South Carolina

SUMMARY

South Carolina launched an ambitious price and quality transparency website in 2014 called SCHealthData.org, aiming to post revenue and utilization data, hospital chargemasters and comparative price data for common DRGS. The state also recently passed a law capping prices a provider may charge for a patient’s medical records. In the 2017 legislative session, however, none of the bills affecting markets and transparency were passed in the Legislature.

During the 2018 session, South Carolina passed the price transparency bill H5038, which allows a pharmacy or pharmacist to inform a patient of a lower cost including cash prices.  The legislature also introduced bills that would require disclosure of drug costs (H4490), prohibit pharmacists from providing information on the amount of cost share (S815), and expand the use of telemedicine (H4529).  However, none of those bills passed.

 

LEGISLATION/REGULATION

Legislative Calendar

South Carolina’s most recent legislative session ran from 1/9/2018 – 6/7/2018.

 

Recent Legislative Developments

Healthcare Transparency

2018 H5038 PHARMACY BENEFIT MANAGER: Would prohibit a pharmacy benefits manager from prohibiting or penalizing a pharmacy or pharmacist from informing the patient of a lower cost including the cash price. Would prohibit pharmacy benefit manager from reducing reimbursement after a claim has been adjudicated or charge or hold a pharmacist or pharmacy responsible for any fee that is related to a claim. Would prohibit a pharmacy benefit manager from restricting pharmacy delivery services. Would prohibit a pharmacy benefits manager from restricting a covered person’s ability to access prescription medications available at network pharmacies Passed – Signed by Governor on 5/3/18 and became Act No. 177 (amends § 38-71-2130).
H4490 Requires manufacturers of diabetes prescription drugs to provide certain cost information to the Department of Health and Environmental Control and requires certain nonprofit organizations that receive funding from these manufacturers to compile reports addressing the funding received and make the information publicly available. It also requires the Department to post reported information on its publicly accessible website. This bill would amend section 38-17-16 relating to mandated insurance coverage for the treatment of diabetes, so as to require certain health insurance policies to provide notice in certificate of coverage during open enrollments periods of available prescription drugs to treat diabetes and the use of formularies. Inactive – Dead.
H5044 PHARMACY BENEFIT MANAGERS: Would prohibit pharmacy benefit managers from prohibiting or penalizing a pharmacist for providing an insured with information on the amount of the insured cost share for a prescribed drug and the clinical efficacy of an alternative drug. When selling an alternative drug, network pharmacies must be allowed to offer and provide direct delivery services. Pharmacy benefit managers could not require patients to use mail order pharmacies, charge a copayment that exceeds the drug acquisition cost, charge pharmacies a claims adjudication fee, or recoup duplicate pharmacy payments. It would require pharmacy benefit managers to disclose data sources used for drug reimbursement amounts and update reimbursement information at least every seven days. Would require pharmacy benefit managers to ensure that dispensing fees are not included in the drug component reimbursement and to reimburse a provider within seven business days. Inactive – Dead.
S815 Proposes to prohibit a pharmacist or pharmacy from providing an insured information on the amount of the insured’s cost share for a prescribed drug and the clinical efficacy of an alternative drug, if available. The pharmacist or pharmacy may not be penalized by a pharmacy benefit manager for disclosing such information to an insured or for selling an available alternative drug. Inactive – Dead.
2017 S400 To enact the “South Carolina Right to Shop for Health Care Act” providing that a health care provider must disclose the allowed amount of a non-emergency admission, procedure, or service within a certain time frame; to require an insurance carrier to establish access to an interactive mechanism on its publicly accessible website to allow an enrollee to obtain certain information; to providing that a carrier must provide a good faith estimate of the allowed amount and out of pocket costs of a proposed non-emergency procedure or service upon request; all health insurance carriers shall offer shared savings incentive programs as components of all health insurance plans, subject to certain exceptions, to require carriers to annually e reports of certain related information to the Department Inactive– Dead.

 

Healthcare Cost

  • None identified.

 

Healthcare Markets

2018 H4529 This bill would allow certain board of registered nurses and physician assistants to perform delegated medical acts by means of telemedicine. Inactive– Dead.
2017 H3115  To amend the code of laws of South Carolina, 1976, by adding Article 9 to Chapter 6, Title 44 so as to enact the “South Carolina Access to Health Care Act” to direct the State Department of Health and Human Services to design health care coverage program comparable to the Arkansas option, by accepting federal funds , to provide that the program is contingent upon the appropriate approvals of the program designed by the United States Dept. of Health and Human Services, and further provide that the program is contingent upon specified levels of federal health care funding, and to provide that the state assumes no obligation to any private insurance carrier participating in the program other than the payment of premiums as allowed pursuant to the South Carolina Access to Health Care Act. Inactive– Dead.
S8 To amend the code of laws of South Carolina, 1976, by adding Section 38-5-25 so as to provide that a Health Care Sharing Ministry is not engaging in the business of insurance and not subject to regulation by the Dept. of Insurance and to define the term “Health Care Sharing Ministry.” Inactive– Dead.
S235 To amend Chapter 57, Title 38 of the 1976 Code, relating to Insurance Trade Practices, by adding Section 38-57-190, to provide that terms and conditions of health care contracts issued by group, or large group market do not discriminate unreasonably against or among health care providers willing and qualified to meet the terms and conditions of participation established by a health insurance issuer and do not otherwise prohibit or limit participation by a provider who is willing to accept an issuer’s terms and conditions for participation in providing health care services; by adding Section 38-71-450, to provide that individual health insurance policies or certificates of coverage may provide for wellness credits or discounts; and by adding Section 38-71-815, to provide that group health insurance policies or certificates of coverage may provide for wellness or discounts and to define wellness credits or discounts. Inactive– Dead.

 

Key Statutes

We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.

Transparency in Healthcare

  • SC Code § 44-6-170 creates a Data Oversight Council comprised of members of the healthcare delivery public and private community for the purposes of making periodic recommendations to the Joint Legislative Health Care Planning and Oversight Committee and the General Assembly respecting the collection and release of healthcare-related data “which the council considers necessary to assist in the formation of health care policy in the State.” The Office of Research and Statistics of the Revenue and Fiscal Affairs Office is directed to promulgate regulations regarding the collection of inpatient and outpatient information.
    • Accordingly, “all general acute care hospitals and specialized hospitals including, but not limited to, psychiatric hospitals, alcohol and substance abuse hospitals, and rehabilitation hospitals shall provide inpatient and financial information to the office as set forth in regulations;” and all hospital-based and freestanding ambulatory surgical facilities must provide outpatient information as set forth in regulations.
    • Principles and protocols for the release of healthcare data for consumers, purchasers, healthcare facilities, healthcare insurers, healthcare professionals, researchers and governmental agencies is available here.

 

  • Legislative Proviso 33.34 (DHHS: Medicaid Accountability and Quality Improvement Initiative) directs the Department of Health and Human Services to implement an accountability and quality improvement program that links rate incentives to hospital participation in initiatives designed to reduce total system cost. Under the proviso, one of the initiatives may include participation in a price and quality transparency effort. Implementation of the proposed initiative is subject to the approval by the Centers for Medicare and Medicaid Services (CMS). Quarterly reports demonstrating progress towards the goals established in the proviso are available here.

 

  • Legislative Proviso 33.26 (DHHS: Medicaid Accountability and Quality Improvement Initiative) permits the Department of Health and Human Services to tie Disproportionate Share Hospital (DSH) payments to participation in the Health Outcomes Initiative. Providers must provide the department with “patient, service and financial data to assist in the operation and ongoing evaluation of both the initiatives resulting from this proviso, and other price, quality, transparency and DSH accountability efforts currently underway or initiated by the department” in order to receive funds under the proviso.

 

  • SC Code § 38-71-2130prohibits pharmacy benefit managers from prohibiting or penalizing a pharmacy or pharmacist from informing the patient of a lower cost including the cash price.

 

Healthcare Markets

  • C. Code Ann. § 44-7-500 through 44-7-590 (Health Care Cooperation Act) permits the state attorney general to authorize cooperative agreements between healthcare providers, purchasers, and provider networks by issuing a Certificate of Public Advantage (COPA) if the likely benefits resulting from the agreements outweigh the disadvantages attributable to a reduction in competition that may result from such agreements. A COPA is issued by a state to a merging entity intended to confer state action immunity from prosecution under federal antitrust laws.

 

  • SC Code § 44-7-110 through 44-7-394 prohibits health care providers from acquiring, replacing, or adding to their facilities and equipment, except in specified circumstances, without the prior approval of the Department of Health and Environmental Control through the state’s Certificate of Need (CON) process.

 

  • SC Code § 38-71-310 provides that a policy or certificate of health insurance may not be issued or delivered to consumers without prior approval of the Director of Insurance. Premium rates applicable to the health insurance policy or certificate may not be used unless they have been approved by the Director, who “may disapprove premium rates if he determines that the benefits provided in the policies or certificates are unreasonable in relation to the premiums charged.”

 

Healthcare Costs

 

FY 2018 BUDGET

South Carolina operates on a yearly budget cycle. South Carolina’s fiscal year begins on July 1 and ends on June 30 in the following year. South Carolina enacted its FY 2018 Budget during the regular legislative session. To view the FY 2018 Budget proposal, click here.

 

LITIGATION/ENFORCEMENT

  • In January 2014, the Federal Trade Commission and Community Health Systems, Inc. agreed to a settlement in connection with that provider’s proposed $7.6 billion acquisition of rival health system Health Management Associates, Inc. The FTC announced that the settlement requires Community Health Systems, one of the nation’s largest hospital operators, to divest hospitals and related assets, including outpatient facilities, in Alabama and South Carolina as a condition of the acquisition. Find the FTC case summary and related documents here.

 

  • South Carolina’s CON program was suspended by the Department of Health and Environmental Control after Governor Nikki Haley issued a line-item veto in 2013 eliminating funding for the program. A challenge to the decision to suspend the program was issued by healthcare providers in the S.C. Supreme Court (Amisub of South Carolina, Inc. et al. v. South Carolina Department of Health and Environmental Control, Op. No. 27382 (S.C. Sup. Ct. filed April 14, 2014)). The court ultimately held that the Department has a non-discretionary statutory responsibility to administer the CON program and enforce the CON Act, notwithstanding the governor’s intention to withdraw funding from the program. The CON program is currently active again; however, the legislature is poised to make legislative changes to the process.

 

KEY RESOURCES

South Carolina Legislature

South Carolina Attorney General

South Carolina Department of Insurance