S*912 Session 109 (1991-1992)
S*0912(Rat #0468, Act #0403 of 1992) General Bill, By Saleeby
A Bill to amend Section 38-33-20, Code of Laws of South Carolina, 1976,
relating to definitions in the Health Maintenance Organization Act, so as to
delete the definitions of the Department of Health and Environmental Control
and Chief Insurance Commissioner; to amend Section 38-33-40, relating to
applications for a certificate of authority, so as to delete the requirements
of the Department pertaining to the applications and revise the requirements
for an organization's proposed plan of operation; to amend Section 38-33-90,
relating to organization reports, so as to delete the requirement of a copy of
the reports for the Department; to amend Section 38-33-110, relating to the
complaint system, so as to delete the provision for consultation with the
Department; to amend Section 38-33-170, relating to examinations of the
organizations, so as to change the reference to examination by the Department
to Commission and delete the reference to examination of providers with whom
an organization has contracts, agreements, or other arrangements; to amend
Section 38-33-180, relating to suspension or revocation of certificates of
authority, so as to delete the provision for Department certification to the
Commissioner; to amend Section 38-33-270, relating to suspension or revocation
of certificates of authority, so as to delete the provision for Department
certification to the Commissioner; to amend Section 38-33-270, relating to
contractual powers to fulfill obligations under the Act, so as to change the
reference to Department to Commissioner and provide for assessments for
consulting expenses; and to amend the 1976 Code by adding Chapter 30 to Title
44 so as to provide for the South Carolina Health Care Professional Compliance
Act.-amended title
04/18/91 Senate Introduced, read first time, placed on calendar
without reference SJ-5
04/23/91 Senate Read second time SJ-247
04/23/91 Senate Unanimous consent for third reading on next
legislative day SJ-247
04/24/91 Senate Read third time and sent to House SJ-17
04/25/91 House Introduced and read first time HJ-60
04/25/91 House Referred to Committee on Medical, Military,
Public and Municipal Affairs HJ-61
04/15/92 House Committee report: Favorable with amendment
Medical, Military, Public and Municipal Affairs HJ-11
04/29/92 House Debate adjourned until Thursday, April 30, 1992 HJ-296
05/05/92 House Amended HJ-28
05/05/92 House Read second time HJ-33
05/06/92 House Read third time and returned to Senate with
amendments HJ-8
05/07/92 Senate House amendment amended SJ-59
05/07/92 Senate Returned to House with amendments SJ-59
05/14/92 House Debate adjourned on Senate amendments until
Tuesday, May 19, 1992 HJ-308
05/19/92 House Concurred in Senate amendment and enrolled HJ-61
05/27/92 Ratified R 468
06/02/92 Signed By Governor
06/02/92 Effective date 06/02/92
06/02/92 Act No. 403
07/08/92 Copies available
(A403, R468, S912)
AN ACT TO AMEND SECTION 38-33-20, CODE OF
LAWS OF SOUTH CAROLINA, 1976, RELATING TO
DEFINITIONS IN THE HEALTH MAINTENANCE
ORGANIZATION ACT, SO AS TO DELETE THE
DEFINITIONS OF THE DEPARTMENT OF HEALTH AND
ENVIRONMENTAL CONTROL AND CHIEF INSURANCE
COMMISSIONER; TO AMEND SECTION 38-33-40,
RELATING TO APPLICATIONS FOR A CERTIFICATE OF
AUTHORITY, SO AS TO DELETE THE REQUIREMENTS OF
THE DEPARTMENT PERTAINING TO THE APPLICATIONS
AND REVISE THE REQUIREMENTS FOR AN
ORGANIZATION'S PROPOSED PLAN OF OPERATION; TO
AMEND SECTION 38-33-90, RELATING TO
ORGANIZATION REPORTS, SO AS TO DELETE THE
REQUIREMENT OF A COPY OF THE REPORTS FOR THE
DEPARTMENT; TO AMEND SECTION 38-33-110,
RELATING TO THE COMPLAINT SYSTEM, SO AS TO
DELETE THE PROVISION FOR CONSULTATION WITH
THE DEPARTMENT; TO AMEND SECTION 38-33-170,
RELATING TO EXAMINATIONS OF THE
ORGANIZATIONS, SO AS TO CHANGE THE REFERENCE
TO EXAMINATION BY THE DEPARTMENT TO
COMMISSION AND DELETE THE REFERENCE TO
EXAMINATION OF PROVIDERS WITH WHOM AN
ORGANIZATION HAS CONTRACTS, AGREEMENTS, OR
OTHER ARRANGEMENTS; TO AMEND SECTION 38-33-180,
RELATING TO SUSPENSION OR REVOCATION OF
CERTIFICATES OF AUTHORITY, SO AS TO DELETE THE
PROVISION FOR DEPARTMENT CERTIFICATION TO THE
COMMISSIONER; TO AMEND SECTION 38-33-270,
RELATING TO CONTRACTUAL POWERS TO FULFILL
OBLIGATIONS UNDER THE ACT, SO AS TO CHANGE THE
REFERENCE TO DEPARTMENT TO COMMISSIONER AND
PROVIDE FOR ASSESSMENTS FOR CONSULTING
EXPENSES; AND TO AMEND THE 1976 CODE BY ADDING
CHAPTER 30 TO TITLE 44 SO AS TO PROVIDE FOR THE
SOUTH CAROLINA HEALTH CARE PROFESSIONAL
COMPLIANCE ACT.
Whereas, Public Law 102-141, Section 633, effective October 28,
1991, requires certification by the state public health official that
guidelines issued by the Centers for Disease Control or guidelines
which are equivalent to those promulgated by the Centers for
Disease Control concerning recommendations for preventing the
transmission of the human immunodeficiency virus and the
hepatitis B virus during exposure-prone invasive procedures,
except for emergency situations when the patient's life or limb is
in danger, have been instituted by the State; that these state
guidelines apply to health professionals practicing within the State
and are consistent with federal law; that compliance with these
guidelines is the responsibility of the state public health official;
and that these responsibilities include a process for determining
what appropriate disciplinary or other actions must be taken to
ensure compliance; and
Whereas, if certification is not provided within one year following
enactment of Public Law 102-141, Section 633, the State is
ineligible to receive assistance under the Public Health Service
Act (42 U.S.C. 301, et seq.) until the certification is provided;
and
Whereas, it has been determined that state compliance with Public
Law 102-141, Section 633, can best be effected by authorizing the
South Carolina Department of Health and Environmental Control
to oversee compliance and by requiring licensing boards to adopt
guidelines to ensure compliance with the above-referenced public
law. Now, therefore,
Be it enacted by the General Assembly of the State of South
Carolina:
Definitions deleted
SECTION 1. Section 38-33-20 of the 1976 Code is amended to
read:
"Section 38-33-20. As used in this chapter:
(1) `Basic health care services' means emergency care,
inpatient hospital and physician care, and outpatient medical
services. It does not include dental services, mental health
services, or services for alcohol or drug abuse, although a health
maintenance organization at its option may elect to provide these
services in its coverage.
(2) `Commissioner' means the Chief Insurance
Commissioner.
(3) `Copayment' or `deductible' means the amount specified in
the evidence of coverage that the enrollee shall pay directly to the
provider for covered health care services, which may be stated in
either specific dollar amounts or as a percentage of the provider's
usual or customary charge.
(4) `Enrollee' means an individual who is enrolled in a health
maintenance organization.
(5) `Evidence of coverage' means a certificate, an agreement,
or a contract issued to an enrollee setting out the coverage to
which he is entitled.
(6) `Health care services' means services included in
furnishing an individual medical or dental care or hospitalization
or incident to the furnishing of care or hospitalization, and other
services to prevent, alleviate, cure, or heal human illness, injury,
or physical disability.
(7) `Health maintenance organization' means a person who
undertakes to provide or arrange for basic health care services to
enrollees for a fixed prepaid premium.
(8) `Person' means a natural or an artificial person including,
but not limited to, individuals, partnerships, associations, trusts, or
corporations.
(9) `Provider' means a physician, dentist, hospital, or other
person properly licensed, where required, to furnish health care
services."
Requirements for certificate of authority applications and
plans of operation
SECTION 2. Section 38-33-40 of the 1976 Code is amended to
read:
"Section 38-33-40. (A) The commissioner shall issue
a certificate of authority to a person filing an application pursuant
to Section 38-33-30 if, upon payment of the application fee
prescribed in Section 38-33-220, the commissioner is satisfied
that:
(1) The persons responsible for the conduct of the affairs
of the applicant are competent, trustworthy, and possess good
reputations.
(2) The health maintenance organization's proposed plan
of operation has arrangements for an on-going quality assurance
program.
(3) The health maintenance organization effectively
provides or arranges for the provision of basic health care services
for a fixed prepaid premium, except to the extent of reasonable
requirements for deductibles or co-payments.
(4) The health maintenance organization is financially
responsible, is able to meet its obligations to enrollees and
prospective enrollees, and otherwise meets the requirements of
this chapter. In making this determination, considerations by the
commissioner may include, but are not limited to:
(a) the financial soundness of the arrangements for health
care services and the schedule of charges used in connection with
them;
(b) the adequacy of working capital;
(c) an agreement with an insurer, a government, or other
organization for insuring the payment of the cost of health care
services or the provision for automatic applicability of an
alternative coverage if the health maintenance organization is
discontinued;
(d) an agreement with providers for the provision of
health care services;
(e) a deposit of cash or securities submitted in accordance
with Section 38-33-130.
(5) The enrollees are afforded an opportunity to
participate in matters of policy and operation pursuant to Section
38-33-60.
(6) Nothing in the proposed method of operation,
pursuant to Section 38-33-30 or by independent investigation, is
contrary to the public interest.
(B) No health maintenance organization may be licensed
unless it has employed or contracted with or made arrangements
satisfactory to the commissioner with both physicians and
hospitals to participate as providers in each geographic area to be
served, as identified by the health maintenance organization under
Section 38-33-30."
Health maintenance organization reports
SECTION 3. Section 38-33-90 of the 1976 Code is amended to
read:
"Section 38-33-90. (A) Every health maintenance
organization annually before March second shall file a report
verified by at least two principal officers with the commissioner
covering the preceding calendar year. The report must be on
forms prescribed by the commissioner.
(B) The commissioner may require quarterly reports and
additional information considered necessary to enable him to
carry out his duties under this chapter. The reports and
information must be furnished in the time and manner prescribed
by the commissioner.
(C) Upon timely written request by a principal officer setting
forth reasons why the statements, reports, or information in
subsections (A) and (B) cannot be filed within the time required,
the commissioner, in writing, may grant an extension of filing
time not to exceed thirty days."
Complaint system
SECTION 4. Section 38-33-110 of the 1976 Code is amended to
read:
"Section 38-33-110. (A)(1) Every health maintenance
organization shall establish and maintain a complaint system
which is approved by the commissioner to provide reasonable
procedures for the resolution of written complaints initiated by
enrollees.
(2) Each health maintenance organization, with the
annual report required in Section 38-33-90, shall submit to the
commissioner an annual report in a form he prescribes which must
include:
(a) a summary of written complaints handled through the
health maintenance organization's approved complaint system.
The summary must include the total number of complaints
organized by the nature of the complaint and the average time
taken to resolve the complaint;
(b) the number, amount, and disposition of malpractice
claims made by enrollees of the health maintenance organization
that it settled during the year.
(B) The commissioner at any time may examine the complaint
system. Information concerning complaints and malpractice
claims filed pursuant to this section must be held in confidence
and are not subject to disclosure under the Freedom of
Information Act."
Examinations of health maintenance organizations
SECTION 5. Section 38-33-170 of the 1976 Code is amended to
read:
"Section 38-33-170. (A) The commissioner may make
an examination of the affairs of a health maintenance organization
and providers with whom the organization has contracts,
agreements, or other arrangements as often as is reasonably
necessary for the protection of the interests of the people of this
State but not less frequently than once every three years. The
commissioner may accept the report of an examination made by
the state where the health maintenance organization is domiciled.
(B) The commissioner may make an examination concerning
the quality of health care service of a health maintenance
organization and providers with whom the organization has
contracts, agreements, or other arrangements as often as is
reasonably necessary for the protection of the interests of the
people of this State but not less frequently than once every three
years.
(C) Every health maintenance organization and provider shall
submit its relevant books and records for the examinations and
facilitate them. For the purpose of examinations, the
commissioner and the department may administer oaths to and
examine the officers and agents of the health maintenance
organization and the principals of the providers concerning their
business.
(D) The expenses of examinations under this section are
assessed against the organization being examined and remitted to
the commissioner for whom the examination is being
conducted."
Department certification deleted
SECTION 6. Section 38-33-180 of the 1976 Code is amended to
read:
"Section 38-33-180. (A) The commissioner may
suspend or revoke a certificate of authority issued to a health
maintenance organization if he finds that one or more of the
following conditions exist:
(1) The health maintenance organization is operating
significantly in contravention of its basic organizational document
or in a manner contrary to that described in other information
submitted under Section 38-33-30, unless amendments to the
submissions have been filed with and approved by the
commissioner.
(2) The health maintenance organization issues evidence
of coverage or uses a schedule of charges for health care services
which do not comply with the requirements of Section
38-33-80.
(3) The health maintenance organization does not provide
or arrange for basic health care services.
(4) The health maintenance organization does not meet
the requirements of Section 38-33-40 or is unable to fulfill its
obligations to furnish health care services.
(5) The health maintenance organization is financially
unsound or reasonably may be expected to be unable to meet its
obligations to enrollees or prospective enrollees.
(6) The health maintenance organization has failed to
implement a mechanism affording the enrollees an opportunity to
participate in matters of policy and operation under Section
38-33-60.
(7) The health maintenance organization has failed to
implement the complaint system required by Section 38-33-110 in
a reasonable manner to resolve valid complaints.
(8) The health maintenance organization, or a person on
its behalf, advertised or merchandised its services in an untrue,
misrepresentative, misleading, deceptive, or unfair manner.
(9) The continued operation of the health maintenance
organization is hazardous to its enrollees.
(10) The health maintenance organization otherwise has
failed to comply with this chapter or regulations promulgated
under it.
(B) A certificate of authority is suspended or revoked only
after compliance with the requirements of Section 38-33-210.
(C) When the certificate of authority of a health maintenance
organization is suspended, the health maintenance organization,
during the suspension, may not enroll additional enrollees except
newborn children or other newly acquired dependents of existing
enrollees and may not engage in advertising or solicitation.
(D) When the certificate of authority of a health maintenance
organization is revoked, the organization shall proceed,
immediately following the effective date of the order of
revocation, to wind up its affairs and may conduct no further
business except as may be essential to the orderly conclusion of
the affairs of the organization. It may not engage in further
advertising or solicitation. The commissioner, by written order,
may permit further operation of the organization he finds to be in
the best interest of enrollees, to the end that enrollees are afforded
the greatest practical opportunity to obtain continuing health care
coverage."
Contracting by commissioner; assessments for consulting
expenses
SECTION 7. Section 38-33-270 of the 1976 Code is amended to
read:
"Section 38-33-270. (A) The commissioner, in carrying
out the obligations under Sections 38-33-40, 38-33-170(B), and
38-33-180(A), may contract with qualified persons to make
recommendations concerning the determinations required to be
made by him. The recommendations may be accepted in full or in
part by the commissioner.
(B) The commissioner may assess the health maintenance
organization directly for consulting expenses incurred pursuant to
subsection (A) and require the organization to remit payment
directly to the consultant. These expenses must be reasonable.
The commissioner is not required to but may consider the results
of a quality assurance examination made at an appropriate time by
a person with whom the health maintenance organization has a
contract to provide health care services or by a person who has a
legitimate interest in the quality of care provided by the
organization."
Health Care Professional Compliance Act
SECTION 8. Title 44 of the 1976 Code is amended by
adding:
"CHAPTER 30
Health Care Professional Compliance Act
Section 44-30-10. This chapter may be cited as the `South
Carolina Health Care Professional Compliance Act'.
Section 44-30-20. As used in this chapter:
(1) `CDC' means the Centers for Disease Control of the Public
Health Service.
(2) `CDC recommendations' means the July 12, 1991, CDC
document (MMWR, Volume 40, No. RR-8) entitled
`Recommendations for Preventing Transmission of Human
Immunodeficiency Virus and Hepatitis B Virus to Patients During
Exposure-Prone Invasive Procedures' or equivalent guidelines
developed by the department and approved by the CDC and any
appropriate supplements or revisions thereto.
(3) `Department' means the South Carolina Department of
Health and Environmental Control.
(4) `Educational institutions' means the health professional
schools of dentistry, medicine, and nursing and any other
educational program or institution providing training for health
care professionals.
(5) `Expert review panel' means a panel of experts in
composition and function as defined in the CDC
recommendations and appointed or approved by the
department.
(6) `Health care professional' means a physician, physician's
assistant, dentist, dental hygienist, registered nurse, licensed
practical nurse, or podiatrist practicing or licensed to practice in
South Carolina.
(7) `Licensing board' means these health professional
licensing boards which are state agencies and which license and
regulate specific health care professions: the State Board of
Medical Examiners, the State Board of Nursing for South
Carolina, the South Carolina State Board of Dentistry, and the
State Board of Podiatry Examiners.
(8) `Public law' means Public Law 102-141, Section 633,
enacted October 28, 1991, applicable to health care
professionals.
(9) `State public health official' means the commissioner of
the department or the commissioner's designee.
Section 44-30-30. (A) The department is authorized to ensure
and oversee the implementation of Public Law 102-141, Section
633, and applicable CDC recommendations and any appropriate
supplements and revisions to the CDC recommendations which
apply to health care professionals.
(B) The department shall provide consultation and assistance
to licensing boards, as appropriate, to ensure compliance with
CDC recommendations.
(C) The department shall appoint at least one or approve an
existing expert review panel, consistent with the CDC
recommendations in composition and function, whose
recommendations must be considered requirements and must be
binding upon the affected health care professionals.
Section 44-30-40. (A) By October 1, 1992, each licensing
board shall adopt the CDC recommendations and shall
communicate with its respective health care professionals by
written notice of their adoption. This written notice must include
information that noncompliance may subject the licensee to
disciplinary proceedings before the licensing board. The notice
must provide information regarding education and training in the
areas of infection control, universal precautions, and disinfection
and sterilization techniques.
(B) Each licensing board shall institute disciplinary or other
action for violations by its respective health care professionals of
the CDC recommendations and any other requirements adopted
pursuant to this chapter.
Section 44-30-50. No member of an expert review panel or
licensing board and no person or organization providing
consultation to an expert review panel or licensing board may be
subject to civil or criminal liability for actions or omissions made
during investigations or hearings or made in rulings or decisions
when acting within the scope of official duties and while carrying
out the responsibilities of this chapter. No other person providing
written or oral information to an expert review panel or a
licensing board may be subject to civil or criminal liability for
actions taken or statements made in good faith during an
investigation or hearing.
Section 44-30-60. An expert review panel is considered a
professional committee pursuant to Chapter 71, Title 40, `Liability
of Members of Professional Committees'. Proceedings, records,
and information acquired or produced by the panel is confidential
pursuant to Section 40-71-20, except that the expert review panel
may notify a person or entity charged with supervision or
monitoring of the requirements set forth in Section 44-30-30(3),
and must notify the appropriate licensing board and the
department of any occurrence of noncompliance by the health
care professional with the requirements of the expert review
panel.
Section 44-30-70. A health care professional who violates a
recommendation of the expert review panel as set forth in Section
44-30-40 and related regulations is subject to disciplinary action
by the appropriate licensing board. Nothing in this chapter
prohibits the department from taking any action it considers
necessary to protect the public health pursuant to Section
44-1-140.
Section 44-30-80. An educational institution providing basic
training programs for health care professionals in preparation for
licensure in the State shall certify annually to the department that
it provides curricula for infection control, universal precautions,
and sterilization and disinfection techniques appropriate for health
care professionals participating in its education programs.
Section 44-30-90. The department and each licensing board
shall promulgate regulations necessary to accomplish the purposes
set forth in this chapter and to comply with public law no later
than October 1, 1992."
Time effective
SECTION 9. This act takes effect upon approval by the
Governor.
Approved the 2nd day of June, 1992. |