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May 24, 2000
Introduced by Senators McConnell, Matthews, Courtney, Patterson, Reese, Hayes, Jackson, Passailaigue, Bryan, Hutto, Courson, Richardson, Ravenel, Washington, Giese and Short
S. Printed 5/24/00--H.
Read the first time March 17, 2000.
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTIONS 1-11-760 AND 38-71-280 SO AS TO REQUIRE THE STATE HEALTH INSURANCE PLAN AND GROUP HEALTH INSURANCE TO PROVIDE COVERAGE FOR TREATMENT OF MENTAL HEALTH CONDITIONS AND ALCOHOL OR SUBSTANCE ABUSE; TO PROHIBIT ANY TERM OR CONDITION OF THE COVERAGE FROM PLACING ANY GREATER BURDEN ON ACCESS TO TREATMENT FOR A MENTAL HEALTH CONDITION OR FOR ALCOHOL OR SUBSTANCE ABUSE THAN ON ACCESS TO TREATMENT FOR A PHYSICAL HEALTH CONDITION; TO AUTHORIZE MANAGEMENT OF CARE FOR TREATMENT OF MENTAL HEALTH CONDITIONS AND FOR ALCOHOL OR SUBSTANCE ABUSE; AND TO REQUIRE THE DIVISION OF INSURANCE SERVICES OF THE STATE BUDGET AND CONTROL BOARD TO REPORT TO THE GENERAL ASSEMBLY ON THE IMPACT OF THIS COVERAGE ON HEALTH INSURANCE COSTS UNDER THE STATE HEALTH INSURANCE PLAN DURING A THREE-YEAR PERIOD; TO PROVIDE THAT, IF THERE IS A GREATER THAN ONE PERCENT INCREASE IN HEALTH INSURANCE COSTS UNDER THE STATE HEALTH PLAN AT THE END OF THE THREE-YEAR PERIOD OR A 3.4 PERCENT INCREASE AT ANY TIME DURING THAT PERIOD AS A RESULT OF PROVIDING THE COVERAGE REQUIRED BY THIS ACT, THE STATE HEALTH PLAN MAY OPT OUT AND THE REQUIREMENTS APPLICABLE TO GROUP HEALTH INSURANCE PLANS UNDER THIS ACT DO NOT TAKE EFFECT; AND TO PROVIDE THAT, IF THE ACT TAKES EFFECT FOR GROUP HEALTH INSURANCE PLANS, A PLAN MAY OPT OUT IF AT ANY TIME THEREAFTER THE PLAN'S INSURANCE COSTS INCREASE BY MORE THAN THREE PERCENT AS A RESULT OF PROVIDING THIS COVERAGE.
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 1-11-760. (A) As used in this section:
(1) 'Alcohol or substance abuse' means a condition or disorder involving alcohol or substance abuse that falls under any of the categories listed in the Diagnostic and Statistical Manual IV or subsequent editions.
(2) 'State health insurance plan' means health insurance plans offered or administered by the State Budget and Control Board. This definition does not include dental insurance, accidental death and dismemberment insurance, disability insurance, long-term care insurance, or any other supplemental health insurance plan offered or administered by the State Budget and Control Board.
(3) 'Mental health condition' means any mental or nervous condition that is caused by a biological disorder of the brain and results in a clinically significant or psychological syndrome or pattern that substantially limits the functioning of the person with that illness, limited to: schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, pervasive developmental disorder or autism, panic disorder, obsessive-compulsive disorder social anxiety disorder, anorexia, bulimia, asperger's disorder, intermittent explosive disorder, post-traumatic stress disorder, psychosis not otherwise specified when diagnosed in a child under seventeen years of age, Rett's disorder, or Tourette's disorder.
(4) 'Term or condition' means any lifetime or annual payment limits, deductibles, copayments, coinsurance, out-of-pocket limits, visit limits, or any other cost-sharing requirements.
(B) The state health insurance plan shall provide coverage for medically necessary treatment of a mental health condition and alcohol or substance abuse and shall not establish any term or condition that places a greater financial burden on an insured for access to treatment for a mental health condition or alcohol or substance abuse than for access to treatment for a physical health condition. Any deductible or out-of-pocket limits required under the state health insurance plan must be comprehensive for coverage of mental health conditions, alcohol or substance abuse, and physical health conditions.
(C) If the state health insurance plan does not otherwise provide for management of care under the plan or does not provide for the same degree of management of care for all health conditions, it may provide management of care for medically necessary treatment of mental health conditions and alcohol or substance abuse as long as the management of care does not diminish or negate the purpose of this section. The management of care must also ensure that timely and appropriate access to care is available, that the quantity, location, and specialty distribution of health care providers is adequate, and that administrative or clinical protocols do not reduce access to medically necessary treatment for any insured.
(D) To be eligible for coverage under this section for the treatment of a mental health condition or alcohol or substance abuse, the treatment must be rendered by a licensed health professional who is acting within the scope of his or her license and in accordance with the provisions of the plan or contract.
(E) A portion of the increase in total health insurance costs resulting from the application of the provisions of the section must be borne by persons covered by the state health insurance plan.
(F) The state health insurance plan may opt out of the requirements of this section if, as a result of the application of this section, the total health insurance costs of the state health insurance plan increase by more than:
(1) one percent by the end of the three-year period beginning January 1, 2002, and ending December 31, 2004; or
(2) 3.39 percent at any time beginning January 1, 2002, and ending December 31, 2004."
SECTION 2. If any provision of this act or the application of a provision to any person or circumstance is held to be unconstitutional, the remainder of this act and its application to any person or circumstance shall not be affected thereby.
SECTION 3. The Budget and Control Board shall conduct a study to assess the impact of this act for the period beginning January 1, 2002 through December 31, 2003, using actual incurred claims for that period as paid through July 1, 2004. The Budget and Control board shall report its findings to the General assembly by December 31, 2004.
SECTION 4. This act takes effect upon approval by the Governor, except that SECTION 1 takes effect January 1, 2002. This act is repealed January 1, 2005.
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