method used to develop premiums for a health insurance plan that spreads financial risk across a large population and allows adjustments only for age, gender, family composition, and geographic area.
(8) 'DHHS' means the Department of Health and Human Services.
(9) 'Department' means the Department of Health.
(10) 'Enrollee' means a child who has been determined eligible for and is receiving coverage under this article.
(11) 'Enrollment ceiling' means the maximum number of children receiving premium assistance payments, excluding children enrolled in Medicaid, that may be enrolled at any time in the South Carolina Kidcare program. The maximum number shall be established annually in the general appropriations act or by general law.
(12) 'Family' means the group or the individuals whose income is considered in determining eligibility for the South Carolina Kidcare program. The family includes a child with a custodial parent or caretaker relative who resides in the same house or living unit. The family may also include other individuals whose income and resources are considered in whole or in part in determining eligibility of the child.
(13) 'Family income' means cash received at periodic intervals from any source, such as wages, benefits, contributions, or rental property. Income also may include any money that is counted as income under the Family Independence Program administered by the Department of Social Services.
(14) 'Guarantee issue' means that health benefits coverage must be offered to an individual regardless of the individual's health status, preexisting condition, or claims history.
(15) 'Health benefits coverage' means protection that provides payment of benefits for covered health care services or that otherwise provides, either directly or through arrangements with other persons, covered health care services on a prepaid per capita basis or on a prepaid aggregate fixed-sum basis.
(16) 'Health insurance plan' means health benefits coverage under a health plan offered by any certified health maintenance organization or authorized health insurer, except a plan that is limited to the following: a limited benefit, specified disease, or specified accident; hospital indemnity; accident only; limited benefit convalescent care; Medicare supplement; credit disability; dental; vision; long-term care; disability income; coverage issued as a supplement to another health plan; workers' compensation liability or other insurance; or motor vehicle medical payment only.
(17) 'Medicaid' means the medical assistance program authorized by Title XIX of the Social Security Act, and regulations thereunder, and administered in this State by the DHHS.
(18) 'Medically necessary' means the use of any medical treatment, service, equipment, or supply necessary to palliate the effects of a terminal condition, or to prevent, diagnose, correct, cure, alleviate, or preclude deterioration of a condition that threatens life, causes pain or suffering, or results in illness or infirmity and which is:
(a) consistent with the symptom, diagnosis, and treatment of the enrollee's condition;
(b) provided in accordance with generally accepted standards of medical practice;
(c) not primarily intended for the convenience of the enrollee, the enrollee's family, or the health care provider;
(d) the most appropriate level of supply or service for the diagnosis and treatment of the enrollee's condition; and
(e) approved by the appropriate medical body or health care specialty involved as effective, appropriate, and essential for the care and treatment of the enrollee's condition.
(19) 'Medikids' means a component of the South Carolina Kidcare program of medical assistance authorized by Title XXI of the Social Security Act, and regulations thereunder, and as administered by Department of Health and Human Services.
(20) 'Preexisting condition exclusion' means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before the date.
(21) 'Premium' means the entire cost of a health insurance plan, including the administration fee or the risk assumption charge.
(22) 'Premium assistance payment' means the monthly consideration paid by the agency per enrollee in the South Carolina Kidcare program towards health insurance premiums.
(23) 'Program' means the South Carolina Kidcare program, the medical assistance program authorized by Title XXI of the Social Security Act as part of the federal Balanced Budget Act of 1997.
(24) 'Resident' means a United States citizen, or qualified alien, who is domiciled in this State.
(25) 'Substantially similar' means that, with respect to additional services as defined in Section 2103(c)(2) of Title XXI of the Social Security Act, these services must have an actuarial value equal to at least seventy-five percent of the actuarial value of the coverage for that service in the benchmark benefit plan and, with respect to the basic services as defined in Section 2103(c)(1) of Title XXI of the Social Security Act, these services must be the same as the services in the benchmark benefit plan.
Section 44-82-315. The South Carolina Kidcare program is created to provide a defined set of health benefits to previously uninsured, low-income children through the establishment of a variety of affordable health benefits coverage options from which families may select coverage and through which families may contribute financially to the health care of their children.
Section 44-82-320. The South Carolina Kidcare program includes health benefits coverage provided to children through:
(1) Medicaid;
(2) Medikids as created in Section 44-82-325;
(3) The South Carolina Healthy Kids Corporation as created in Section 44-82-520;
(4) Employer-sponsored group health insurance plans approved under; and
(5) The Children's Medical Services network established in Article 1. Except for coverage under the Medicaid program, coverage under the South Carolina Kidcare program is not an entitlement. No cause of action shall arise against the State, the department, the South Carolina Department of Social Services, or the DHHS for failure to make health services available to any person under this article.
Section 44-82-325. (A) The Medikids program component is created in the Department of Health and Human Services to provide health care services under the South Carolina Kidcare program to eligible children using the administrative structure and provider network of the Medicaid program.
(B) The director of the department shall appoint an administrator of the Medikids program component. The Department of Health and Human Services is designated as the state agency authorized to make payments for medical assistance and related services for the Medikids program component of the South Carolina Kidcare program. Payments shall be made, subject to any limitations or directions in the general appropriations act, only for covered services provided to eligible children by qualified health care providers under the South Carolina Kidcare program.
(C) The Medikids program component shall not be subject to the licensing requirements of the South Carolina Insurance Department or regulations of the department.
(D) Benefits provided under the Medikids program component shall be the same benefits provided to children as specified in the State Medicaid plan for mandatory and optional Medicaid services.
(E) A child who is under the age of five years is eligible to enroll in the Medikids program component of the South Carolina Kidcare program, if the child is a member of a family that has a family income which exceeds the Medicaid applicable income level but which is equal to or below two hundred percent of the current federal poverty level. In determining the eligibility of the child, an assets test is not required. A child who is eligible for Medikids may elect to enroll in South Carolina Healthy Kids coverage or employer-sponsored group coverage. However, a child who is eligible for Medikids may participate in the South Carolina Healthy Kids program only if the child has a sibling participating in the South Carolina Healthy Kids program and the child's county of residence permits such enrollment.
(F) Enrollment in the Medikids program component may only occur during periodic open enrollment periods as specified by DHHS. During the first twelve months of the program, there must be at least one, but no more than three, open enrollment periods. The initial open enrollment period shall be for ninety days, and subsequent open enrollment periods during the first year of operation of the program shall be for thirty days. After the first year of the program, DHHS shall determine the frequency and duration of open enrollment periods. An applicant shall apply for enrollment in the Medikids program component and proceed through the eligibility determination process at any time throughout the year. However, enrollment in Medikids may not begin until the next open enrollment period; and a child may not receive services under the Medikids program until the child is enrolled in a managed care plan. In addition, once determined eligible, an applicant may receive choice counseling and select a managed care plan
(G) DHHS shall establish a special enrollment period of thirty days duration for any newborn child who is eligible for Medikids, or for any child who is enrolled in Medicaid if the child loses Medicaid eligibility and becomes eligible for Medikids, or for any child who is enrolled in Medikids if the child moves to another county that is not within the coverage area of the child's Medikids managed care plan department.
(H) DHHS shall establish enrollment criteria that includes penalties or waiting periods of not fewer than thirty days for reinstatement of coverage upon voluntary cancellation for nonpayment of premiums.
Section 44-82-330. (A) A child whose family income is equal to or below two hundred percent of the federal poverty level is eligible for the South Carolina Kidcare program as provided in this section. In determining the eligibility of a child, an assets test is not required.
(B) A child who is not eligible for Medicaid, but who is eligible for the South Carolina Kidcare program, may obtain coverage under any of the other types of health benefits coverage authorized in this article if the coverage is approved and available in the county in which the child resides. However, a child who is eligible for Medikids may participate in the South Carolina Healthy Kids program, as provided for in Article 5, only if the child has a sibling participating in the South Carolina Healthy Kids program and the child's county of residence permits such enrollment.
(C) A child who is eligible for the South Carolina Kidcare program who is a child with special health care needs, as determined through a risk-screening instrument, is eligible for health benefits coverage from and may be referred to the Children's Medical Services network.
(D) The following children are not eligible to receive premium assistance for health benefits coverage under this article:
(1) a child who is eligible for coverage under a state health benefit plan on the basis of a family member's employment with a public agency in the State;
(2) a child who is covered under a group health benefit plan or under other health insurance coverage, excluding coverage provided under the South Carolina Healthy Kids Corporation as established under Article 5;
(3) a child who is seeking premium assistance for employer-sponsored group coverage, if the child has been covered by the same employer's group coverage during the six months prior to the family's submitting an application for determination of eligibility under the South Carolina Kidcare program;
(4) a child who is an alien, but who does not meet the definition of qualified alien, in the United States; or
(5) a child who is an inmate of a public institution or a patient in an institution for mental diseases.
(E) A child whose family income is above two hundred percent percent of the federal poverty level or a child who is excluded under the provisions of subsection (D) may participate in the South Carolina Kidcare program excluding the Medicaid program but is subject to the following provisions:
(1) The family is not eligible for premium assistance payments and must pay the full cost of the premium including any administrative costs.
(2) DHHS is authorized to place limits on enrollment in Medikids by these children in order to avoid adverse selection. The number of children participating in Medikids whose family income exceeds two hundred percent of the federal poverty level must not exceed ten percent of total enrollees in the Medikids program.
(3) The board of directors of the South Carolina Healthy Kids Corporation, established pursuant to Article 5 is authorized to place limits on enrollment of these children in order to avoid adverse selection. In addition, the board is authorized to offer a reduced benefit package to these children in order to limit program costs for such families. The number of children participating in the South Carolina Healthy Kids program whose family income exceeds two hundred percent of the federal poverty level must not exceed ten percent of total enrollees in the South Carolina Healthy Kids program.
(4) Children described in this subsection are not counted in the annual enrollment ceiling for the South Carolina Kidcare program.
(F) Once a child is determined eligible for the South Carolina Kidcare program, the child is eligible for coverage under the program for six months without a redetermination or reverification of eligibility, if the family continues to pay the applicable premium. A child who has not attained the age of five years and who has been determined eligible for the Medicaid program is eligible for coverage for twelve months without a redetermination or reverification of eligibility.
Section 44-82-335. (A) For purposes of the South Carolina Kidcare program, benefits available under Medicaid and Medikids include those goods and services provided under the medical assistance program authorized by Title XIX of the Social Security Act, and regulations thereunder, as administered in this State by DHHS. This includes those mandatory and optional Medicaid services authorized under the State Medicaid Plan, rendered on behalf of eligible individuals by qualified providers, in accordance with federal requirements for Title XIX, subject to any limitations or directions provided for in the general appropriations act or state law, and according to methodologies and limitations set forth in DHHS regulations and policy manuals and handbooks incorporated by reference thereto.
(B) In order for health benefits coverage to qualify for premium assistance payments for an eligible child under the health benefits coverage, except for coverage under Medicaid and Medikids, must include the following minimum benefits, as medically necessary:
(1) Preventive health services including:
(a) well-child care, including services recommended in the Guidelines for Health Supervision of Children and Youth as developed by the American Academy of Pediatrics;
(b) immunizations and injections;
(c) health education counseling and clinical services;
(d) vision screening; and
(e) hearing screening.
(2) All covered services provided for the medical care and treatment of an enrollee who is admitted as an inpatient to a hospital except:
(a) all admissions must be authorized by the enrollee's health benefits coverage provider;
(b) the length of the patient stay must be determined based on the medical condition of the enrollee in relation to the necessary and appropriate level of care;
(c) room and board may be limited to semiprivate accommodations, unless a private room is considered medically necessary or semiprivate accommodations are not available;
(d) admissions for rehabilitation and physical therapy are limited to fifteen days for each contract year.
(3) Visits to an emergency room or other licensed facility if needed immediately due to an injury or illness and delay means risk of permanent damage to the enrollee's health.
(4) Maternity and newborn care including prenatal and postnatal care, with the following limitations:
(a) coverage may be limited to the fee for vaginal deliveries; and
(b) initial inpatient care for newborn infants of enrolled adolescents shall be covered, including normal newborn care, nursery charges, and the initial pediatric or neonatal examination, and the infant may be covered for up to 3 days following birth.
(5) Organ transplantation services including pretransplant, transplant, and postdischarge services and treatment of complications after transplantation for transplants deemed necessary and appropriate
(6) Outpatient services including preventive, diagnostic, therapeutic, palliative care services, and other services provided to an enrollee in the outpatient portion of a health facility except that:
(a) services must be authorized by the enrollee's health benefits coverage provider; and
(b) treatment for temporomandibular joint disease (TMJ) is specifically excluded.
(7) Behavioral health services:
(a) mental health benefits including:
(1) inpatient services, limited to not more than thirty inpatient days for each contract year for psychiatric admissions, or residential services in licensed facilities in lieu of inpatient psychiatric admissions; however, a minimum of ten of the thirty days must be available only for inpatient psychiatric services when authorized by a physician; and
(2) outpatient services, including outpatient visits for psychological or psychiatric evaluation, diagnosis, and treatment by a licensed mental health professional, limited to a maximum of forty outpatient visits each contract year.
(b) Substance abuse services include:
(1) inpatient services, limited to not more than seven inpatient days per contract year for medical detoxification only and thirty days of residential services; and
(2) outpatient services, including evaluation, diagnosis, and treatment by a licensed practitioner, limited to a maximum of forty outpatient visits for each contract year.
(8) Durable medical equipment including equipment and devices that are medically indicated to assist in the treatment of a medical condition and specifically prescribed as medically necessary, with the following limitations:
(a) low-vision and telescopic aides are not included;
(b) corrective lenses and frames may be limited to one pair every two years, unless the prescription or head size of the enrollee changes;
(c) hearing aids shall be covered only when medically indicated to assist in the treatment of a medical condition;
(d) Covered prosthetic devices include artificial eyes and limbs, braces, and other artificial aids.
(9) Health practitioner services including services and procedures rendered to an enrollee when performed to diagnose and treat diseases, injuries, or other conditions, including care rendered by health practitioners acting within the scope of their practice, with the following exceptions:
(a) chiropractic services shall be provided in the same manner as in the State Medicaid Plan;
(b) podiatric services may be limited to one visit per day totaling two visits per month for specific foot disorders.
(10) Home health services including prescribed home visits by both registered and licensed practical nurses to provide skilled nursing services on a part-time intermittent basis, subject to the following limitations:
(a) coverage may be limited to include skilled nursing services only;
(b) meals, housekeeping, and personal comfort items may be excluded; and
(c) private duty nursing is limited to circumstances where such care is medically necessary.
(11) Hospice services include reasonable and necessary services for palliation or management of an enrollee's terminal illness, with the following exceptions:
(a) Once a family elects to receive hospice care for an enrollee, other services that treat the terminal condition will not be covered; and
(b) Services required for conditions totally unrelated to the terminal condition are covered to the extent that the services are included in this section.
(12) Laboratory and x-ray services including diagnostic testing, which includes clinical radiologic, laboratory, and other diagnostic tests.
(13) Nursing facility services including regular nursing services, rehabilitation services, drugs and biologicals, medical supplies, and the use of appliances and equipment furnished by the facility, with the following limitations:
(a) all admissions must be authorized by the health benefits coverage provider;
(b) the length of the patient stay shall be determined based on the medical condition of the enrollee in relation to the necessary and appropriate level of care, but is limited to not more than one hundred days for each contract year;
(c) room and board may be limited to semiprivate accommodations, unless a private room is considered medically necessary or semiprivate accommodations are not available;
(d) specialized treatment centers and independent kidney disease treatment centers are excluded;
(e) private duty nurses, television, and custodial care are excluded;
(f) admissions for rehabilitation and physical therapy are limited to fifteen days for each contract year.
(14) Prescribed drugs within these conditions:
(a) coverage shall include drugs prescribed for the treatment of illness or injury when prescribed by a licensed health practitioner acting within the scope of his or her practice;
(b) prescribed drugs may be limited to generics if available and brand name products if a generic substitution is not available, unless the prescribing licensed health practitioner indicates that a brand name is medically necessary;
(c) prescribed drugs covered under this section shall include all prescribed drugs covered under the State Medicaid Plan.
(15) Therapy services including rehabilitative services, which include occupational, physical, respiratory, and speech therapies, with the following limitations:
(a) services must be for short-term rehabilitation where significant improvement in the enrollee's condition will result; and
(b) services shall be limited to not more than twenty-four treatment sessions within a sixty-day period for each episode or injury, with the sixty-day period beginning with the first treatment.
(16) Transportation services including emergency transportation required in response to an emergency situation.
(17) Lifetime maximum of one million for each covered child.
(18) Cost-sharing provisions must comply with Section 44-82-340.
(19) The following exclusions apply:
(a) experimental or investigational procedures that have not been clinically proven by reliable evidence are excluded;
(b) services performed for cosmetic purposes only or for the convenience of the enrollee are excluded; and
(c) abortion may be covered only if necessary to have the life of the mother or if the pregnancy is the result of an act of rape or incest.
(C) This section sets the minimum benefits that must be included in any health benefits coverage, other than Medicaid or Medikids coverage, offered under this article. Health benefits coverage may include additional benefits not included under this subsection, but may not include benefits excluded under this section. Health benefits coverage may extend any limitations beyond the minimum benefits described in this section. Except for the Children's Medical Services network, the agency may not increase the premium assistance payment for either additional benefits provided beyond the minimum benefits described in this section or the imposition of less restrictive service limitations.
(D) Health insurers, health maintenance organizations, and their agents are subject to the provisions of the South Carolina Insurance Code, except for any provisions waived in this section. Except as expressly provided in this section, a law requiring coverage for a specific health care service or benefit, or a law requiring reimbursement, utilization, or consideration of a specific category of licensed health care practitioner, does not apply to a health insurance plan policy or contract offered or delivered under this article unless that law is made expressly applicable to such policies or contracts. Notwithstanding any other provision of law, a health maintenance organization may issue contracts providing benefits equal to, exceeding, or actuarially equivalent to the benefit plan authorized by this section.
Section 44-82-340. These limitations on premiums and cost-sharing are established for the program:
(1) enrollees who receive coverage under the Medicaid program may not be required to pay:
(a) Enrollment fees, premiums, or similar charges; or
(b) copayments, deductibles, coinsurance, or similar charges;
(2) Enrollees in families with a family income equal to or below one hundred fifty percent of the federal poverty level, who are not receiving coverage under the Medicaid program, may not be required to pay:
(a) enrollment fees, premiums, or similar charges that exceed the maximum monthly charge permitted under Section 1916(b)(1) of the Social Security Act; or
(b) copayments, deductibles, coinsurance, or similar charges that exceed a nominal amount, as determined consistent with regulations referred to in Section 1916(a)(3) of the Social Security Act. However, these charges may not be imposed for preventive services, including well-baby and well-child care, age-appropriate immunizations, and routine hearing and vision screenings.
(3) Enrollees in families with a family income above one hundred fifty percent of the federal poverty level, who are not receiving coverage under the Medicaid program or who are not eligible under Section 44-82-330(E), may be required to pay enrollment fees, premiums, copayments, deductibles, coinsurance, or similar charges on a sliding scale related to income, except that the total annual aggregate cost-sharing with respect to all children in a family may not exceed five percent of the family's income. However, copayments, deductibles, coinsurance, or similar charges may not be imposed for preventive services, including well-baby and well-child care, age-appropriate immunizations, and routine hearing and vision screenings.
Section 44-82-345. In order for health insurance coverage to qualify for premium assistance payments for an eligible child under this article, the health benefits coverage must:
(1) be certified by the Department of Insurance as meeting, exceeding, or being actuarially equivalent to the benchmark benefit plan;
(2) be guarantee issued;
(3) be community rated;
(4) not impose any preexisting condition exclusion for covered benefits; however, group health insurance plans may permit the imposition of a preexisting condition exclusion;
(5) comply with the applicable limitations on premiums and cost-sharing in Section 44-82-340;
(6) comply with the quality assurance and access standards developed under Section 44-82-370; and
(7) establish periodic open enrollment periods, which may not occur more frequently than quarterly.
Section 44-82-350. The Department of Health and Human Services, in consultation with the Department of Health and Environmental Control, the Department of Social Services, and the South Carolina Healthy Kids Corporation, shall by January 1 of each year submit to the Governor and the General Assembly a report of the South Carolina Kidcare program. In addition to the items specified under Section 2108 of Title XXI of the Social Security Act, the report shall include an assessment of access to health care, as well as the following:
(1) an assessment of the operation of the program, including the progress made in reducing the number of uncovered low-income children;
(2) an assessment of the effectiveness in increasing the number of children with creditable health coverage;
(3) the characteristics of the children and families assisted under the program, including ages of the children, family income, and access to or coverage by other health insurance prior to the program and after disenrollment from the program;
(4) the quality of health coverage provided, including the types of benefits provided;
(5) the amount and level, including payment of part or all of any premium, of assistance provided;
(6) the average length of coverage of a child under the program;
(7) the program's choice of health benefits coverage and other methods used for providing child health assistance;
(8) the sources of nonfederal funding used in the program;
(9) an assessment of the effectiveness of Medikids, Children's Medical Services network, and other public and private programs in the State in increasing the availability of affordable quality health insurance and health care for children;
(10) a review and assessment of state activities to coordinate the program with other public and private programs;
(11) an analysis of changes and trends in the State that affect the provision of health insurance and health care to children;
(12) a description of any plans the State has for improving the availability of health insurance and health care for children;
(13) recommendations for improving the program;
(14) other studies as necessary.
Section 44-82-360. In order to implement this article, the following agencies shall have the following duties:
(1) the Department of Social Services shall:
(a) develop a simplified eligibility application mail-in form to be used for determining the eligibility of children for coverage under the South Carolina Kidcare program, in consultation with DHHS, the Department of Health, and the South Carolina Healthy Kids Corporation. The simplified eligibility application form must include an item that provides an opportunity for the applicant to indicate whether coverage is being sought for a child with special health care needs. Families applying for children's Medicaid coverage must also be able to use the simplified application form without having to pay a premium;
(b) establish and maintain the eligibility determination process under the program except as specified in item (5). The department shall directly, or through the services of a contracted third-party administrator, establish and maintain a process for determining eligibility of children for coverage under the program. The eligibility determination process must be used solely for determining eligibility of applicants for health benefits coverage under the program. The eligibility determination process must include an initial determination of eligibility for any coverage offered under the program, as well as a redetermination or reverification of eligibility each subsequent six months. A child who has not attained the age of five years and who has been determined eligible for the Medicaid program is eligible for coverage for twelve months without a redetermination or reverification of eligibility. In conducting an eligibility determination, the department shall determine if the child has special health care needs;
(c) inform program applicants about eligibility determinations and provide information about eligibility of applicants to Medicaid, Medikids, the Children's Medical Services network, and the South Carolina Healthy Kids Corporation, and to insurers and their agents, through a centralized coordinating office;
(d) promulgate regulations necessary for conducting program eligibility functions.
(2) The Department of Health and Environmental Control shall:
(a) design an eligibility intake process for the program, in coordination with the Department of Social Services, DHHS, and the South Carolina Healthy Kids Corporation. The eligibility intake process may include local intake points that are determined by the Department of Health and Environmental Control in coordination with the Department of Social Services;
(b) design and implement program outreach activities;
(c) chair a state-level coordinating council to review and make recommendations concerning the implementation and operation of the program. The coordinating council shall include representatives from the department, the Department of Social Services, DHHS, the South Carolina Healthy Kids Corporation, the Department of Insurance, local government, health insurers, health maintenance organizations, health care providers, families participating in the program, and organizations representing low-income families;
(d) in consultation with the South Carolina Healthy Kids Corporation and the Department of Social Services, establish a toll-free telephone line to assist families with questions about the program;
(e) promulgate regulations necessary to implement outreach activities.
(3) The Department of Health and Human Services shall:
(a) calculate the premium assistance payment necessary to comply with the premium and cost-sharing limitations specified in Section 44-82-340. The premium assistance payment for each enrollee in a health insurance plan participating in the South Carolina Healthy Kids Corporation shall equal the premium approved by the South Carolina Healthy Kids Corporation and the Department of Insurance, less any enrollee's share of the premium established within the limitations specified in Section 44-82-340. The premium assistance payment for each enrollee in an employer-sponsored health insurance plan approved under this article shall equal the premium for the plan adjusted for any benchmark benefit plan actuarial equivalent benefit rider approved by the Department of Insurance, less any enrollee's share of the premium established within the limitations specified in Section 44-82-340. In calculating the premium assistance payment levels for children with family coverage, the department shall set the premium assistance payment levels for each child proportionately to the total cost of family coverage;
(b) Annually calculate the program enrollment ceiling based on estimated per-child premium assistance payments and the estimated appropriation available for the program;
(c) make premium assistance payments to health insurance plans on a periodic basis. The department may use its Medicaid fiscal agent or a contracted third-party administrator in making these payments. The agency may require health insurance plans that participate in the Medikids program or employer-sponsored group health insurance to collect premium payments from an enrollee's family. Participating health insurance plans shall report premium payments collected on behalf of enrollees in the program to the department in accordance with a schedule established by the department;
(d) monitor compliance with quality assurance and access standards;
(e) establish a mechanism for investigating and resolving complaints and grievances from program applicants, enrollees, and health benefits coverage providers, and maintain a record of complaints and confirmed problems;
(f) approve health benefits coverage for participation in the program, following certification by the Department of Insurance;
(g) promulgate regulations necessary for calculating premium assistance payment levels, calculating the program enrollment ceiling, making premium assistance payments, monitoring access and quality assurance standards, investigating and resolving complaints and grievances, administering the Medikids program, and approving health benefits coverage. The Department of Health and Human Services is designated the lead state agency for Title XXI of the Social Security Act for purposes of receipt of federal funds, for reporting purposes, and for ensuring compliance with federal and state regulations.
(4) The Department of Insurance shall certify that health benefits coverage plans that seek to provide services under the South Carolina Kidcare program, except those offered through the South Carolina Healthy Kids Corporation or the Children's Medical Services network, meet, exceed, or are actuarially equivalent to the benchmark benefit plan and that health insurance plans will be offered at an approved rate. In determining actuarial equivalence of benefits coverage, the Department of Insurance and health insurance plans must comply with the requirements of Section 2103 of Title XXI of the Social Security Act. The department shall promulgate regulations necessary for certifying health benefits coverage plans.
(5) The South Carolina Healthy Kids Corporation shall retain its functions authorized by law, including eligibility determination for participation in the Healthy Kids program.
(6) The Department of Health and Human Services, the Department of Health and Environmental Control, the Department of Social Services, the South Carolina Healthy Kids Corporation, and the Department of Insurance, after consultation with and approval of the Speaker of the House of Representatives and the President of the Senate, are authorized to make program modifications that are necessary to overcome any objections of the United States Department of Health and Human Services to obtain approval of the state's child health insurance plan under Title XXI of the Social Security Act.
Section 44-82-365. The department shall develop a program, in conjunction with the Department of Education, the Department of Social Services, the Department of Health and Human Services, the South Carolina Healthy Kids Corporation, local governments, employers, and other stakeholders to identify low-income, uninsured children and, to the extent possible and subject to appropriation, refer them to the Department of Social Services for eligibility determination and provide parents with information about choices of health benefits coverage under the South Carolina Kidcare program. These activities shall include, but are not limited to, training community providers in effective methods of outreach; conducting public information campaigns designed to publicize the South Carolina Kidcare program, the eligibility requirements of the program, and the procedures for enrollment in the program; and maintaining public awareness of the South Carolina Kidcare program. Special emphasis shall be placed on the identification of minority children for referral to and participation in the South Carolina Kidcare program.
Section 44-82-370. Except for Medicaid, the department, in consultation with DHHS and the South Carolina Healthy Kids Corporation, shall develop a minimum set of quality assurance and access standards for all program components. The standards must include a process for granting exceptions to specific requirements for quality assurance and access. Compliance with the standards shall be a condition of program participation by health benefits coverage providers. These standards shall comply with the provisions Title XXI of the Social Security Act.
Section 44-82-505. This article may be cited as the South Carolina Healthy Kids Corporation Act.'
Section 44-82-510. (A) The General Assembly finds that increased access to health care services could improve children's health and reduce the incidence and costs of childhood illness and disabilities among children in this State. Many children do not have comprehensive, affordable health care services available. It is the intent of the General Assembly that the South Carolina Healthy Kids Corporation provide comprehensive health insurance coverage to such children. The corporation is encouraged to cooperate with any existing health service programs funded by the public or the private sector.
(B) It is the intent of the General Assembly that the South Carolina Healthy Kids Corporation serve as one of several providers of services to children eligible for medical assistance under Title XXI of the Social Security Act. Although the corporation may serve other children, the General Assembly intends the primary recipients of services provided through the corporation be school-age children with a family income below two hundred percent of the federal poverty level, who do not qualify for Medicaid. It is also the intent of the General Assembly that state and local government South Carolina Healthy Kids funds, to the extent permissible under federal law, be used to obtain matching federal dollars.
Section 44-82-515. Nothing in this article shall be construed as providing an individual with an entitlement to health care services. No cause of action shall arise against the State, the South Carolina Healthy Kids Corporation, or a unit of local government for failure to make health services available under this section.
Section 44-82-520. (A) There is created the South Carolina Healthy Kids Corporation, a not-for-profit corporation which operates on sites designated by the corporation.
(B) The South Carolina Healthy Kids Corporation shall phase in a program to:
(1) organize school children groups to facilitate the provision of comprehensive health insurance coverage to children;
(2) arrange for the collection of any family, local contributions, or employer payment or premium, in an amount to be determined by the board of directors, to provide for payment of premiums for comprehensive insurance coverage and for the actual or estimated administrative expenses procedures for the operation of the corporation;
(3) establish, with consultation from appropriate professional organizations, standards for preventive health services and providers and comprehensive insurance benefits appropriate to children; provided that such standards for rural areas shall not limit primary care providers to board-certified pediatricians;
(4) establish eligibility criteria which children must meet in order to participate in the program;
(5) establish procedures under which applicants to and participants in the program may have grievances reviewed by an impartial body and reported to the board of directors of the corporation;
(6) establish participation criteria and, if appropriate, contract with an authorized insurer, health maintenance organization, or insurance administrator to provide administrative services to the corporation;
(7) establish enrollment criteria which shall include penalties or waiting periods of not fewer than sixty days for reinstatement of coverage upon voluntary cancellation for nonpayment of family premiums;
(8) if a space is available, establish a special open enrollment period of thirty days' duration for any child who is enrolled in Medicaid or Medikids if such child loses Medicaid or Medikids eligibility and becomes eligible for the South Carolina Healthy Kids program;
(9) contract with authorized insurers or any provider of health care services, meeting standards established by the corporation, for the provision of comprehensive insurance coverage to participants. Such standards shall include criteria under which the corporation may contract with more than one provider of health care services in program sites. Health plans shall be selected through a competitive bid process. The selection of health plans shall be based primarily on quality criteria established by the board. The health plan selection criteria and scoring system, and the scoring results, shall be available upon request for inspection after the bids have been awarded;
(10) develop and implement a plan to publicize the South Carolina Healthy Kids Corporation, the eligibility requirements of the program, and the procedures for enrollment in the program and to maintain public awareness of the corporation and the program;
(11) secure staff necessary to properly administer the corporation. Staff costs shall be funded from state and local matching funds and such other private or public funds as become available. The board of directors shall determine the number of staff members necessary to administer the corporation;
(12) as appropriate, enter into contracts with local school boards or other agencies to provide onsite information, enrollment, and other services necessary to the operation of the corporation;
(13) provide a report annually to the Governor, The Director of the Department of Insurance, the Superintendent of Education, Senate President, and the Speaker of the House of Representatives.
(14) each fiscal year, establish a maximum number of participants by county, on a statewide basis, who may enroll in the program without the benefit of local matching funds. Thereafter, the corporation may establish local matching requirements for supplemental participation in the program. The corporation may vary local matching requirements and enrollment by county depending on factors which may influence the generation of local match including, but not limited to, population density, per capita income, existing local tax effort, and other factors. The corporation also may accept in-kind match in lieu of cash for the local match requirement to the extent allowed by Title XXI of the Social Security Act; and
(15) establish eligibility criteria, premium and cost-sharing requirements, and benefit packages which conform to the provisions of the South Carolina Kidcare program established in Article 3.
(C) Coverage under the corporation's program is secondary to any other available private coverage held by the participant child or family member. The corporation may establish procedures for coordinating benefits under this program with benefits under other public and private coverage.
Section 44-82-525. The South Carolina Healthy Kids Corporation shall be a private corporation not for profit, and shall have all powers necessary to carry out the purposes of this article, including, but not limited to, the power to receive and accept grants, loans, or advances of funds from any public or private agency and to receive and accept from any source contributions of money, property, labor, or any other thing of value, to be held, used, and applied for the purposes of this article.
Section 44-82-530. (A) The South Carolina Healthy Kids Corporation shall operate subject to the supervision and approval of a board of directors chaired by the Insurance Commissioner or her or his designee, and composed of twelve other members selected for three-year terms of office:
(1) one member appointed by the Superintendent of Education from among three persons nominated by the South Carolina Association of School Administrators;
(2) one member appointed by the Superintendent of Education from among three persons nominated by the South Carolina Association of School Boards;
(3) one member appointed by the Superintendent of Education from the Office of School Health Programs of the South Carolina Department of Education;
(4) one member appointed by the Governor from among three members nominated by the South Carolina Pediatric Society;
(5) one member, appointed by the Governor, who represents the Children's Medical Services Program;
(6) one member appointed by the Director of the Department of Insurance from among three members nominated by the South Carolina Hospital Association;
(7) two members, appointed by the Insurance Commissioner, who are representatives of authorized health care insurers or health maintenance organizations;
(8) one member, appointed by the Governor, from among three members nominated by the South Carolina Academy of Family Physicians;
(9) one member, appointed by the Governor, who represents the Department of Health and Human Services; and
(B) A member of the board of directors may be removed by the official who appointed that member. The board shall appoint an executive director, who is responsible for other staff authorized by the board.
(C) Board members are entitled to receive, from funds of the corporation, reimbursement for per diem and mileage as provided by law for members of boards, committees, and commissions.
(D) There shall be no liability on the part of, and no cause of action shall arise against, any member of the board of directors, or its employees or agents, for any action they take in the performance of their powers and duties under this article.
Section 44-82-535. (A) The corporation shall not be deemed an insurer. The officers, directors, and employees of the corporation shall not be deemed to be agents of an insurer. Neither the corporation nor any officer, director, or employee of the corporation is subject to the licensing requirements of the insurance code or the rules of the Department of Insurance. However, any marketing representative utilized and compensated by the second corporation must be appointed as a representative of the insurers or health services providers with which the corporation contracts.
(B) The board has complete fiscal control over the corporation and is responsible for all corporate operations.
(C) The Department of Insurance shall supervise any liquidation or dissolution of the corporation and shall have, with respect to such liquidation or dissolution, all power granted to it pursuant to the insurance code.
Section 44-82-540. (A) Notwithstanding any other provision of law to the contrary, the South Carolina Healthy Kids Corporation shall have access to the medical records of a student upon receipt of permission from a parent or guardian of the student. Such medical records may be maintained by state and local agencies. Any identifying information, including medical records and family financial information, obtained by the corporation pursuant to this subsection is confidential. Neither the corporation nor the staff or agents of the corporation may release, without the written consent of the participant or the parent or guardian of the participant, to any state or federal agency, to any private business or person, or to any other entity, any confidential information received pursuant to this subsection.
(B) A person who violates subsection (A) is guilty of a misdemeanor and, upon conviction, must be fined one thousand dollars or imprisoned for sixty days.
Section 44-82-705 . (A) The General Assembly finds that the high-risk and disabled newborn infants in this State need in-hospital and outpatient developmental evaluation and intervention and that their families need training and support services. The General Assembly further finds that there is an identifiable and increasing number of infants who need developmental evaluation and intervention and family support due to the fact that increased numbers of low-birthweight and sick full-term newborn infants are now surviving because of the advances in neonatal intensive care medicine; increased numbers of medically involved infants are remaining inappropriately in hospitals because their parents lack the confidence or skills to care for these infants without support; and increased numbers of infants are at risk due to parent risk factors, such as substance abuse, teenage pregnancy, and other high-risk conditions.
(B) It is the intent of the General Assembly to establish developmental evaluation and intervention services at all hospitals providing Level II or Level III neonatal intensive care services, in order that families with high-risk or disabled infants may gain the services and skills they need to support their infants.
(C) It is the intent of the General Assembly to provide a statewide coordinated program to screen, diagnose, and manage high-risk infants identified as hearing-impaired. The program shall develop criteria to identify infants who are at risk of having hearing impairments, and shall ensure that all parents or guardians of newborn infants are provided with materials regarding hearing impairments prior to discharge of the newborn infants from the hospital.
(D) It is the intent of the General Assembly that a methodology be developed to integrate information on infants with potentially disabling conditions with other early intervention programs, including Part C of Public Law No. 105-17.
Section 44-82-710. (A) Developmental evaluation and intervention services shall be established at each hospital that provides Level II or Level III neonatal intensive care services. Program services shall be made available to an infant or toddler identified as being at risk for developmental disabilities, or identified as medically involved, who, along with his or her family, would benefit from program services. Program services shall be made available to infants or toddlers in a Level II or Level III neonatal intensive care unit or in a pediatric intensive care unit, infants who are identified as being at high risk for hearing impairment or who are hearing-impaired, or infants who physician assistant, psychologist, psychotherapist, educator, social worker, nurse, physical or occupational therapist, speech pathologist, developmental evaluation and intervention program director, case manager, others who are involved with the in-hospital and posthospital discharge care plan, and anyone the family wishes to include as a member of the team. The family support plan is a written plan that describes the infant or toddler, the therapies and services the infant or toddler and his or her family need, and the intended outcomes of the services.
(B) These developmental evaluation and intervention services must be included:
(1) discharge planning by the multidisciplinary team, including referral and follow-up to primary medical care and modification of the family support plan;
(2) education and training for neonatal and pediatric intensive care services staff, volunteers, and others, as needed, in order to expand the services provided to high-risk, developmentally disabled, medically involved, or hearing-impaired infants and toddlers and their families;
(3) follow-up intervention services after hospital discharge, to aid the family and the high-risk, developmentally disabled, medically involved, or hearing-impaired infant's or toddler's transition into the community. Support services shall be coordinated at the request of the family and within the context of the family support plan;
(4) referral to and coordination of services with community providers;
(5) educational materials about infant care, infant growth and development, community resources, medical conditions and treatments, and family advocacy. Materials regarding hearing impairments shall be provided to each parent or guardian of a hearing-impaired infant or toddler;
(6) involvement of the parents and guardians of each identified high-risk, developmentally disabled, medically involved, or hearing-impaired infant or toddler."
SECTION 3. This act takes effect upon approval by the Governor.
This web page was last updated on Wednesday, December 9, 2009 at 9:27 A.M.