South Carolina General Assembly
110th Session, 1993-1994

Bill 507


                    Current Status
Introducing Body:               Senate
Bill Number:                    507
Ratification Number:            175
Act Number:                     130
Primary Sponsor:                Giese
Type of Legislation:            GB
Subject:                        Nonidentifying health care
                                information
Companion Bill Number:          3660
Date Bill Passed both Bodies:   19930603
Computer Document Number:       436/11032AC.93
Governor's Action:              S
Date of Governor's Action:      19930614
Introduced Date:                19930304
Date of Last Amendment:         19930512
Last History Body:              ------
Last History Date:              19930614
Last History Type:              Act No. 130
Scope of Legislation:           Statewide
All Sponsors:                   Giese
                                Martin
                                Passailaigue
                                Washington
                                Rose
                                Ryberg
                                Wilson
                                Drummond
Type of Legislation:            General Bill

History

Bill   Body    Date          Action Description              CMN  Leg Involved
----   ------  ------------  ------------------------------  ---  ------------
507    ------  19930614      Act No. 130
507    ------  19930614      Signed by Governor
507    ------  19930610      Ratified R 175
507    House   19930603      Read third time, enrolled for
                             ratification
507    House   19930602      Read second time
507    House   19930601      Recalled from Committee         27
507    House   19930527      Introduced, read first time,    27
                             referred to Committee
507    Senate  19930526      Read third time, sent to House
507    Senate  19930512      Amended, read second time,
                             ordered to third reading with
                             notice of general amendments
507    Senate  19930511      Committee Report: Favorable     13
                             with amendment
507    Senate  19930304      Introduced, read first time,    13
                             referred to Committee
View additional legislative information at the LPITS web site.


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

(A130, R175, S507)

AN ACT TO AMEND SECTION 44-6-150, AS AMENDED, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO THE MEDICALLY INDIGENT ASSISTANCE PROGRAM, SO AS TO DELETE PROVISIONS RELATING TO THE METHOD OF ADJUSTING CHARGES FOR PATIENTS SPONSORED BY THE PROGRAM AND RELATING TO A SYSTEM OF REIMBURSEMENT; TO AMEND SECTION 44-6-155, AS AMENDED, RELATING TO THE MEDICAID EXPANSION FUND, SO AS TO DELETE PROVISIONS RELATING TO HOSPITAL REIMBURSEMENT FOR CARE GIVEN TO PATIENTS SPONSORED BY THE PROGRAM; TO AMEND SECTION 44-6-170, AS AMENDED, RELATING TO STANDARDIZED ANNUAL REPORTING BY HOSPITALS, SO AS TO ESTABLISH THE DATA OVERSIGHT COUNCIL TO PROVIDE FOR THE METHOD AND CONTENT OF INFORMATION THAT MAY BE RELEASED, TO PROVIDE FOR A HEALTH DATA ANALYSIS TASK FORCE, TO REQUIRE SPECIALIZED HOSPITALS TO REPORT, TO REVISE DATA TO BE REPORTED TO INCLUDE CERTAIN PATIENT SPECIFIC INFORMATION AND INJURY CODES, AND TO PROVIDE PENALTIES; TO AMEND SECTION 44-6-180, AS AMENDED, RELATING TO CONFIDENTIALITY OF PATIENT RECORDS, SO AS TO REVISE THESE PROVISIONS TO CONFORM TO CONFIDENTIALITY PROVISIONS OF SECTION 44-6-170; TO AMEND SECTION 44-6-200, AS AMENDED, RELATING TO FALSIFICATION OF INFORMATION, SO AS TO DELETE PROVISIONS RELATING TO FALSE INFORMATION USED TO SEEK REIMBURSEMENT FROM THE PROGRAM.

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

Medically Indigent Assistance Program; duties of hospitals and commission

SECTION 1. Section 44-6-150 of the 1976 Code, as last amended by Act 189 of 1989, is further amended to read:

"Section 44-6-150. (A) There is created the South Carolina Medically Indigent Assistance Program administered by the commission. The program is authorized to sponsor inpatient hospital care for which hospitals shall receive no reimbursement. A general hospital equipped to provide the necessary treatment shall:

(1) admit a patient sponsored by the program; and

(2) accept the transfer of a patient sponsored by the program from a hospital which is not equipped to provide the necessary treatment. In addition to or in lieu of an action taken affecting the license of the hospital, when it is established that an officer, employee, or member of the hospital medical staff has violated this section, the South Carolina Department of Health and Environmental Control shall require the hospital to pay a civil penalty of up to ten thousand dollars.

(B) Hospital charges for patients sponsored by the Medically Indigent Assistance Program must be reported to the Division of Research and Statistical Services pursuant to Section 44-6-170.

(C) In administering the Medically Indigent Assistance Program, the commission shall determine:

(1) the method of administration including the specific procedures and materials to be used statewide in determining eligibility for the program;

(a) In a nonemergency, the patient shall submit the necessary documentation to the patient's county of residence or its designee to determine eligibility before admission to the hospital.

(b) In an emergency, the hospital shall admit the patient pursuant to Section 44-7-260. If a hospital holds the patient financially responsible for all or a portion of the inpatient hospital bill, and if the hospital determines that the patient could be eligible for the program, it shall forward the necessary documentation along with the patient's bill and other supporting information to the patient's county of residence or its designee for processing. A county may request that all hospital bills incurred by its residents sponsored by the program be submitted to the county or its designee for review.

(2) the population to be served, including eligibility criteria based on family income and resources. Eligibility is determined on an episodic basis for a given spell of illness. Eligibility criteria must be uniform statewide and may include only those persons who meet the program's definition of medically indigent;

(3) the health care services covered;

(4) a process by which an eligibility determination can be contested and appealed; and

(5) the program may not sponsor a patient until all other means of paying for or providing services have been exhausted. This includes Medicaid, Medicare, health insurance, employee benefit plans, or other persons or agencies required by law to provide medical care for the person. Hospitals may require eligible patients whose gross family income is between one hundred percent and two hundred percent of the federal poverty guidelines, to make a copayment based on a sliding payment scale developed by the commission based on income and family size.

(D) Nothing in this section may be construed as relieving hospitals of their Hill-Burton obligation to provide unreimbursed medical care to indigent persons."

Medicaid Expansion Fund

SECTION 2. Section 44-6-155 of the 1976 Code, as last amended by Act 105 of 1991, is further amended to read:

"Section 44-6-155. (A) There is created the Medicaid Expansion Fund into which must be deposited funds:

(1) collected pursuant to Section 44-6-146;

(2) collected pursuant to Section 12-23-810; and

(3) appropriated pursuant to subsection (B).

This fund must be separate and distinct from the general fund. These funds are supplementary and may not be used to replace general funds appropriated by the General Assembly or other funds used to support Medicaid. These funds and the programs specified in subsection (C) are exempt from any budgetary cuts, reductions, or eliminations caused by the lack of general fund revenues. Earnings on investments from this fund must remain part of the separate fund and must not be deposited in the general fund.

(B) The commission shall estimate the amount of federal matching funds which will be spent in the State during the next fiscal year due to the changes in Medicaid authorized by subsection (C). Based on this estimate, the General Assembly shall appropriate to the Medicaid Expansion Fund state funds equal to the additional state revenue generated by the expenditure of these federal funds.

(C) Monies in the fund must be used to:

(1) provide Medicaid coverage to pregnant women and infants with family incomes above one hundred percent but below one hundred eighty-five percent of the federal poverty guidelines;

(2) provide Medicaid coverage to children aged one through six with family income below federal poverty guidelines;

(3) provide Medicaid coverage to aged and disabled persons with family income below federal poverty guidelines;

(4) provide Medicaid coverage through a medically-needy program to eligible persons in families with medical expenses which reduce the net family income below state and federal standards;

(5) provide Medicaid reimbursement for hospital patients in need of subacute care, including patients in swing beds;

(6) provide a pool of at least forty-four million dollars for the sole purpose of adjusting Medicaid reimbursement for hospitals as provided in Section 44-6-140(A)(1). Funds in the pool not immediately used for this purpose must be carried forward for eventual use for this purpose;

(7) provide up to two hundred forty thousand dollars to reimburse the Division of Research and Statistical Services and hospitals for the cost of collecting and reporting data pursuant to Section 44-6-170; and

(8) supplement state funds needed to administer items (3) and (4), not to exceed $700,000.

(D) Any funds not expended for the purposes specified in subsection (C) during a given year are carried forward to the succeeding year for the same purposes."

Data Oversight Council; duties; hospital data to be reported; penalties

SECTION 3. Section 44-6-170 of the 1976 Code, as last amended by Act 105 of 1991, is further amended to read:

"Section 44-6-170.

(A) As used in this section:

(1) `Division' means the Division of Research and Statistical Services of the Budget and Control Board.

(2) `Council' means the Data Oversight Council.

(3) `Committee' means the Joint Legislative Health Care Planning and Oversight Committee.

(B) There is established the Data Oversight Council comprised of:

(1) one hospital administrator;

(2) the chief executive officer or designee of the South Carolina Hospital Association;

(3) one physician;

(4) the chief executive officer or designee of the South Carolina Medical Association;

(5) one representative of major third party health care payers;

(6) one representative of the managed health care industry;

(7) one nursing home administrator;

(8) three representatives of nonhealth care-related businesses;

(9) one representative of a nonhealth care-related business of less than one hundred employees;

(10) the executive vice president or designee of the South Carolina Chamber of Commerce;

(11) a member of the Governor's office staff;

(12) a representative from the Human Services Coordinating Council;

(13) the commissioner or his designee of the South Carolina Department of Health and Environmental Control;

(14) the executive director or his designee of the State Health and Human Services Finance Commission;

(15) the chairman or his designee of the Health Planning Committee created pursuant to Section 44-7-180.

The members enumerated in items (1) through (10) must be appointed by the Governor for three-year terms and until their successors are appointed and qualify; the remaining members serve ex officio. The Governor shall appoint one of the members to serve as chairman. The division shall provide staff assistance to the council.

(C) The division, with the approval of the council, shall promulgate regulations to implement this section in accordance with the Administrative Procedures Act. No data may be released by the division except in a format recommended by the council and approved by the committee. Patient identifiers gathered pursuant to this section are confidential. The information collected may not be released to entities or individuals unless release is made of aggregate statistical information so that no individual patient may be identified. The committee, upon recommendations of the council, shall determine what provider-identifiable data should be released for public use and what data should be released for research purposes. Any such release must be preceded by notice to the identified provider, who must be provided sufficient time to review the information and whose written response must be considered before a release and must be included, if requested, in the release. Nothing in this section may be construed to change or interfere with the mode of collection and format of release of existing inpatient hospital data by the division by general acute care hospitals, until recommendations are adopted by the council and approved by the committee. The council shall make periodic recommendations to the committee and the General Assembly concerning the collection and release of health care-related data by the State. The council shall forward to the committee, before December 2, 1993, recommendations for the collection of additional health care information and data including, but not limited to, all outpatient data, information concerning health care manpower needs for the State, information to assist in the development and evaluation of health outcomes, and other information the council may consider necessary to assist in the formation of health care policy in the State. Recommendations by the council mandating the collection of this data apply to every provider or insurer affected by the recommendation, regardless of how the data is collected by the provider or insurer. Every effort must be made to utilize existing data sources.

(D) Information may be required to be produced only with respect to admissions of and treatment to patients after the effective date of the regulations implementing this section, except that data with respect to the medical history of the patient reasonably necessary to evaluation of the admission of and treatment to the patient may be required.

(E) The division shall convene a Health Data Analysis Task Force composed of technical representatives of universities and of the private sector and public agencies including, but not limited to, health care providers and insurers to make recommendations to the council concerning types of analysis needed to carry out this section.

(F) All general acute care hospitals and specialized hospitals including, but not limited to, psychiatric hospitals, alcohol and substance abuse hospitals, and rehabilitation hospitals shall provide the following information to the division: hospital-specific information for the twelve-month period from October first through September thirtieth for each federal fiscal year. This information must be reported by March first of the following year:

(1) total gross revenue, including:

(a) gross inpatient revenue;

(b) Medicare gross revenue;

(c) Medicaid gross revenue;

(d) South Carolina Medically Indigent Assistance Program gross revenue;

(2) total deductions for contractual allowances from gross revenue, including:

(a) Medicare contractual allowances;

(b) Medicaid contractual allowances; and

(c) other contractual allowances;

(3) total direct costs of medical education:

(a) reimbursed; and

(b) unreimbursed;

(4) total indirect costs of medical education:

(a) reimbursed; and

(b) unreimbursed;

(5) total costs of bad debt and charity care:

(a) South Carolina Medically Indigent Assistance Program;

(b) other charity care; and

(c) bad debt;

(6) total admissions, including:

(a) Medicare admissions;

(b) Medicaid admissions;

(c) South Carolina Medically Indigent Assistance Program admissions; and

(d) other admissions;

(7) total patient days;

(8) average length of stay;

(9) total outpatient visits;

(10) extracts of the following medical record information:

(a) patient date of birth;

(b) patient number;

(c) patient sex;

(d) patient county of residence;

(e) patient zip code;

(f) patient race;

(g) date of admission;

(h) source of admission;

(i) type of admission;

(j) discharge date;

(k) principal and up to eight other diagnoses;

(l) principal procedure and date;

(m) patient status at discharge;

(n) up to five other procedures;

(o) hospital identification number;

(p) principal source of payment;

(q) total charges and components of those charges, including associated room and board units;

(r) patient medical record or chart number;

(s) attending physician and primary surgeon;

(t) patient name, patient social security number, and patient address; and

(u) external cause of injury code (E-code), as set forth in regulation.

Release must be made no less than semi-annually of the patient medical record information listed in this subsection to the submitting hospital and the information listed in items (10)(a) through (r) and (u) to the hospital's designee.

(G) A person violating this section is guilty of a misdemeanor and, upon conviction, must be fined not more than five thousand dollars or imprisoned not more than one year, or both."

Confidentiality

SECTION 4. Section 44-6-180 of the 1976 Code, as last amended by Act 189 of 1989, is further amended to read:

"Section 44-6-180. (A) Patient records received by counties, the commission, or other entities involved in the administration of the program created pursuant to Section 44-6-150 are confidential. Patient records gathered pursuant to Section 44-6-170 are also confidential. The division shall use patient-identifiable data collected pursuant to Section 44-6-170 for the purpose of linking various data bases to carry out the purposes of Section 44-6-170. Linked data files must be made available to those agencies providing data files for linkage. No agency receiving patient-identifiable data collected pursuant to Section 44-6-170 may release this data in a manner such that an individual patient or provider may be identified except as provided in Section 44-6-170. Nothing in this section may be construed to limit access by a submitting provider or its designee to that provider's information.

(B) A person violating this section is guilty of a misdemeanor and, upon conviction, must be fined not more than five thousand dollars or imprisoned not more than one year, or both."

Penalties

SECTION 5. Section 44-6-200 of the 1976 Code, as last amended by Act 189 of 1989, is further amended to read:

"Section 44-6-200. (A) A person who commits a material falsification of information required to determine eligibility for the Medically Indigent Assistance Program is guilty of a misdemeanor and, upon conviction, must be fined not more than five hundred dollars or imprisoned for not more than one year, or both.

(B) Unless otherwise specified in this chapter, an individual or facility violating this chapter or a regulation under this chapter is guilty of a misdemeanor and, upon conviction, must be fined not more than one hundred dollars for the first offense and not more than five thousand dollars for a subsequent offense."

Time effective

SECTION 6. This act takes effect upon approval by the Governor, except, the reporting requirement in Section 44-6-170(F)(10)(u) takes effect October 1, 1994.

Approved the 14th day of June, 1993.