Download This Version in Microsoft Word format
Indicates Matter Stricken
Indicates New Matter
COMMITTEE REPORT
February 27, 2008
S. 669
S. Printed 2/27/08--S.
Read the first time April 12, 2007.
To whom was referred a Bill (S. 669) to amend the Code of Laws of South Carolina, 1976, by adding Section 43-7-465 so as to provide that all insurers that are responsible for payment of a claim, etc., respectfully
That they have duly and carefully considered the same and recommend that the same do pass:
HARVEY S. PEELER, JR. for Committee.
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 43-7-465 SO AS TO PROVIDE THAT ALL INSURERS THAT ARE RESPONSIBLE FOR PAYMENT OF A CLAIM FOR A HEALTH CARE ITEM OR SERVICE AS A CONDITION OF DOING BUSINESS IN THIS STATE SHALL PROVIDE INFORMATION TO THE DEPARTMENT OF HEALTH AND HUMAN SERVICES ON INDIVIDUALS WHO RECEIVE MEDICAL ASSISTANCE UNDER THE STATE PLAN, SHALL ACCEPT THE STATE'S RIGHT OF RECOVERY OF CERTAIN PAYMENTS MADE UNDER THE STATE PLAN, SHALL RESPOND TO CLAIMS, AND SHALL AGREE NOT TO DENY CLAIMS ON THE BASIS OF THE TIME THE CLAIM WAS FILED, IF TIMELY FILED, THE FORMAT OF THE CLAIM FORM, OR FAILURE TO PRESENT DOCUMENTATION AT THE POINT OF SALE THAT IS THE BASIS OF THE CLAIM.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Article 5, Chapter 7, Title 43 of the 1976 Code is amended by adding:
"Section 43-7-465. All health insurers, including self-insured plans, group health plans, as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974, service benefit plans, managed care organizations, pharmacy benefit managers, or other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service, as a condition of doing business in South Carolina, shall:
(1) provide, with respect to individuals who are eligible for, or are provided, medical assistance under the State plan, upon the request of the Department of Health and Human Services, information to determine during what period the individual or the individual's spouse or dependents may be, or may have been, covered by a health insurer and the nature of the coverage that is or was provided by the health insurer, including the name, address, and identifying number of the plan, in a manner prescribed by the Secretary of the United States Health and Human Services;
(2) accept the State's right of recovery and the assignment to the State any right of an individual or other entity to payment from the party for an item of service for which payment has been made under the State plan;
(3) respond to any inquiry by the State regarding a claim for payment for any health care item or service that is submitted not later than three years after the date of the provision of the health care item or service; and
(4) agree not to deny a claim submitted by the State solely on the basis of the date of submission of the claim, the type or format of the claim form, or a failure to present proper documentation at the point-of-sale that is the basis of the claim, if:
(a) the claim is submitted by the State within the three-year period beginning on that date on which the item or service was furnished; and
(b) any action by the State to enforce its rights with respect to the claim is commenced within six years of the State's submission of the claim."
SECTION 2. This act takes effect upon approval by the Governor.
This web page was last updated on Monday, June 22, 2009 at 3:07 P.M.