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Legislative and Regulatory Issues

2022 Legislative Report

The South Carolina General Assembly adjourned the regular 2022 session on May 12th. Pursuant to the adoption of the Sine Die resolution, the General Assembly then reconvened to address the state budget, outstanding conference committee reports, and gubernatorial vetoes.  What follows is a final list of legislation tracked throughout the session, including carryovers from 2021. Legislation that did not pass will not be carried over to 2023. 


For questions about SCAHP’s position on any of the bills addressed in this report, please contact Jim Ritchie, Executive Director.

Acronyms are listed and explained at the conclusion of the document.

PASSED LEGISLATION

SCAHP High Priority Bills 

Step Therapy/Prior Authorization:  H.3775 (Rep. Robinson – D) as passed provides that if a health benefit plan covers treatment of stage four advanced, metastatic cancer, and denies a PA request or a claim for a recognized diagnostic imaging service based upon an adverse medical necessity determination, the covered person shall have a right to an expedited external review. Does not apply to ERISA plans. “Recognized diagnostic imaging service” for diagnosis and treatment of stage four advanced, metastatic cancer are those for which the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology provides a uniform consensus that use is appropriate and is supported by peer-reviewed literature. The bill was signed by the governor on May 16 (Act 187). Effective 5/16/2022. The bill initially set restrictions on step therapy and PA for drugs, but was amended to apply to diagnostic imaging services. AHIP opposed and collaborated with industry allies to ameliorate the bill.  

Organ Donors:  H.4597 (Rep. Bustos - R) prohibits a health insurer that covers anatomical gifts, organ transplants, or related treatment from the following: denying coverage to a covered person solely on the basis of the person's disability; denying to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the health benefit plan, solely for the purpose of avoiding the requirements of this section; penalizing or otherwise reducing or limiting the reimbursement of an attending provider, or provide monetary or nonmonetary incentives to an attending provider, to induce such provider to provide care to an insured or enrollee in a manner inconsistent with this section; or reducing or limiting coverage benefits to a patient for the medical services or other services related to organ transplantation performed pursuant to this section as determined in consultation with the attending physician and patient. The bill was signed by the governor on May 13 (Act 163). Effective 5/13/2022.

Right of Conscience:  H.4776 (Rep. Willis – R) authorizes medical practitioners, health care institutions, and health care payers not to participate in health care services that violate the practitioner's or entity's conscience and to protect these individuals and entities from civil, criminal, or administrative liability. The bill passed and was signed by the governor on June 17 (Act 235). Effective 6/17/2022.

Long Term Care/Interstate Compact:  H.4832 (Rep. Sandifer - R) requires long term care plans to provide written notice to policyholders of a rate increase 30 days prior to the effective date, and to file the proposed increase with DOI. The required notice must show the proposed rate, state that it is subject to regulatory approval, direct policyholders to present their concerns or objections to the DOI, and include contact information for the DOI. Rate increases may not be implemented until the effective date or the date approved by the DOI, whichever is later. Additionally, provides for the repeal of the Interstate Insurance Product Regulation Compact. The bill was signed by the governor on May 16. (Act 220). Effective 5/16/22.

Pharmacist Administered Contraceptives:  S.628 (Sen. Davis – R) authorizes pharmacists to dispense a self-administered hormonal contraceptive or administer an injectable hormonal contraceptive pursuant to a standing prescription drug order. Provides self-administered hormonal contraceptives and injectable hormonal contraceptives are covered pharmacy services under Medicaid. The bill was signed by the governor on May 23 (Act 210).

Telehealth: S.1179 (Sen. Shealy - R) allows psychologists, social workers and addiction counselors licensed in other states to register and practice telehealth in SC. The bill was signed by the governor on May 13 (Act 155). Effective 6/12/2022.


 SCAHP Medium Priority Bills

Vaccines:  H.3126 (Rep. Jones - R) declares the federal COVID-19 vaccine mandate unconstitutional and prohibits the state from enacting such a mandate. Signed by the governor on April 25 (Act 142). Effective 4/25/2022.

Psychology Interjurisdictional Compact: H.3833 (Rep. Erickson – R) enters the state into the Psychology Interjurisdictional Compact. The bill was signed by the governor on May 13 (Act 159). Effective 5/13/2022.

Audiology and Speech-Language Pathology Interstate Compact: H.3840 (Rep. Erickson - R) enters the state into the Audiology and Speech-Language Pathology Interstate Compact Act. The bill was signed by the governor on May 13 (Act 160). Effective 5/13/2022.

SCAHP Low Priority Bills

Occupational Therapy Licensure Compact: H.3599 (Rep. Newton - R) enacts the Occupational Therapy Licensure Compact, a multistate occupational licensure compact to provide for the reciprocal practice of occupational therapy among the states that are parties to the compact. The bill was signed by the governor on May 13 (Act 158). Effective 5/13/2022.

UNPASSED LEGISLATION 

Certificate of Need: 

  • H.3161 (Rep. Taylor - R)/H.3223 (Rep. Davis - R)/S.290 (Sen. Climer – R)  repeals and eliminates references to certificate of need requirements in statutes.
  • S. 370 (Sen. Talley – R) amends certificate of need requirements and exemptions.
  • S.717 (Sen. Jackson – D) adds diabetes screening facilities to certificate of need statutes.

Vaccines: 

  • H.3217 (Rep. Chumley - R) allows individuals to opt out of infectious or contagious disease vaccinations for any reason and prohibits regulatory authorities from interfering with the prescribing practices of a practitioner.
  • H.3511(Rep. Long - R) allows individuals to opt out of infectious or contagious disease vaccinations and to prohibit discrimination against individuals who exercise their right not to be vaccinated.

Medicaid Expansion: 

  • H.3226 (Rep. Garvin - D) provides for expansion of Medicaid under the ACA beginning January 1, 2022.
  • H.3269 (Rep. Garvin - D)/ S.83 (Sen. Malloy - D)  provides that a statewide advisory referendum must be conducted by the state election commission at the same time as the 2022 general election on the question of whether South Carolina should participate in Medicaid expansion.
  • S. 210 (Sen. Johnson – D) provides the state Medicaid plan include expansion for individuals up to 133% FPL.

Mandated Benefits: 

  • H.3234 (Rep. Huggins - R) requires plans to provide coverage for hearing aids and replacement hearing aids for covered individuals with impaired hearing. Coverage is limited to $1,500 per hearing aid, and replacements of one per ear every 36 months.
  • H.3400 (Rep. Garvin - D)/ S.193 (Sen. Hembree - R) requires plans to provide coverage the billed charges for one hearing aid per ear, for individuals with impaired hearing documented by a licensed physician or audiologist.
  • H.3748 (Rep. Matthews - D)/S.577 (Sen. Fanning - D) requires individual and group health insurance and HMOs to cover annual well-woman examinations, which includes a pelvic examination, breast examination, and contraceptive counseling.
  • H.3749 (Rep. Bernstein – D)/S.485 (Sen. Shealy - R) amends newborn child coverage to include coverage for pasteurized donor human milk and human milk products derived from donor human milk, including fortifier, when ordered as medically necessary.
  • H.4052 (Rep. Williams – D) requires individual health insurance to cover minor children regardless of whether the child is a dependent of an insured of the issuer. Also requires individual and group health insurance policies and HMOs to provide coverage for maternity care, which includes prenatal, delivery, and postpartum.
  • S.298 (Sen. Climer - R) requires coverage for early detection of cardiovascular disease for insureds who meet specified criteria.

Preexisting Conditions:  H.3239 (Rep. Garvin - D) prohibits preexisting condition exclusions in health benefit plans.

Medicaid:  H.3362 (Rep. Fry - R) requires Medicaid health plans to ensure access to appropriate clinical services for the effective treatment of opioid use disorders, including access to medications.

Surprise Billing:  H.3401 (Rep. Garvin - D)/S.314 (Sen. Fanning - D) addresses surprise billing, and provides that insureds are only responsible for cost-sharing requirements or other out-of-pocket expenses that would be imposed if rendered in-network. Prohibits insurers from imposing greater cost-sharing requirements on OON emergency services than for in-network. If an insured receives emergency services from an OON provider, the provider may bill the insurer directly, and the insurer must reimburse the greatest of: the amount the plan would pay for the same services if rendered in-network; the usual, customary, and reasonable rate for the same services, or the amount Medicare would reimburse for the same services. It also makes it an unfair trade practice for an insurer or health care provider to engage in the practice of surprise billing. Within one year of the Act, the DOI must report to the Governor and the General Assembly on the efficacy of dispute resolution practices between providers, including physicians, laboratories, and hospitals and insurers and make recommendations for any changes that should be made based on best practices from surprise billing laws in other states. The DOI also shall post this information on its agency website.

Vision:  H.4536 (Rep. Danning – R) prohibits vision insurers from controlling the professional judgement, manner or practice of an optometrist or optician.

Medicaid Buy-In:  H.3573 (Rep. Thigpen - D) establishes a Medicaid buy-in program to provide quality, affordable health insurance for certain residents of the state.

Right of Conscience:  H.3518 (Rep. Willis - R)/S.811 (Sen. Kimbrell – R) authorizes medical practitioners, health care institutions, and health care payers not to participate in health care services that violate the practitioner's or entity's conscience and to protect these individuals and entities from civil, criminal, or administrative liability.  

Behavior Analysts:  H.3731 (Rep. Erickson - R)/S.630 (Sen. Davis – R) provides for licensure of behavioral analysts.

Department of Health:  H. 3766 (Rep. Yow - R)/S.2 (Sen. Peeler – R) abolishes the Department of Public Health and Environmental Control, and instead establishes the Department of Public Health.

Telemedicine: 

  •  H. 3867 (Rep. Sandifer – R) provides that a contract between an HMO or insurer issuing comprehensive coverage through an individual or group health insurance policy and a telemedicine provider be voluntary and establish mutually acceptable payment rates or pay methodologies for services provided through telemedicine. A health plan or HMO is not required to enter into a contract or reimbursement agreement for telemedicine services. The bill also authorizes health professionals not licensed in this State to provide telemedicine if the health care professional is registered with the Department of Labor, Licensing and Regulation, and provides health care services within the applicable scope of practice established by this State.
  •  S.265 (Sen. Matthews - D) prohibits hospitals from utilizing telemedicine to deliver intensive or critical care services and to require such services be provided or supervised by a physician who is board-certified in critical care medicine.
  • H.3230 (Rep. Herbkersman - R) requires SCDHHS to reimburse practitioners for mental health telehealth services delivered to patients enrolled in Medicaid.

Direct Primary Care:  H.4169 (Rep. Thayer – R)/S.718 (Sen. Gambrell – R) provides that a direct primary care agreement is not a contract of insurance in this State and is not subject to regulation by the DOI. Such agreements must do the following: allow either party to terminate the agreement in writing, without penalty or payment of a termination fee, at any time or after a notice period specified in the agreement not to exceed sixty days; describe the health care services to be provided in exchange for payment of a periodic fee; specify the amount of the periodic fee and any additional fees to be paid by a third party; allow the periodic fee and any additional fees to be paid by a third party; prohibit the provider from charging or receiving additional compensation for health care services included in the periodic fee; and conspicuously and prominently state that the agreement is not health insurance and does not meet any individual health insurance mandate required by federal law.

Uninsured:  H.4198 (Rep. Williams - D) prohibits hospitals from charging uninsured patients fees in excess of the maximum fees charged to insured patients for the same services.

Insulin Copay Cap:  H.4245 (Rep. Johnson - R) caps an insured's monthly cost-sharing obligation for covered prescription insulin drugs at $100 for a 30-day supply, regardless of amount or type. 

Organ Donors:  H.4537/H.4839 (Rep. Jefferson - D) prohibits disability income or long term care policies from discriminating against living kidney donors. Discrimination includes: Declining or limiting coverage solely due to the status of such person as a living kidney donor; Precluding an insured from donating all or part of a kidney as a condition of continuing the insurance policy; or Discriminating in the offering, issuance, cancellation, amount of such coverage, price, or any other condition for a person, based solely and without any additional actuarial risks upon the status of such person as a living kidney donor.

Dental:

  •  H.4588 (Rep. Tedder - D) prohibits dental plans from including an alternative benefit clause, which is a provision that provides that when a less expensive dental procedure that serves the same function is available, the insurer only will provide coverage for the less expensive procedure, despite the recommendation of the dentist. Cost differences are to be paid by the subscriber.
  • H.4589 (Rep. Tedder - D) prohibits the exclusion of preexisting conditions in dental policies issued in this state.

Right to Shop:  S.289 (Sen. Climer - R) requires carriers to offer shared savings incentive programs as components of all health insurance plans. 

Cost Sharing Rebates:  S.642 (Sen. Gambrell - R) provides that an enrollee's defined cost sharing for each prescription drug must be calculated at the point of sale based on a price that is reduced by an amount equal to at least 80% of all rebates received, or to be received, in connection with the dispensing or administration of the prescription drug. A PBM may not publish or otherwise reveal information regarding the actual amount of rebates an insurer receives on a product or therapeutic class of products, manufacturer, or pharmacy-specific basis. Such information is proprietary and confidential and considered a trade secret under the South Carolina Freedom of Information Act, and may not be disclosed directly or indirectly, or in a manner that would allow for the identification of an individual product, therapeutic class of products, or manufacturer, or in a manner that would have the potential to compromise the financial, competitive, or proprietary nature of the information. A pharmacy benefits manager shall impose the confidentiality protections of this section on any vendor or downstream third party that performs health care or administrative services on behalf of the pharmacy benefits manager that may receive or have access to rebate information. This does not apply to Medicaid or the Public Employee Plan.

Cybersecurity:  H. 3063 (Rep. Bryant - R) enacts the "South Carolina Biometric Data Privacy Act" and to provide certain requirements for a business that collects a consumer's biometric information, to allow the consumer to request that a business delete the collected biometric information and to prohibit the sale of biometric information, to establish certain standards of care for a business that collects biometric information, to establish a procedure for a consumer to opt out of the sale of biometric information, to prohibit a business from discriminating against a consumer who opts out of the sale of their biometric information, and to provide a penalty.

Vaccines: H.3175 (Rep. Rutherford - D) provides that qualified licensed pharmacists may prescribe and administer injectable hormonal contraceptives and prescribe and dispense self-administered hormonal contraceptives under a standing prescription drug order, to provide for written joint protocol provisions, and to define necessary terms.

Substance Abuse Treatment:  H.3365 (Fry - R) To authorize certain health care practitioners to administer or dispense methadone or other narcotic treatment medications to patients of narcotic treatment programs.

Telemedicine: H.4085 (Rep. G.M. Smith – R) defines teledentistry, and requires it to be consistent with standard of care for in-person delivery, including synchronous and asynchronous methods. Sets provisions on establishing a dentist-patient relationship, and provides that it may not be used to expand the scope of practice or change permissible duties of dental auxiliaries. Defines teledentistry as the practice of dentistry using electronic communications, information technology, or other means between a licensee in one location and a patient in another location, with or without an intervening practitioner. 

General Insurance:  S.688 (Sen. Adams - R) requires all insurers issuing accident or health policies, if the premiums on the policies are collected directly by mail on a quarterly, semiannual, or annual basis, to provide a discounted premium to a policyholder who, at the time of entering into the insurance policy, has legally executed a declaration pursuant to the Death with Dignity Act. The discounted premium shall continue as long as the policyholder maintains a legally enforceable declaration.

Telemedicine: H.3227 (Rep. Gilliard - D) To add the right of residents to communicate with persons by videotelephony or web-based video communication technologies.

Prescription Drug Monitoring Program:  H.3998 (Rep. Fry – R) adds Fentanyl related substances to the list of Schedule I controlled substances. Introduced version added Schedule V controlled substances to the prescribed and dispensed controlled substances monitored under the program.

If you have any questions or concerns, please contact Jim Ritchie at jritchie@scalliance.org, 803.256.9003

 

Acronyms:

ACA – Affordable Care Act

DOI – Department of Insurance

ERISA – Employee Retirement Income Security Act of 1974

HMO – Health Maintenance Organization

FPL – Federal Poverty Level

OON – Out-of-Network

PA – Prior Authorization

PBM – Pharmacy Benefit Manager

SCDHHS – South Carolina Department of Health and Human Services

Contact

Jritchie@scalliance.org
803-256-9003
PO Box 2573
Columbia, SC 29202

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