Current Status Bill Number:1151 Type of Legislation:General Bill GB Introducing Body:Senate Introduced Date:19980327 Primary Sponsor:Bryan All Sponsors:Bryan, Leatherman, Hutto, Elliott, Waldrep, Lander, J. Verne Smith, Leventis Drafted Document Number:res1664.jeb Residing Body:Senate Current Committee:Banking and Insurance Committee 02 SBI Subject:Medical and health insurance plans, coverage for mental illness, drugs, alcohol abuse; managed care organization
Body Date Action Description Com Leg Involved
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Senate 19980327 Introduced, read first time, 02 SBI
referred to Committee
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TO AMEND CHAPTER 71, TITLE 38, CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-285 SO AS TO REQUIRE HEALTH INSURANCE PLANS TO PROVIDE COVERAGE FOR TREATMENT OF MENTAL ILLNESS OR ALCOHOL OR SUBSTANCE ABUSE, TO ALLOW A PLAN THAT DOES NOT PROVIDE FOR MANAGEMENT OF CARE OR THE SAME DEGREE OF MANAGEMENT OF CARE FOR ALL HEALTH CONDITIONS, TO PROVIDE COVERAGE FOR SUCH TREATMENT THROUGH A MANAGED CARE ORGANIZATION, TO ESTABLISH TREATMENT CONDITIONS TO QUALIFY FOR COVERAGE, AND TO REQUIRE THE DEPARTMENT OF INSURANCE TO REPORT TO THE GENERAL ASSEMBLY ON THE FISCAL IMPACT.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Chapter 71, Title 38 of the 1976 Code is amended by adding:
"Section 38-71-285. (A) As used in this section:
(1) `Health insurance plan' means a health insurance policy or health benefit plan offered by a health insurer or a health maintenance organization, including a health benefit plan offered or administered by the State or any subdivision or instrumentality of the State.
(2) `Mental health condition' means a condition or disorder involving mental illness or alcohol or substance abuse that falls under any of the categories listed in the Diagnostic and Statistical Manual IV, or subsequent editions.
(3) `Rate, term, or condition' means any lifetime or annual payment limits, deductibles, copayments, coinsurance and any other cost-sharing requirements, out-of-pocket limits, visit limits, and any other financial component of health insurance coverage that affects the insured.
(B) A health insurance plan shall provide coverage for treatment of a mental health condition and shall not establish any rate, term, or condition that places a greater financial burden on an insured for access to treatment for a mental health condition than for access to treatment for a physical health condition. Any deductible or out-of-pocket limits required under a health insurance plan must be comprehensive for coverage of both mental health and physical health conditions.
(C) A health insurance plan that does not otherwise provide for management of care under the plan, or that does not provide for the same degree of management of care for all health conditions, may provide coverage for treatment of mental health conditions through a managed care organization if the managed care organization is in compliance with regulations promulgated by the director that assure that the system for delivery of treatment for mental health conditions does not diminish or negate the purpose of this section. The regulations promulgated by the director shall ensure that timely and appropriate access to care is available, that the quantity, location, and specialty distribution of health care providers is adequate, and that administrative or clinical protocols do not reduce access to medically necessary treatment for any insured.
(D) A health insurance plan is in compliance with this section if at least one choice for treatment of mental health conditions provided to the insured within the plan has rates, terms, and conditions that place no greater financial burden on the insured that for access to treatment of physical conditions. The director may disapprove any plan that the director determines to be inconsistent with the purposes of this section.
(E)(1) To be eligible for coverage under this section for the treatment of mental illness, the treatment must be rendered by a licensed or certified mental health professional or in a mental health facility that provides a program for the treatment of a mental health condition pursuant to a written plan. A nonprofit hospital or a medical service corporation may require a mental health facility or licensed or certified mental health professional to enter into a contract as a condition of providing benefits.
(2) To be eligible for coverage under this section for treatment of alcohol or substance abuse, the treatment must be rendered by a substance abuse counselor or in an institution that provides a program for the treatment of alcohol or substance dependency pursuant to a written plan.
(F) This section must not be construed to:
(1) limit the provision of specialized medical services for individuals with mental health or substance disorders;
(2) supersede the provisions of federal law, federal or state Medicaid policy, or the terms and conditions imposed on any Medicaid waiver granted to the State with respect to the provision of services to individuals with mental health or substance abuse disorders."
SECTION 2. Before July 1, 2000, the Department of Insurance shall report to the General Assembly on:
(1) an estimate of the impact of this act on health insurance costs;
(2) actions taken by the department to assure that health insurance plans are in compliance with this act and that quality and access to treatment for mental health conditions provided by the plans are not compromised by providing financial parity for such coverage;
(3) identification of any segments of the population of South Carolina that may be excluded from access to treatment for mental health and substance abuse conditions at the level provided by this act, including an estimate of the number of South Carolinians excluded from such access under health benefit plans offered or administered by employers who receive the majority of their annual revenues from contract, grants, or other expenditures by state agencies.
SECTION 3. This act takes effect July 1, 1998, and applies to insurance policies issued or renewed on or after this act's effective date.