South Carolina General Assembly
113th Session, 1999-2000

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Bill 3413


Indicates Matter Stricken
Indicates New Matter


                    Current Status

Bill Number:                      3413
Type of Legislation:              General Bill GB
Introducing Body:                 House
Introduced Date:                  19990128
Primary Sponsor:                  Maddox
All Sponsors:                     Maddox, J.H. Neal, Allen, Lloyd, 
                                  Rutherford
Drafted Document Number:          l:\council\bills\psd\7180ac99.doc
Residing Body:                    House
Current Committee:                Labor, Commerce and Industry Committee 26 
                                  HLCI
Subject:                          Insurance, Medical and health; 
                                  maintenance organizations, payor of service 
                                  has right to choose health care provider


                        History

Body    Date      Action Description                     Com     Leg Involved
______  ________  ______________________________________ _______ ____________
House   19990128  Introduced, read first time,           26 HLCI
                  referred to Committee


                             Versions of This Bill

View additional legislative information at the LPITS web site.


(Text matches printed bills. Document has been reformatted to meet World Wide Web specifications.)

A BILL

TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-270 SO AS TO PROVIDE THAT A PERSON PARTICIPATING IN A HEALTH MAINTENANCE ORGANIZATION OR A PREFERRED PROVIDER ORGANIZATION HAS THE RIGHT TO RECEIVE HEALTH CARE FROM THE PROVIDER CHOSEN BY THE PERSON AND MAY NOT BE DENIED ACCESS TO TREATMENT BY PARTICIPATING OR NONPARTICIPATING PROVIDERS AND TO PROHIBIT THE ORGANIZATION FROM REDUCING BENEFITS OR ITS REIMBURSEMENT RATE OR FROM TERMINATING OR CANCELING A PROVIDER AGREEMENT WITHOUT CAUSE.

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

SECTION 1. The 1976 Code is amended by adding:

"Section 38-71-270. (A) As used in this section:

(1) 'Participating provider' means a health care provider who has been accepted by and has signed a provider contract with a managed care organization or a preferred provider organization.

(2) 'Nonparticipating provider' means a health care provider who has not signed a provider contract with a managed care organization or a preferred provider organization.

(3) 'Patient' means an individual covered under a health care services plan designed by a managed care organization or a preferred provider organization.

(B) A person has the right to receive health care from the provider chosen by the person. A person enrolled in a managed care plan or a preferred provider organization may not be denied access to treatment by participating or nonparticipating providers. If an enrollee in a managed care plan or a preferred provider organization elects to receive health care services from a nonparticipating provider, the managed care organization or a preferred provider organization may not penalize the patient by reducing benefits and must reimburse the nonparticipating provider, when assigned by the patient, at the same reimbursement rate as it reimburses similar participating providers. Any deductible stated in the insurance contract must remain the same. Terms and conditions may not discriminate against or among health care providers.

(C) It is unlawful for a managed care organization or a preferred provider organization to terminate or cancel its agreement with any provider without cause.

(D) The provisions of this section take precedence over terms, conditions, and provisions of an existing contract.

(E) If any provision of this section or the application of a provision, to any person under any circumstances, is held to be invalid, then that determination does not affect provisions or applications of this section which can be given effect without the invalid provision or application. To that end, the provisions of this section are severable."

SECTION 2. This act takes effect July 1, 1999.

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