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COMMITTEE AMENDMENT ADOPTED
March 10, 2005
S. 49
Introduced by Senators Hayes, Elliott, Hutto, Leventis, Rankin, Patterson, Land, Short, Richardson, Lourie, McConnell and Courson
S. Printed 3/10/05--S.
Read the first time January 11, 2005.
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-290 SO AS TO REQUIRE HEALTH INSURANCE PLANS TO PROVIDE COVERAGE FOR TREATMENT OF MENTAL ILLNESS OR ALCOHOL OR SUBSTANCE ABUSE, TO ALLOW A PLAN THAT DOES NOT PROVIDE FOR MANAGEMENT OF CARE OR THE SAME DEGREE OF MANAGEMENT OF CARE FOR ALL HEALTH CONDITIONS TO PROVIDE COVERAGE FOR SUCH TREATMENT THROUGH A MANAGED CARE ORGANIZATION, TO ESTABLISH TREATMENT CONDITIONS TO QUALIFY FOR COVERAGE, AND TO REQUIRE THE DEPARTMENT OF INSURANCE TO REPORT TO THE GENERAL ASSEMBLY ON THE FISCAL IMPACT.
Amend Title To Conform
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Chapter 71, Title 38 of the 1976 Code is amended by adding:
"Section 38-71-290. (A) As used in this section:
(1) 'Health insurance plan' means a health insurance policy or health benefit plan offered by a health insurer or a health maintenance organization, including a qualified health benefit plan offered or administered by the State or a subdivision or instrumentality of the State, that provides health insurance coverage as defined by Section 38-71-670(6);
(2) 'Mental health condition' means the following psychiatric illnesses as defined by the ' Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV), and subsequent editions published by the American Psychiatric Association:
(a) Bipolar Disorder,
(b) Major Depressive Disorder,
(c) Obsessive Compulsive Disorder,
(d) Paranoid and Other Psychotic Disorder,
(e) Schizoaffective Disorder,
(f) Schizophrenia,
(g) Anxiety Disorder,
(h) Post-traumatic Stress Disorder, and
(i) Depression in childhood and adolescence.
(3) 'Rate, term, or condition' means lifetime or annual payment limits, deductibles, copayments, coinsurance and other cost-sharing requirements, out-of-pocket limits, visit limits, and any other financial component of health insurance coverage that affects the insured.
(4) 'Settings' means either emergency, outpatient, or inpatient care.
(5) 'Modalities' means therapeutic methods or agents including, without limitation, surgery, or pharmaceuticals.
(B) A health insurance plan must provide coverage for treatment of a mental health condition and may not establish a rate, term, or condition that places a greater financial burden on an insured for access to treatment for a mental health condition than for access to treatment for a physical health condition in similar settings and treatment modalities. Any deductible or out-of-pocket limits required under a health insurance plan must be comprehensive for coverage of both mental health and physical health conditions.
(C) A health insurance plan that does not otherwise provide for management of care under the plan, or that does not provide for the same degree of management of care for all health conditions, may provide coverage for treatment of mental health conditions through a managed care organization if the managed care organization is in compliance with regulations promulgated by the director. The regulations promulgated by the director must 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 prevent access to medically necessary treatment for the insured.
(D) A health insurance plan complies with this section if at least one choice for treatment of mental health conditions provided to the insured within the plan has rates, terms, and conditions that place no greater financial burden on the insured than for access to treatment of physical conditions in similar settings and treatment modalities. The director may disapprove a plan that the director determines to be inconsistent with the purposes of this section.
(E) To be eligible for coverage under this section for the treatment of mental illness, the treatment must be rendered by a licensed physician, licensed mental health professional, or certified mental health professional in a mental health facility that provides a program for the treatment of a mental health condition pursuant to a written treatment plan. A health insurance plan may require a mental health facility, licensed physician, or licensed or certified mental health professional to enter into a contract as a condition of providing benefits.
(F) The provisions of this section do not:
(1) limit the provision of specialized medical services for individuals with mental health disorders;
(2) supersede the provisions of federal law, federal or state Medicaid policy, or the terms and conditions imposed on a Medicaid waiver granted to the State for the provision of services to individuals with mental health disorders; or
(3) require a health insurance plan to provide rates, terms, or conditions for access to treatment for mental illness that are identical to rates, terms, or conditions for access to treatment for a physical condition."
SECTION 2. Before July 1, 2008, the Department of Insurance shall report to the General Assembly on:
(1) an estimate of the impact of this act on health insurance costs;
(2) actions taken by the department to assure that health insurance plans are in compliance with this act and that quality and access to treatment for mental health conditions provided by the plans are not compromised by providing financial parity for such coverage; and
(3) identification of any segments of the population of South Carolina that may be excluded from access to treatment for mental health conditions at the level provided by this act, including an estimate of the number of South Carolinians excluded from such access under health benefit plans offered or administered by employers who receive the majority of their annual revenues from contract, grants, or other expenditures by state agencies.
SECTION 3. The State Employee Insurance Program shall continue to provide mental health parity in the same manner and with the same management practices as included in the plan beginning in 2002, and is not under the jurisdiction of the Department of Insurance.
SECTION 4. This act does not apply to a health insurance plan that is individually underwritten and does not apply to a health insurance plan provided to a small employer, as defined by Section 38-71-1330(17) of the 1976 Code.
SECTION 5. This act takes effect June 30, 2006, and applies to health insurance plans issued or renewed on or after the effective date of this act.
This web page was last updated on Tuesday, June 23, 2009 at 2:44 P.M.