summary
Introduced
04/02/2025
04/02/2025
In Committee
04/02/2025
04/02/2025
Crossed Over
Passed
Dead
Introduced Session
126th General Assembly
Bill Summary
Amend The South Carolina Code Of Laws So As To Enact The "patients' Right To Transparency And Timely Access To Healthcare Services Act"; By Adding Section 44-116-10 So As To Define Necessary Terms; By Adding Section 44-116-20 So As To Exclude Certain Healthcare Providers From Preauthorization Requirements Who Meet A Ninety Percent Threshold Of Preauthorization Requests For Medications And Treatments During A Particular Time Period; By Adding Section 44-116-30 So As To Require A Fair And Transparent Prior Authorization Process For Medications And Treatments; By Adding Section 44-116-40 So As To Establish Timelines For Preauthorization Decisions; By Adding Section 44-116-50 So As To Prohibit Ongoing Prior Authorization Requirements For Patients Living With Chronic Conditions After Prior Authorization Has Been Provided Under Certain Circumstances; By Adding Section 44-116-60 So As To Prohibit Insurance Companies From Switching Pharmaceuticals During A Policy Year; By Adding Section 44-116-70 So As To Allow For Step Therapy Exceptions; By Adding Section 44-116-80 So As To Provide That Once Prior Authorization Is Granted, Health Carriers Must Pay For The Service With Exceptions; By Adding Section 44-116-90 So As To Require Continuity Of Care When A Patient Changes Insurance Policies; By Adding Section 44-116-100 So As To Require Certain Filings For Insurance Companies For Transparency Concerning Approval And Denial Rates; And By Adding Section 44-116-110 So As To Provide For Enforcement Of The Chapter.
AI Summary
This bill establishes the "Patients' Right to Transparency and Timely Access to Healthcare Services Act" in South Carolina, which introduces comprehensive regulations for health insurance prior authorization processes. The bill defines numerous healthcare-related terms and creates several key protections for patients and healthcare providers, including requiring health carriers to make prior authorization requirements publicly accessible, establishing strict timelines for authorization decisions (48 hours for non-urgent care and 24 hours for urgent care), and prohibiting health carriers from removing covered prescription drugs during a policy year without specific justifications. The legislation mandates a fair and transparent prior authorization process, allows healthcare providers who receive 90% or more prior authorization approvals to be exempt from future authorizations for those services, and creates a detailed step therapy exception process that allows patients and providers to request alternatives when initial prescribed treatments are denied. Additionally, the bill requires health carriers to annually report their authorization and denial rates to the Department of Insurance, ensures continuity of care when patients change insurance plans, and provides mechanisms for patients and providers to appeal authorization decisions. The act will take effect upon gubernatorial approval and apply to health insurance plans renewed on or after January 1, 2026.
Committee Categories
Health and Social Services
Sponsors (4)
Last Action
Referred to Committee on Medical Affairs (on 04/02/2025)
Official Document
bill text
bill summary
Loading...
bill summary
Loading...
bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.scstatehouse.gov/billsearch.php?billnumbers=0531&session=126&summary=B |
| BillText | https://www.scstatehouse.gov/sess126_2025-2026/prever/531_20250402.htm |
Loading...