Current Status Bill Number:3039 Type of Legislation:General Bill GB Introducing Body:House Introduced Date:19970114 Primary Sponsor:Cato All Sponsors:Cato, Seithel, Haskins and Altman Drafted Document Number:BBM\10962JM.97 Residing Body:Senate Current Committee:Banking and Insurance Committee 02 SBI Date of Last Amendment:19970204 Subject:Medical and health insurance plan, enrollees to receive services through network of contracted providers
Body Date Action Description Com Leg Involved
______ ________ _______________________________________ _______ ____________
Senate 19970206 Introduced, read first time, 02 SBI
referred to Committee
House 19970205 Read third time, sent to Senate
House 19970204 Amended, read second time
House 19970129 Committee report: Favorable with 26 HLCI
amendment
House 19970116 Referred to Committee 26 HLCI
House 19970116 Recalled from Committee 25 HJ
House 19970114 Introduced, read first time, 25 HJ
referred to Committee
House 19961211 Prefiled, referred to Committee 25 HJ
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AMENDED
February 4, 1997
H. 3039
S. Printed 2/4/97--H.
Read the first time January 14, 1997.
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-33-320 SO AS TO PROVIDE THAT, TO THE EXTENT THAT A HEALTH BENEFIT PLAN OR HEALTH INSURER REQUIRES ENROLLEES TO RECEIVE HEALTH SERVICES THROUGH A NETWORK OF CONTRACTED PROVIDERS, THE PROVISIONS OF THESE CONTRACTS DO NOT LIMIT THE CONTRACT PROVIDER'S ABILITY TO DISCUSS WITH AN ENROLLEE THE TREATMENT OPTIONS AVAILABLE TO THE ENROLLEE, RISKS ASSOCIATED WITH THE TREATMENTS, OR A RECOMMENDED COURSE OF TREATMENT OR LEGAL OBLIGATIONS TO INDIVIDUAL PATIENTS AS SPECIFIED UNDER THE PROVIDER'S PROFESSIONAL LICENSE, AND PROVIDE FOR RELATED MATTERS.
Amend Title To Conform
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. The 1976 Code is amended by adding:
"Section 38-33-320. (A) To the extent that a health maintenance organization requires enrollees to receive health services through a network of contracted providers, the provisions of these contracts do not limit the contract provider's:
(1) ability to discuss with an enrollee the treatment options available to the enrollee, risks associated with the treatments, utilization management decisions, or a recommended course of treatment; or
(2) legal obligations to individual patients as specified under the provider's professional license.
(B) Nothing in this section may be construed to:
(1) prevent a health benefit plan or a health plan insurer from prohibiting disclosure, by contracted parties, of trade secrets of competitive value;
(2) subject a health benefit plan or health plan insurer to liability for clinical decisions made by the contract provider; or
(3) limit the ability of a health benefit plan or health plan insurer to otherwise administer its provider contracts."
SECTION 2. The 1976 Code is amended by adding:
"Section 38-71-270. (A) To the extent that an insurer, health maintenance organization, or any other entity providing health insurance, which is licensed to do business in this State and is subject to state insurance regulation, requires enrollees or insured persons to receive health services through a network of contracted providers, the provisions of these contracts do not limit the contract provider's:
(1) ability to discuss with an enrollee or insured person the treatment options available to the enrollee or insured person, risks associated with the treatments, utilization management decisions, or a recommended course of treatment; or
(2) legal obligations to individual patients as specified under the provider's professional license.
(B) Nothing in this section may be construed to:
(1) prevent an insurer, health maintenance organization, or any other entity providing health insurance, which is licensed to do business in this State and is subject to state insurance regulation, from prohibiting disclosure, by contracted parties, of trade secrets of competitive value;
(2) subject an insurer, health maintenance organization, or any other entity providing health insurance, which is licensed to do business in this State and is subject to state insurance regulation, to liability for clinical decisions made by the contract provider; or
(3) limit the ability of an insurer, health maintenance organization, or any other entity providing health insurance, which is licensed to do business in this State and is subject to state insurance regulation, to otherwise administer its provider contracts."
SECTION 3. This act takes effect upon approval by the Governor.