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Bill 1278

                    Current Status

Bill Number:                      1278
Type of Legislation:              General Bill GB
Introducing Body:                 Senate
Introduced Date:                  20020514
Primary Sponsor:                  Thomas
All Sponsors:                     Thomas
Drafted Document Number:          l:\council\bills\dka\4998zw02.doc
Residing Body:                    Senate
Current Committee:                Banking and Insurance Committee 02 SBI
Subject:                          Insurers and HMO's prohibited from 
                                  requiring providers to agree to certain 
                                  conditions


                        History

Body    Date      Action Description                     Com     Leg Involved
______  ________  ______________________________________ _______ ____________
Senate  20020514  Introduced, read first time,           02 SBI
                  referred to Committee


              Versions of This Bill

TO AMEND SECTION 38-57-130, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO MISREPRESENTATIONS, SPECIAL INDUCEMENTS, AND REBATES PROHIBITED ON ALL INSURANCE CONTRACTS, SO AS TO PROHIBIT INSURERS AND HEALTH MAINTENANCE ORGANIZATIONS FROM REQUIRING PROVIDERS TO AGREE TO CERTAIN UNNEGOTIATED REIMBURSEMENT ADJUSTMENTS, TO PROHIBIT INSURERS AND HEALTH MAINTENANCE ORGANIZATIONS FROM REQUIRING PROVIDERS TO ADJUST THEIR CHARGES IN ACCORDANCE WITH RATES CHARGED TO OTHER PAYORS, AND TO PROHIBIT INSURERS AND HEALTH MAINTENANCE ORGANIZATIONS FROM REQUIRING PROVIDERS TO AGREE TO FILING ITS CONTRACTUAL REIMBURSEMENT RATES WITH THE DEPARTMENT OF INSURANCE.

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

SECTION 1. Section 38-57-130 of the 1976 Code is amended by adding at the end:

"(4) No insurer or health maintenance organization may require as an element of a service agreement that a provider, as defined in Chapter 33, agree to:

(a) the unnegotiated adjustment by the insurer or health maintenance organization of the provider's contractual reimbursement rate to equal the lowest reimbursement rate the provider has agreed to charge another payor;

(b) a requirement that the provider adjust, or enter into negotiations to adjust its charges to the insurer or health maintenance organization if the provider agrees to charge another payor a lower rate; or

(c) a requirement that the provider file with the director, or his designee, for information purposes his or its contractual reimbursement rates from other payors."

SECTION 2. This act takes effect upon approval by the Governor.

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