Indicates Matter Stricken

Indicates New Matter

 

Committee Report

March 24, 2026

 

H. 3874

 

Introduced by Reps. J. E. Johnson and Schuessler

 

S. Printed 3/24/26--H.

Read the first time January 30, 2025

 

________

 

The committee on House Labor, Commerce and Industry

To whom was referred a Bill (H. 3874) to amend the South Carolina Code of Laws by amending Section 42-15-90, relating to fees of attorneys and physicians and hospital charges approved by the commission, etc., respectfully

Report:

That they have duly and carefully considered the same, and recommend that the same do pass with amendment:

 

   Amend the bill, as and if amended, by striking all after the enacting words and inserting:

SECTION 1.  Section 42-15-90(C) of the S.C. Code is amended to read:

 

    (C)(1) The commission may adopt criteria to establish a new fee schedule or adjust an existing fee schedule to establish maximum allowable payments for medical services provided by medical practitioners exclusive of hospital inpatient services and hospital outpatient services and ambulatory surgery centers. based in whole or in part on the requirements of a federally funded program, but if it adopts adjustments to an existing fee schedule, it must adopt these adjustments on an annual basis and the adjustments may not exceed the percentage change indicated by the federally funded program. The commission shall conduct an evidentiary hearing to review a proposed adjustment to increase or reduce these fees by more than ten percent annually to determine whether to:

           (a) increase or reduce the proposed adjustment as the commission considers appropriate;  or

           (b) accept the proposed adjustment.The commission, in consultation with the cost containment committee must establish a medical fee schedule and a related system that includes, but is not limited to, procedures for a review of charges and enforcement and implementation procedures. In establishing the fee schedule, the commission must strive to assure the delivery of quality medical care in workers' compensation cases and access by injured workers to primary and specialist care while controlling prices and system costs. The commission may consider multiple reimbursement systems and methodologies in developing the fee schedule including, but not limited to, applying multiple conversion factors to the Centers for Medicare and Medicaid Services (CMS) Resource Based Relative Value Scale (RBRVS) system.

       (2)(a) A decision of the commission to increase or reduce a fee schedule to establish maximum allowable payments for medical services provided by medical practitioners exclusive of hospital inpatient services and hospital outpatient services and ambulatory surgery centers by more than ten percent is reviewable by expedited appeal to the Administrative Law Court pursuant to the Administrative Procedures Act.

           (b) On appeal, the court may:

               (i) accept the increase or decrease;

               (ii) impose a lesser increase or decrease;

               (iii) revert the fee schedule as it was immediately prior to the annual adjustment;

               (iv) adjust the appropriate conversion factors as necessary;  or

               (v) make other adjustments the court considers reasonable.

           (c) The court shall issue a decision within ninety days after it receives the appeal.

           (d) During the pendency of this appeal, the portion of the fee schedule under review must remain the same as it was immediately prior to the proposed changes, but all other portions of the fee schedule or conversion factors are effective and remain unchanged.The commission must retain experts to assist in the development of the fee schedule and related systems.

       (3) The commission, in consultation with the cost containment committee, must review the fee schedules adopted pursuant to this section on an annual basis and, when appropriate, the commission shall revise the fee schedules as necessary. The annual review must consider among other factors, the medical consumer price index and the workers' compensation fee schedules of other states in the region.

       (4) The commission must hold a public hearing to receive comments from stakeholders and shall consider comments received in consultation with the cost containment committee prior to finalizing the annual fee schedule update.

       (5) The cost containment committee must be comprised of seven voting members appointed by the commission. Two members representing the medical provider industry; two members representing the workers' compensation insurance industry; two members representing the employer community; and the final member will be the chairperson of the commission or his appointee.

 

SECTION 2.  This act takes effect upon approval by the Governor.

Renumber sections to conform.

Amend title to conform.

 

WILLIAM HERBKERSMAN for Committee.

statement of estimated fiscal impact

Explanation of Fiscal Impact

State Expenditure

This bill modifies the process by which WCC establishes and reviews the medical fee schedule process to promote access and delivery of medical care for injured workers.

WCC currently sets the medical fee schedule and indicates that this bill does not alter the agency's responsibilities. Therefore, this bill will have no expenditure impact. 

 

 

Frank A. Rainwater, Executive Director

Revenue and Fiscal Affairs Office

 

_______

 

 

 

 

 

 

 

 

A bill

 

TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY AMENDING SECTION 42-15-90, RELATING TO FEES OF ATTORNEYS AND PHYSICIANS AND HOSPITAL CHARGES APPROVED BY THE COMMISSION, SO AS TO ALLOW THE COMMISSION TO ESTABLISH MEDICAL FEE SCHEDULES AND RELATED SYSTEMS.

 

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

 

SECTION 1.  Section 42-15-90(C) of the S.C. Code is amended to read:

 

    (C)(1) The commission may adopt criteria to establish a new fee schedule or adjust an existing fee schedule to establish maximum allowable payments for medical services provided by medical practitioners exclusive of hospital inpatient services and hospital outpatient services and ambulatory surgery centers based in whole or in part on the requirements of a federally funded program, but if it adopts adjustments to an existing fee schedule, it must adopt these adjustments on an annual basis and the adjustments may not exceed the percentage change indicated by the federally funded program. The commission shall conduct an evidentiary hearing to review a proposed adjustment to increase or reduce these fees by more than ten percent annually to determine whether to:

           (a) increase or reduce the proposed adjustment as the commission considers appropriate;  or

           (b) accept the proposed adjustment.

       (2)(a) A decision of the commission to increase or reduce a fee schedule to establish maximum allowable payments for medical services provided by medical practitioners exclusive of hospital inpatient services and hospital outpatient services and ambulatory surgery centers by more than ten percent is reviewable by expedited appeal to the Administrative Law Court pursuant to the Administrative Procedures Act.

           (b) On appeal, the court may:

               (i) accept the increase or decrease;

               (ii) impose a lesser increase or decrease;

               (iii) revert the fee schedule as it was immediately prior to the annual adjustment;

               (iv) adjust the appropriate conversion factors as necessary;  or

               (v) make other adjustments the court considers reasonable.

           (c) The court shall issue a decision within ninety days after it receives the appeal.

           (d) During the pendency of this appeal, the portion of the fee schedule under review must remain the same as it was immediately prior to the proposed changes, but all other portions of the fee schedule or conversion factors are effective and remain unchanged.The commission may establish medical fee schedules and a related system that includes, but is not limited to, procedures for a review of charges and enforcement and implementation procedures.  In establishing the fee schedules, the commission must strive to assure the delivery of quality medical care in workers' compensation cases and access by injured workers to primary and specialist care while controlling prices and system costs. The commission may consider any and all reimbursement systems and methodologies in developing the fee schedules including, but not limited to, applying multiple conversion factors to a relative value scale calculation.

       (2) The commission may retain experts to assist in the development of the fee schedules and related systems.

       (3) The commission must review the fee schedules adopted pursuant to this section on an annual basis and, when appropriate, the commission must revise the fee schedules as necessary. The annual review should consider among other factors, the medical consumer price index and the workers' compensation fee schedules of other states in the region.

 

SECTION 2.  This act takes effect upon approval by the Governor.

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