S*507 Session 110 (1993-1994)
S*0507(Rat #0175, Act #0130) General Bill, By Giese, Drummond, Martin,
Passailaigue, M.T. Rose, Ryberg, Washington and Wilson
Similar(H 3660)
A Bill to amend Section 44-6-150, as amended, Code of Laws of South Carolina,
1976, relating to the Medically Indigent Assistance Program, so as to delete
provisions relating to the method of adjusting charges for patients sponsored
by the program and relating to a system of reimbursement; to amend Section
44-6-155, as amended, relating to the Medicaid Expansion Fund, so as to delete
provisions relating to hospital reimbursement for care given to patients
sponsored by the program; to amend Section 44-6-170, as amended, relating to
standardized annual reporting by hospitals, so as to establish the Data
Oversight Council to provide for the method and content of information that
may be released, to provide for a Health Data Analysis Task Force, to require
specialized hospitals to report, to revise data to be reported to include
certain patient specific information and injury codes, and to provide
penalties; to amend Section 44-6-180, as amended, relating to confidentiality
of patient records, so as to revise these provisions to conform to
confidentiality provisions of Section 44-6-170; to amend Section 44-6-200, as
amended, relating to falsification of information, so as to delete provisions
relating to false information used to seek reimbursement from the
program.-amended title
03/04/93 Senate Introduced and read first time SJ-5
03/04/93 Senate Referred to Committee on Medical Affairs SJ-5
05/11/93 Senate Committee report: Favorable with amendment
Medical Affairs SJ-40
05/12/93 Senate Amended SJ-9
05/12/93 Senate Read second time SJ-19
05/12/93 Senate Ordered to third reading with notice of
amendments SJ-19
05/26/93 Senate Read third time and sent to House SJ-29
05/27/93 House Introduced and read first time HJ-108
05/27/93 House Referred to Committee on Medical, Military,
Public and Municipal Affairs HJ-108
06/01/93 House Recalled from Committee on Medical, Military,
Public and Municipal Affairs HJ-63
06/02/93 House Read second time HJ-26
06/03/93 House Read third time and enrolled HJ-12
06/10/93 Ratified R 175
06/14/93 Signed By Governor
06/14/93 Effective date Act No. 130
06/14/93 See act for exception to or explanation of
effective date
07/19/93 Copies available
(A130, R175, S507)
AN ACT TO AMEND SECTION 44-6-150, AS AMENDED, CODE
OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO THE
MEDICALLY INDIGENT ASSISTANCE PROGRAM, SO AS TO
DELETE PROVISIONS RELATING TO THE METHOD OF
ADJUSTING CHARGES FOR PATIENTS SPONSORED BY THE
PROGRAM AND RELATING TO A SYSTEM OF REIMBURSEMENT;
TO AMEND SECTION 44-6-155, AS AMENDED, RELATING TO THE
MEDICAID EXPANSION FUND, SO AS TO DELETE PROVISIONS
RELATING TO HOSPITAL REIMBURSEMENT FOR CARE GIVEN TO
PATIENTS SPONSORED BY THE PROGRAM; TO AMEND SECTION
44-6-170, AS AMENDED, RELATING TO STANDARDIZED ANNUAL
REPORTING BY HOSPITALS, SO AS TO ESTABLISH THE DATA
OVERSIGHT COUNCIL TO PROVIDE FOR THE METHOD AND
CONTENT OF INFORMATION THAT MAY BE RELEASED, TO
PROVIDE FOR A HEALTH DATA ANALYSIS TASK FORCE, TO
REQUIRE SPECIALIZED HOSPITALS TO REPORT, TO REVISE
DATA TO BE REPORTED TO INCLUDE CERTAIN PATIENT
SPECIFIC INFORMATION AND INJURY CODES, AND TO PROVIDE
PENALTIES; TO AMEND SECTION 44-6-180, AS AMENDED,
RELATING TO CONFIDENTIALITY OF PATIENT RECORDS, SO AS
TO REVISE THESE PROVISIONS TO CONFORM TO
CONFIDENTIALITY PROVISIONS OF SECTION 44-6-170; TO
AMEND SECTION 44-6-200, AS AMENDED, RELATING TO
FALSIFICATION OF INFORMATION, SO AS TO DELETE
PROVISIONS RELATING TO FALSE INFORMATION USED TO SEEK
REIMBURSEMENT FROM THE PROGRAM.
Be it enacted by the General Assembly of the State of South Carolina:
Medically Indigent Assistance Program; duties of hospitals and
commission
SECTION 1. Section 44-6-150 of the 1976 Code, as last amended by Act
189 of 1989, is further amended to read:
"Section 44-6-150. (A) There is created the South Carolina
Medically Indigent Assistance Program administered by the commission.
The program is authorized to sponsor inpatient hospital care for which
hospitals shall receive no reimbursement. A general hospital equipped to
provide the necessary treatment shall:
(1) admit a patient sponsored by the program; and
(2) accept the transfer of a patient sponsored by the program from a
hospital which is not equipped to provide the necessary treatment. In addition to or in lieu of an action taken affecting the license of the
hospital, when it is established that an officer, employee, or member of the
hospital medical staff has violated this section, the South Carolina
Department of Health and Environmental Control shall require the hospital
to pay a civil penalty of up to ten thousand dollars.
(B) Hospital charges for patients sponsored by the Medically Indigent
Assistance Program must be reported to the Division of Research and
Statistical Services pursuant to Section 44-6-170.
(C) In administering the Medically Indigent Assistance Program, the
commission shall determine:
(1) the method of administration including the specific procedures and
materials to be used statewide in determining eligibility for the
program;
(a) In a nonemergency, the patient shall submit the necessary
documentation to the patient's county of residence or its designee to
determine eligibility before admission to the hospital.
(b) In an emergency, the hospital shall admit the patient pursuant to
Section 44-7-260. If a hospital holds the patient financially responsible for
all or a portion of the inpatient hospital bill, and if the hospital determines
that the patient could be eligible for the program, it shall forward the
necessary documentation along with the patient's bill and other supporting
information to the patient's county of residence or its designee for
processing. A county may request that all hospital bills incurred by its
residents sponsored by the program be submitted to the county or its
designee for review.
(2) the population to be served, including eligibility criteria based on
family income and resources. Eligibility is determined on an episodic basis
for a given spell of illness. Eligibility criteria must be uniform statewide
and may include only those persons who meet the program's definition of
medically indigent;
(3) the health care services covered;
(4) a process by which an eligibility determination can be contested
and appealed; and
(5) the program may not sponsor a patient until all other means of
paying for or providing services have been exhausted. This includes
Medicaid, Medicare, health insurance, employee benefit plans, or other
persons or agencies required by law to provide medical care for the person.
Hospitals may require eligible patients whose gross family income is
between one hundred percent and two hundred percent of the federal
poverty guidelines, to make a copayment based on a sliding payment scale
developed by the commission based on income and family size.
(D) Nothing in this section may be construed as relieving hospitals of
their Hill-Burton obligation to provide unreimbursed medical care to
indigent persons."
Medicaid Expansion Fund
SECTION 2. Section 44-6-155 of the 1976 Code, as last amended by Act
105 of 1991, is further amended to read:
"Section 44-6-155. (A) There is created the Medicaid Expansion
Fund into which must be deposited funds:
(1) collected pursuant to Section 44-6-146;
(2) collected pursuant to Section 12-23-810; and
(3) appropriated pursuant to subsection (B).
This fund must be separate and distinct from the general fund. These
funds are supplementary and may not be used to replace general funds
appropriated by the General Assembly or other funds used to support
Medicaid. These funds and the programs specified in subsection (C) are
exempt from any budgetary cuts, reductions, or eliminations caused by the
lack of general fund revenues. Earnings on investments from this fund
must remain part of the separate fund and must not be deposited in the
general fund.
(B) The commission shall estimate the amount of federal matching
funds which will be spent in the State during the next fiscal year due to the
changes in Medicaid authorized by subsection (C). Based on this estimate,
the General Assembly shall appropriate to the Medicaid Expansion Fund
state funds equal to the additional state revenue generated by the
expenditure of these federal funds.
(C) Monies in the fund must be used to:
(1) provide Medicaid coverage to pregnant women and infants with
family incomes above one hundred percent but below one hundred
eighty-five percent of the federal poverty guidelines;
(2) provide Medicaid coverage to children aged one through six with
family income below federal poverty guidelines;
(3) provide Medicaid coverage to aged and disabled persons with
family income below federal poverty guidelines;
(4) provide Medicaid coverage through a medically-needy program to
eligible persons in families with medical expenses which reduce the net
family income below state and federal standards;
(5) provide Medicaid reimbursement for hospital patients in need of
subacute care, including patients in swing beds;
(6) provide a pool of at least forty-four million dollars for the sole
purpose of adjusting Medicaid reimbursement for hospitals as provided in
Section 44-6-140(A)(1). Funds in the pool not immediately used for this
purpose must be carried forward for eventual use for this purpose;
(7) provide up to two hundred forty thousand dollars to reimburse the
Division of Research and Statistical Services and hospitals for the cost of
collecting and reporting data pursuant to Section 44-6-170; and
(8) supplement state funds needed to administer items (3) and (4), not
to exceed $700,000.
(D) Any funds not expended for the purposes specified in subsection (C)
during a given year are carried forward to the succeeding year for the same
purposes."
Data Oversight Council; duties; hospital data to be reported;
penalties
SECTION 3. Section 44-6-170 of the 1976 Code, as last amended by Act
105 of 1991, is further amended to read:
"Section 44-6-170.
(A) As used in this section:
(1) `Division' means the Division of Research and Statistical Services
of the Budget and Control Board.
(2) `Council' means the Data Oversight Council.
(3) `Committee' means the Joint Legislative Health Care Planning and
Oversight Committee.
(B) There is established the Data Oversight Council comprised of:
(1) one hospital administrator;
(2) the chief executive officer or designee of the South Carolina
Hospital Association;
(3) one physician;
(4) the chief executive officer or designee of the South Carolina
Medical Association;
(5) one representative of major third party health care payers;
(6) one representative of the managed health care industry;
(7) one nursing home administrator;
(8) three representatives of nonhealth care-related businesses;
(9) one representative of a nonhealth care-related business of less than
one hundred employees;
(10) the executive vice president or designee of the South Carolina
Chamber of Commerce;
(11) a member of the Governor's office staff;
(12) a representative from the Human Services Coordinating
Council;
(13) the commissioner or his designee of the South Carolina
Department of Health and Environmental Control;
(14) the executive director or his designee of the State Health and
Human Services Finance Commission;
(15) the chairman or his designee of the Health Planning Committee
created pursuant to Section 44-7-180.
The members enumerated in items (1) through (10) must be appointed
by the Governor for three-year terms and until their successors are
appointed and qualify; the remaining members serve ex officio. The
Governor shall appoint one of the members to serve as chairman. The
division shall provide staff assistance to the council.
(C) The division, with the approval of the council, shall promulgate
regulations to implement this section in accordance with the Administrative
Procedures Act. No data may be released by the division except in a format
recommended by the council and approved by the committee. Patient
identifiers gathered pursuant to this section are confidential. The
information collected may not be released to entities or individuals unless
release is made of aggregate statistical information so that no individual
patient may be identified. The committee, upon recommendations of the
council, shall determine what provider-identifiable data should be released
for public use and what data should be released for research purposes. Any
such release must be preceded by notice to the identified provider, who
must be provided sufficient time to review the information and whose
written response must be considered before a release and must be included,
if requested, in the release. Nothing in this section may be construed to
change or interfere with the mode of collection and format of release of
existing inpatient hospital data by the division by general acute care
hospitals, until recommendations are adopted by the council and approved
by the committee. The council shall make periodic recommendations to the
committee and the General Assembly concerning the collection and release
of health care-related data by the State. The council shall forward to the
committee, before December 2, 1993, recommendations for the collection
of additional health care information and data including, but not limited to,
all outpatient data, information concerning health care manpower needs for
the State, information to assist in the development and evaluation of health
outcomes, and other information the council may consider necessary to
assist in the formation of health care policy in the State. Recommendations
by the council mandating the collection of this data apply to every provider
or insurer affected by the recommendation, regardless of how the data is
collected by the provider or insurer. Every effort must be made to utilize
existing data sources.
(D) Information may be required to be produced only with respect to
admissions of and treatment to patients after the effective date of the
regulations implementing this section, except that data with respect to the
medical history of the patient reasonably necessary to evaluation of the
admission of and treatment to the patient may be required.
(E) The division shall convene a Health Data Analysis Task Force
composed of technical representatives of universities and of the private
sector and public agencies including, but not limited to, health care
providers and insurers to make recommendations to the council concerning
types of analysis needed to carry out this section.
(F) All general acute care hospitals and specialized hospitals including,
but not limited to, psychiatric hospitals, alcohol and substance abuse
hospitals, and rehabilitation hospitals shall provide the following
information to the division: hospital-specific information for the
twelve-month period from October first through September thirtieth for
each federal fiscal year. This information must be reported by March first
of the following year:
(1) total gross revenue, including:
(a) gross inpatient revenue;
(b) Medicare gross revenue;
(c) Medicaid gross revenue;
(d) South Carolina Medically Indigent Assistance Program gross
revenue;
(2) total deductions for contractual allowances from gross revenue,
including:
(a) Medicare contractual allowances;
(b) Medicaid contractual allowances; and
(c) other contractual allowances;
(3) total direct costs of medical education:
(a) reimbursed; and
(b) unreimbursed;
(4) total indirect costs of medical education:
(a) reimbursed; and
(b) unreimbursed;
(5) total costs of bad debt and charity care:
(a) South Carolina Medically Indigent Assistance Program;
(b) other charity care; and
(c) bad debt;
(6) total admissions, including:
(a) Medicare admissions;
(b) Medicaid admissions;
(c) South Carolina Medically Indigent Assistance Program
admissions; and
(d) other admissions;
(7) total patient days;
(8) average length of stay;
(9) total outpatient visits;
(10) extracts of the following medical record information:
(a) patient date of birth;
(b) patient number;
(c) patient sex;
(d) patient county of residence;
(e) patient zip code;
(f) patient race;
(g) date of admission;
(h) source of admission;
(i) type of admission;
(j) discharge date;
(k) principal and up to eight other diagnoses;
(l) principal procedure and date;
(m) patient status at discharge;
(n) up to five other procedures;
(o) hospital identification number;
(p) principal source of payment;
(q) total charges and components of those charges, including
associated room and board units;
(r) patient medical record or chart number;
(s) attending physician and primary surgeon;
(t) patient name, patient social security number, and patient
address; and
(u) external cause of injury code (E-code), as set forth in
regulation.
Release must be made no less than semi-annually of the patient medical
record information listed in this subsection to the submitting hospital and
the information listed in items (10)(a) through (r) and (u) to the hospital's
designee.
(G) A person violating this section is guilty of a misdemeanor and, upon
conviction, must be fined not more than five thousand dollars or
imprisoned not more than one year, or both."
Confidentiality
SECTION 4. Section 44-6-180 of the 1976 Code, as last amended by Act
189 of 1989, is further amended to read:
"Section 44-6-180. (A) Patient records received by counties, the
commission, or other entities involved in the administration of the program
created pursuant to Section 44-6-150 are confidential. Patient records
gathered pursuant to Section 44-6-170 are also confidential. The division
shall use patient-identifiable data collected pursuant to Section 44-6-170
for the purpose of linking various data bases to carry out the purposes of
Section 44-6-170. Linked data files must be made available to those
agencies providing data files for linkage. No agency receiving
patient-identifiable data collected pursuant to Section 44-6-170 may release
this data in a manner such that an individual patient or provider may be
identified except as provided in Section 44-6-170. Nothing in this section
may be construed to limit access by a submitting provider or its designee to
that provider's information.
(B) A person violating this section is guilty of a misdemeanor and, upon
conviction, must be fined not more than five thousand dollars or
imprisoned not more than one year, or both."
Penalties
SECTION 5. Section 44-6-200 of the 1976 Code, as last amended by Act
189 of 1989, is further amended to read:
"Section 44-6-200. (A) A person who commits a material
falsification of information required to determine eligibility for the
Medically Indigent Assistance Program is guilty of a misdemeanor and,
upon conviction, must be fined not more than five hundred dollars or
imprisoned for not more than one year, or both.
(B) Unless otherwise specified in this chapter, an individual or facility
violating this chapter or a regulation under this chapter is guilty of a
misdemeanor and, upon conviction, must be fined not more than one
hundred dollars for the first offense and not more than five thousand dollars
for a subsequent offense."
Time effective
SECTION 6. This act takes effect upon approval by the Governor, except,
the reporting requirement in Section 44-6-170(F)(10)(u) takes effect
October 1, 1994.
Approved the 14th day of June, 1993. |