Current Status Bill Number:200 Ratification Number:191 Act Number:121 Type of Legislation:General Bill GB Introducing Body:Senate Introduced Date:19970121 Primary Sponsor:Courtney All Sponsors:Courtney, Holland, Land, Peeler, Rankin, Alexander, Martin, McGill, Waldrep, Lander, O'Dell, Reese, Rose, Glover, Ford, Thomas, Fair, Anderson, Washington and Elliott Drafted Document Number:egm\18531ac.97 Companion Bill Number:3279 Date Bill Passed both Bodies:19970604 Date of Last Amendment:19970529 Governor's Action:S Date of Governor's Action:19970613 Subject:Eye Care Services Act, Optometry, opthalmologists, optometrists; Insurance, medical and health
Body Date Action Description Com Leg Involved
______ ________ _______________________________________ _______ ____________
------ 19970630 Act No. A121
------ 19970613 Signed by Governor
------ 19970609 Ratified R191
Senate 19970604 Concurred in House amendment,
enrolled for ratification
House 19970530 Read third time, returned to Senate
with amendment
House 19970529 Amended, read second time,
unanimous consent for third reading
on Friday, 19970530
House 19970527 Committee report: Favorable with 26 HLCI
amendment
House 19970417 Introduced, read first time, 26 HLCI
referred to Committee
Senate 19970416 Read third time, sent to House
Senate 19970415 Amended, read second time,
unanimous consent for third reading
on Wednesday, 19970416
Senate 19970410 Recalled from Committee, 02 SBI
placed on the Calendar
Senate 19970305 Co-Sponsor added by Senator Elliott
Senate 19970121 Introduced, read first time, 02 SBI
referred to Committee
View additional legislative information at the LPITS web site.
(A121, R191, S200)
AN ACT TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-440 SO AS TO ENACT THE SOUTH CAROLINA EYE CARE SERVICES ACT AND TO PROHIBIT HEALTH MAINTENANCE ORGANIZATIONS (HMO) AND HEALTH BENEFIT PLANS OFFERING MEDICAL EYE CARE OR VISION CARE BENEFITS FROM UNNECESSARILY RESTRICTING THE PRACTICE OF OPTOMETRISTS PARTICIPATING IN THE HMO OR PLAN; TO PROHIBIT DISCRIMINATION AGAINST OPTOMETRISTS OR OPTHALMOLOGISTS IN THE OPPORTUNITY TO PARTICIPATE OR WITH REGARD TO THE TERMS AND CONDITIONS OF THE HMO OR PLAN; TO REQUIRE AN HMO OR PLAN TO CONTRACT WITH OPTHALMOLOGISTS FOR EYE SURGERY ONLY SERVICES; AND TO PROVIDE PROCEDURES FOR GRIEVANCES RESULTING FROM VIOLATIONS.
Be it enacted by the General Assembly of the State of South Carolina:
Act citation
SECTION 1. This act may be cited as the 'South Carolina Eye Care Services Act'.
Prohibitions for health maintenance organizations and health benefit plans offering eye and vision services
SECTION 2. The 1976 Code is amended by adding:
"Section 38-71-440. (A) As used in this section:
(1) 'Health benefit plan' means any public or private health plan implemented in this State that provides medical eye care or vision care benefits, or both, to covered persons including payments and reimbursements.
(2) 'Ophthalmologist' means a physician licensed pursuant to Title 40, Chapter 47 who practices in South Carolina and who specializes in the medical and surgical care of the eye and visual system and routine vision care.
(3) 'Optometrist' means a doctor of optometry licensed pursuant to Title 40, Chapter 37 who is engaged in the practice of optometry in South Carolina.
(B) No health maintenance organization or health benefit plan which maintains or contracts with a network of ophthalmologists or optometrists, or both, to provide medical eye care or vision care benefits, or both, shall prohibit a participating optometrist from performing medical services within that optometrist's scope of practice set forth in Title 40, Chapter 37, in accordance with the terms of the health maintenance organization or health benefit plan and in accordance with subsections (C) and (I).
(C) No health maintenance organization or health benefit plan which maintains or contracts with a network of ophthalmologists or optometrists, or both, to provide medical eye care or vision care benefits, or both, excepting all self-funded health benefit plans as defined under the Federal Employee Retirement Income Security Act (ERISA) of 1974, shall discriminate against optometry, as a class, or ophthalmology, as a class, with respect to the terms, conditions, privileges, and opportunity of participation or compensation for the same eye care services provided in this section.
(D) No health benefit plan or health maintenance organization shall impose on optometry, as a class, any condition or restriction which is not necessary for the delivery of services or materials, or both, in accordance with and subject to Chapter 37, Title 40.
(E) Any health maintenance organization or health benefit plan may contract for vision care benefits or medical eye care benefits, or both. A health maintenance organization or health benefit plan may contract for surgery only services with ophthalmologists. A health maintenance organization or health benefit plan must be authorized to contract with optometrists and ophthalmologists as either individual panelists or network panelists.
(F) Nothing in this section may be construed to limit, expand, or otherwise affect the scope of practice of optometrists and therapeutically certified optometrists as provided for in Chapter 37, Title 40.
(G) Nothing in this section may be construed to preclude a covered person from receiving emergency medical eye care or to preclude a primary care physician from providing treatment for covered services in accordance with the terms of a health maintenance organization or health benefit plan.
(H) Nothing in this section may be construed to mandate coverage of any service.
(I) Nothing in this plan may be construed to prohibit a health maintenance organization or health benefit plan from professionally credentialing and evaluating all individual optometrists or ophthalmologists within a network or plan in a nondiscriminatory manner. Nothing in this section may be construed to prohibit any health maintenance organization or health benefit plan from limiting the number of optometrists or ophthalmologists in a nondiscriminatory manner or to prohibit a health maintenance organization or health benefit plan from negotiating individually with optometrists or ophthalmologists for individual rates and eye care services in a nondiscriminatory manner.
(J) Any person aggrieved by a violation of this section may file a complaint with the Department of Insurance. After notice to the health maintenance organization or health benefit plan and an opportunity for it to submit a written response to the complaint, the director of the department may make a written determination regarding the complaint. Any party aggrieved by the director's determination is entitled to administrative and judicial review pursuant to Article 3, Chapter 23, Title 1. The director or the administrative law judge, if a hearing before the Administrative Law Judge Division is requested, may impose sanctions that are authorized under current insurance laws if a violation of this section is found to have occurred."
Time effective
SECTION 3. This act takes effect 180 days after signature by the Governor; however, existing contracts may comply with the requirements of this act at their next renewal date.
Approved the 13th day of June, 1997.