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(C) Every The applicant or recipient is considered to have authorized all persons, including insurance companies and providers of medical care, to release to the Commission department all information needed to enforce the assignment rights of the Commission department."

SECTION 195. Section 43-7-430 of the 1976 Code is amended to read:

"Section 43-7-430. (A) The State Health and Human Services Finance Commission department shall be is automatically subrogated, only to the extent of the amount of medical assistance paid by Medicaid, to the rights an the applicant or recipient may have to recover such amounts so paid by Medicaid from any a third party or private insurer. The applicant or recipient shall cooperate fully with the State Health and Human Services Finance Commission department and shall do nothing after medical assistance is provided to prejudice the subrogation rights of the State Health and Human Services Finance Commission department.

(B) An The applicant's and recipient's determination of, and continued eligibility for, medical assistance under Medicaid is contingent upon his cooperation with the Commission department in its efforts to enforce its subrogation rights. Cooperation includes, but is not limited to, reimbursing the Commission department from proceeds or payments received by the recipient from any a third party or private insurer.

(C) Every The applicant or recipient is considered to have authorized all persons, including insurance companies and providers of medical care, to release to the Commission department all information needed to enforce the subrogation rights of the Commission department."

SECTION 196. Section 43-7-440 of the 1976 Code, as last amended by Act 481 of 1994, is further amended to read:

(1) intervene or join in an action or proceeding brought by the applicant or recipient against any a third party, or private insurer, in state or federal court.;

(2) commence and prosecute legal proceedings against any a third party or private insurer who may be liable to any applicant or recipient in state or federal court, either alone or in conjunction with the applicant or recipient, his guardian, personal representative of his estate, dependents, or survivors;

(3) commence and prosecute legal proceedings against any a third party or private insurer who may be liable to an applicant or recipient, or his guardian, personal representative of his estate, dependents, or survivors;

(4) commence and prosecute legal proceedings against any applicant or recipient;

(5) settle and compromise any an amount due to the State Health and Human Services Finance Commission department under its assignment and subrogation rights. Provided, further, any A representative or an attorney retained by an applicant or recipient shall is not be considered liable to State Health and Human Services Finance Commission the department for improper settlement, compromise, or disbursement of funds unless he has written notice of State Health and Human Services Finance Commission's the department's assignment and subrogation rights prior to before disbursement of funds;

(6) reduce any amount due to the State Health and Human Services Finance Commission department by twenty-five percent if the applicant or recipient has retained an attorney to pursue the applicant's or recipient's claim against a third party or private insurer, that amount to represent the State Health and Human Services Finance Commission's department's share of attorney's fees paid by the applicant or recipient. Additionally, the State Health and Human Services Finance Commission department may, in its discretion, may share in other costs of litigation by reducing the amount due it by a percentage of those costs, the percentage calculated by dividing the amount due the State Health and Human Services Finance Commission department by the total settlement received from the third party or private insurer. Provided, further, any A representative or an attorney retained by an the applicant or recipient shall is not be considered liable to State Health and Human Services Finance Commission the department for improper settlement, compromise, or disbursement of funds

(B) Providers and practitioners who participate in the Medicaid program shall cooperate with the Commission department in the identification of third parties whom they have reason to believe may be liable to pay all or part of the medical costs of the injury, disease, or disability of an the applicant or recipient.

(C) Any provision in the contract of a private insurer issued or renewed after June 11, 1986, which denies or reduces benefits because of the eligibility of the insured to receive assistance under Medicaid, is null and void.

In enrolling a person or in making payments for benefits to a person or on behalf of a person, no private insurer may take into account that the person is eligible for or is provided medical assistance under a State Plan for Medical Assistance pursuant to Title XIX of the Social Security Act.

(D) The assignment and subrogation rights of the Commission department are superior to any right of reimbursement, subrogation, or indemnity of any a third party or recipient. Provided, further, any A representative or an attorney retained by an the applicant or recipient shall is not be considered liable to State Health and Human Services Finance Commission the department for improper settlement, compromise, or disbursement of funds unless he has written notice of State Health and Human Services Finance Commission's the department's assignment and subrogation rights prior to before disbursement of funds.

In a case where a third party has a legal liability to make payments for medical assistance to or on behalf of a person, to the extent that payment has been made under a State Plan for Medical Assistance pursuant to Title XIX of the Social Security Act for health care items or services furnished to the person, the State is considered to have acquired the rights of the person to payment by any other party for the health care items or services."

SECTION 197. Section 43-21-130 of the 1976 Code, as last amended by Act 181 of 1993, is further amended to read:

"Section 43-21-130. (A) There is created the Long-Term Care Human Services Coordinating Council (council) composed of the following voting members:

(1) the Governor or his designee;

(2) the Director of the Department of Social Services;

(3) the Director of the Department of Health and Environmental Control;

(5) the Director of the Department of Disabilities and Special Needs;

(6) the Director of the Division on Aging;

(7) the Director of the Department of Health and Human Services;

(8) the Chairman of the Joint Legislative Health Care Planning and Oversight Committee, or his designee;

(9) the Chairman of the Joint Legislative Committee on Aging, or his designee;

(10) one representative of each of the following groups appointed by the Governor annually:

(a) long-term care providers;

(b) long-term care consumers;

(c) persons in the insurance industry developing or marketing a long-term care product.

(B) Each director serving as a council member may authorize in writing a designee to vote on his behalf at two meetings a year. Members appointed by the Governor to represent private groups serve without compensation.

(C) The council shall meet at least quarterly, provide for its own officers, and make an annual report to the General Assembly before January second each year. This report must include new council recommendations. (A) The General Assembly finds that the operation of health and human services may be enhanced by closer working relationships among agencies at the state and local level. The General Assembly finds that coordination at both levels provides opportunities to serve the citizens of South Carolina better through (1) continued expansion of services integration and (2) stronger communication among agencies delivering services.

In order to assist in, recommend, develop policy for, and supervise the expenditure of funds for the continuation of service integration in South Carolina, there is created a Human Services Coordinating Council, hereinafter, entitled the council. The council shall consist of:

(1) the chairperson of the boards of the following agencies: Division on Aging, Department of Alcohol and Other Drug Abuse Services, Commission for the Blind, Division of Foster Care, Department of Education, Department of Health and Environmental Control, Department of Health and Human Services, Division of Veterans' Affairs, John De La Howe School, Department of Mental Health, Department of Disabilities and Special Needs, School for the Deaf and the Blind, Department of Social Services, Department of Vocational Rehabilitation, Guardian ad

(E) Effective July 1, 1995, the Human Services Coordinating Council shall assume the duties and responsibilities of the Aging Coordinating Council and the Long Term Care Council as specified in Sections 43-21-120 through 43-21-140. The council shall establish a long term care standing committee and include on the committee a representative of the long term care industry, a representative of the insurance industry, and a representative of the general public."

"(2) these members who shall serve ex officio:

(a) Attorney General or a designee;

(b) Board of Long Term Health Care Administrators, Executive Director, or a designee;

(c) State Board of Nursing for South Carolina, Executive Director, or a designee;

(d) Commission Division on Aging in the Office of the Governor, Executive Director, or a designee;

(e) Criminal Justice Academy, Executive Department of Public Safety Director, or a designee;

(f) South Carolina Department of Health and Environmental Control, Commissioner, or a designee;

(g) State Department of Mental Health, Commissioner Director, or a designee;

(h) South Carolina Department of Mental Retardation Disabilities and Special Needs, Commissioner Director, or a designee;

(i) Adult Protective Services Program, Director, or a designee;

(j) Department of Health and Human Services Finance Commission, Executive Director, or a designee;

(k) Joint Legislative Committee on Aging, Chair, or a designee;

(l) Police Chiefs' Association, President, or a designee;

(m) Prosecution Coordination Commission, Executive Director, or a designee;

(n) South Carolina Protection and Advocacy System for the Handicapped, Inc., Executive Director, or a designee;

(o) South Carolina Sheriff's Association, Executive Director, or a designee;

(p) South Carolina State Law Enforcement Division, Chief, or a designee;

(q) Long Term Care Ombudsman or a designee;

(r) South Carolina Medical Association, Executive Director, or a designee;

(s) South Carolina Health Care Association, Executive Director, or a designee;

(t) South Carolina Home Care Association, Executive Director, or a designee."

SECTION 199. Section 44-1-50 of the 1976 Code, as last amended by Act 181 of 1993, is further amended to read:

The board shall provide for the administrative organization of the department and shall consolidate and merge existing duties, functions, and officers of the former agencies as may be necessary for economic and efficient administration. Provided, However, that the board may appoint such advisory boards as it considers necessary to carry out the functions of Sections 44-1-10 to 44-1-70, and there shall must be provided a compensation for their services as provided by the law for members of boards and commissions."

SECTION 200. The introductory portion of Section 44-2-75(C) of the 1976 Code, as last amended by Act 181 of 1993, is further amended to read:

"(C) The Department of Insurance may disapprove an application for the formation of an insurance pool and may suspend or withdraw approval whenever he the Department of Insurance finds that the applicant or pool:"

SECTION 201. Section 44-6-5(4) of the 1976 Code, as last amended by Act 181 of 1993, is further amended to read:

"(4) `Market basket index' means the index used by the federal government on January 1, 1986, to measure the inflation in hospital input prices for Medicare reimbursement. If that measure ceases to be calculated in the same manner, the market basket index must be developed and regulations must be promulgated by the commission department using substantially the same methodology as the federal market basket uses on January 1, 1986. Prior to Before submitting the regulations concerning the index to the General Assembly for approval pursuant to the Administrative Procedures Act, the department shall submit them to the Health Care Planning and Oversight Committee for review."

SECTION 202. Section 44-6-140(A)(2) of the 1976 Code, as last amended by Act 181 of 1993, is further amended to read:

"(2) payment on a timely basis to the hospital by the commission department or patient, or both, of the maximum allowable payment amount determined by the commission department; and"

"(A) Every fiscal year the State Treasurer shall withhold from the portion of the Local Government Fund allotted to the counties a sum equal to fifty cents per capita based on the population of the several counties as shown by the latest official census of the United States. The money withheld by the State Treasurer must be placed to the credit of the commission department and used to provide Title XIX (Medicaid) services."

SECTION 204. Section 44-6-170(A)(14) of the 1976 Code, as last amended by Act 181 of 1993, is further amended to read:

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

SECTION 205. Section 44-6-520 of the 1976 Code, as last amended by Act 181 of 1993, is further amended to read:

"Section 44-6-520. No provision of this article limits the right of an owner to sell, lease, or mortgage any a nursing home subject to receivership under this article upon the owner's presenting satisfactory evidence to the court that:

(1) compliance with the applicable requirements of the Department of Health and Human Services has been achieved; or

(2) the purchaser lessee, or mortgagor has assumed the responsibility for achieving such compliance and has filed an acceptable plan of correction with the commission Department of Health and Human Services. Upon sale of the nursing home, the receivership must be terminated."

SECTION 206. Section 44-6-540 of the 1976 Code, as added by Act 449 of 1990, is amended to read:

"Section 44-6-540. The commission Department of Health and Human Services is authorized to promulgate regulations, pursuant to the Administrative Procedures Act, to administer this article."

SECTION 207. Section 44-6-720(B)(4)(b)(iv) and (5) of the 1976 Code, as added by Section 74, Part II, Act 164 of 1993, are amended to read:

"(iv) other deductions provided in regulations of the State Department of Health and Human Services Finance Commission;

(5) upon the death of the beneficiary, a remainder interest in the corpus of the trust passes to the State Department of Health and Human Services Finance Commission. The commission department shall remit the state share of the trust to the general fund; and"

"Section 44-6-730. The State Department of Health and Human Services Finance Commission shall promulgate regulations as are necessary for the implementation of this article and as are necessary to comply with federal law. In addition, the commission department shall amend the state Medicaid plan in a manner that is consistent with this article."

SECTION 209. Section 44-7-90 of the 1976 Code, as added by Act 184 of 1987, is amended to read:

"Section 44-7-90. (A) Based on reports from the State Health and Human Services Finance Commission South Carolina Department of Health and Human Services the department Department of Health and Environmental Control shall determine each nursing home's compliance with its Medicaid nursing home permit. Violations of this article include:

(1) a nursing home exceeding by more than ten percent the number of Medicaid patient days stated in its permit;

(2) a nursing home failing to provide at least ten percent fewer days than the number stated in its permit;

(3) the provisions of any Medicaid patient days by a home without a Medicaid nursing home permit.

(B) Each Medicaid patient day above or below the allowable range is considered a separate violation. The department Department of Health and Environmental Control may levy a fine not to exceed the average rate per for each Medicaid patient day times each violation. Appeals from this action must comply with the appropriate provisions of Chapter 23 of Title 1."

SECTION 210. Section 44-7-170(B) of the 1976 Code, as last amended by Act 511 of 1992, is further amended to read:

"(B) The Certificate of Need provisions of this article do not apply to:

(1) an expenditure by or on behalf of a health care facility for nonmedical projects for services such as refinancing existing debt, parking garages, laundries, roof replacements, computer systems, telephone systems, heating and air conditioning systems, upgrading facilities which do not involve additional square feet or additional health services, replacement of like equipment with similar capabilities, or similar projects as described in regulations;

(2) facilities owned and operated by the State Department of Mental Health and the South Carolina Department of Mental Retardation Disabilities and Special Needs, except an addition of one or more beds to

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This web page was last updated on Monday, June 29, 2009 at 2:12 P.M.