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Current Status Bill Number:View additional legislative information at the LPITS web site.3413 Type of Legislation:General Bill GB Introducing Body:House Introduced Date:19990128 Primary Sponsor:Maddox All Sponsors:Maddox, J.H. Neal, Allen, Lloyd, Rutherford Drafted Document Number:l:\council\bills\psd\7180ac99.doc Residing Body:House Current Committee:Labor, Commerce and Industry Committee 26 HLCI Subject:Insurance, Medical and health; maintenance organizations, payor of service has right to choose health care provider History Body Date Action Description Com Leg Involved ______ ________ ______________________________________ _______ ____________ House 19990128 Introduced, read first time, 26 HLCI referred to Committee Versions of This Bill
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-270 SO AS TO PROVIDE THAT A PERSON PARTICIPATING IN A HEALTH MAINTENANCE ORGANIZATION OR A PREFERRED PROVIDER ORGANIZATION HAS THE RIGHT TO RECEIVE HEALTH CARE FROM THE PROVIDER CHOSEN BY THE PERSON AND MAY NOT BE DENIED ACCESS TO TREATMENT BY PARTICIPATING OR NONPARTICIPATING PROVIDERS AND TO PROHIBIT THE ORGANIZATION FROM REDUCING BENEFITS OR ITS REIMBURSEMENT RATE OR FROM TERMINATING OR CANCELING A PROVIDER AGREEMENT WITHOUT CAUSE.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. The 1976 Code is amended by adding:
"Section 38-71-270. (A) As used in this section:
(1) 'Participating provider' means a health care provider who has been accepted by and has signed a provider contract with a managed care organization or a preferred provider organization.
(2) 'Nonparticipating provider' means a health care provider who has not signed a provider contract with a managed care organization or a preferred provider organization.
(3) 'Patient' means an individual covered under a health care services plan designed by a managed care organization or a preferred provider organization.
(B) A person has the right to receive health care from the provider chosen by the person. A person enrolled in a managed care plan or a preferred provider organization may not be denied access to treatment by participating or nonparticipating providers. If an enrollee in a managed care plan or a preferred provider organization elects to receive health care services from a nonparticipating provider, the managed care organization or a preferred provider organization may not penalize the patient by reducing benefits and must reimburse the nonparticipating provider, when assigned by the patient, at the same reimbursement rate as it reimburses similar participating providers. Any deductible stated in the insurance contract must remain the same. Terms and conditions may not discriminate against or among health care providers.
(C) It is unlawful for a managed care organization or a preferred provider organization to terminate or cancel its agreement with any provider without cause.
(D) The provisions of this section take precedence over terms, conditions, and provisions of an existing contract.
(E) If any provision of this section or the application of a provision, to any person under any circumstances, is held to be invalid, then that determination does not affect provisions or applications of this section which can be given effect without the invalid provision or application. To that end, the provisions of this section are severable."
SECTION 2. This act takes effect July 1, 1999.
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