Current Status Introducing Body:
SenateBill Number: 912Ratification Number: 468Act Number: 403Primary Sponsor: SaleebyType of Legislation: GBSubject: Health maintenance, certificate of authorityDate Bill Passed both Bodies: May 19, 1992Computer Document Number: NO5/7445.BDGovernor's Action: SDate of Governor's Action: Jun 02, 1992Introduced Date: Apr 18, 1991Date of Last Amendment: May 07, 1992Last History Body: ------Last History Date: Jun 02, 1992Last History Type: Act No. 403Scope of Legislation: StatewideAll Sponsors: SaleebyType of Legislation: General Bill
Bill Body Date Action Description CMN ---- ------ ------------ ------------------------------ --- 912 ------ Jun 02, 1992 Act No. 403 912 ------ Jun 02, 1992 Signed by Governor 912 ------ May 27, 1992 Ratified R 468 912 House May 19, 1992 Concurred in Senate amendment, enrolled for ratification 912 House May 14, 1992 Debate adjourned on Senate amendments until Tuesday, May 19, 1992 912 Senate May 07, 1992 House amendments amended, returned to House 912 House May 06, 1992 Read third time, returned to Senate with amendment 912 House May 05, 1992 Amended, read second time 912 House Apr 29, 1992 Debate adjourned until Thursday, April 30, 1992 912 House Apr 15, 1992 Committee Report: Favorable 27 with amendment 912 House Apr 25, 1991 Introduced, read first time, 27 referred to Committee 912 Senate Apr 24, 1991 Read third time, sent to House 912 Senate Apr 23, 1991 Read second time, unanimous consent for third reading on Wednesday, April 24 912 Senate Apr 18, 1991 Introduced, read first time, placed on Calendar without referenceView additional legislative information at the LPITS web site.
(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:
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."
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:
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."
SECTION 9. This act takes effect upon approval by the Governor.
Approved the 2nd day of June, 1992.