S*200 Session 112 (1997-1998)
S*0200(Rat #0191, Act #0121 of 1997) General Bill, By Courtney, Alexander,
Anderson, Elliott, Fair, Ford, Glover, Holland, Land, Lander, Martin, McGill,
O'Dell, Peeler, Rankin, Reese, M.T. Rose, Thomas and Waldrep
Similar(H 3279)
A BILL 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.-AMENDED TITLE
01/21/97 Senate Introduced and read first time SJ-9
01/21/97 Senate Referred to Committee on Banking and Insurance SJ-9
04/10/97 Senate Recalled from Committee on Banking and Insurance SJ-5
04/15/97 Senate Amended SJ-40
04/15/97 Senate Read second time SJ-40
04/15/97 Senate Unanimous consent for third reading on next
legislative day SJ-40
04/16/97 Senate Read third time and sent to House SJ-27
04/17/97 House Introduced and read first time HJ-20
04/17/97 House Referred to Committee on Labor, Commerce and
Industry HJ-20
05/27/97 House Committee report: Favorable with amendment Labor,
Commerce and Industry HJ-94
05/29/97 House Amended HJ-27
05/29/97 House Read second time HJ-29
05/29/97 House Unanimous consent for third reading on next
legislative day HJ-30
05/30/97 House Read third time and returned to Senate with
amendments HJ-3
06/04/97 Senate Concurred in House amendment and enrolled
06/09/97 Ratified R 191
06/13/97 Signed By Governor
06/13/97 Effective date This Act takes effect 180 days
after signature by Governor; however, existing
contracts may comply with the requirements of
this Act at their next renewal date
06/26/97 Copies available
06/26/97 Act No. 121
(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. |