2015-2016 Bill 3726: Palmetto Comprehensive Health Care Act - South Carolina Legislature Online

South Carolina General Assembly

121st Session, 2015-2016

H. 3726

STATUS INFORMATION

General Bill

Sponsors: Reps. Mack, Neal, Gilliard, RobinsonSimpson, Howard, Mitchell, Parks, G.A.Brown, R.L.Brown, Dillard, Rutherford, Weeks and Whipper

Document Path: l:\council\bills\bh\26240vr15.docx

Companion/Similar bill(s): 786

Introduced in the House on February 25, 2015

Currently residing in the House Committee on Labor, Commerce and Industry

Summary: Palmetto Comprehensive Health Care Act

HISTORY OF LEGISLATIVE ACTIONS

DateBodyAction Description with journal page number

2/25/2015HouseIntroduced and read first time (House Journalpage17)

2/25/2015HouseReferred to Committee on Labor, Commerce and Industry (House Journalpage17)

View the latest legislative information at the website

VERSIONS OF THIS BILL

2/25/2015

A BILL

TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, TO ENACT THE PALMETTO COMPREHENSIVE HEALTH CARE ACT BY ADDING CHAPTER 18 TO TITLE 44 SO AS TO CREATE A PUBLICLY FINANCED SINGLEPAYER HEALTH CARE PROGRAM AVAILABLE TO ALL RESIDENTS OF THE STATE EQUALLY; TO PROVIDE DEFINITIONS FOR TERMS USED IN THE CHAPTER; TO ALLOW NONRESIDENTS TO RECEIVE PROGRAM BENEFITS FOR A CERTAIN TIME PERIOD; TO MAKE RESIDENTS WHO MOVE OUT OF STATE INELIGIBLE TO RECEIVE PROGRAM BENEFITS AFTER A CERTAIN TIME PERIOD; TO REQUIRE THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO PROMULGATE REGULATIONS TO RAISE AWARENESS OF THE PROGRAM AMONG RESIDENTS AND HEALTH CARE PROFESSIONALS AND TO FACILITATE ENROLLMENT IN THE PROGRAM; TO APPLY FOR WAIVERS TO ALLOW THE STATE TO OPERATE MEDICARE, MEDICAID, AND OTHER FEDERAL PROGRAMS AS PART OF THE PROGRAM; TO ESTABLISH BENEFITS PROVIDED FOR BY THE PROGRAM INCLUDING, BUT NOT LIMITED TO, PRIMARY CARE, PREVENTIVE CARE, DENTAL AND VISION CARE, PRESCRIPTION DRUG COVERAGE, MATERNITY AND NEWBORN CARE, AND MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES; TO PROHIBIT PRIVATE INSURANCE COMPANIES FROM SELLING HEALTH INSURANCE THAT PROVIDES BENEFITS COVERED BY THE PROGRAM AND TO ALLOW THESE COMPANIES TO SELL POLICIES THAT PROVIDE COVERAGE FOR BENEFITS NOT COVERED BY THE PROGRAM; TO PROHIBIT THE PROGRAM AND HEALTH CARE PROFESSIONALS FROM CHARGING INDIVIDUALS ANY AMOUNTS FOR RECEIVING HEALTH CARE SERVICES INCLUDING, BUT NOT LIMITED TO, PREMIUMS, COPAYS, DEDUCTIBLES, AND COINSURANCE; TO PROVIDE FOR THE PROGRAM TO ISSUE INDIVIDUALS A PROGRAM IDENTIFICATION CARD TO PRESENT TO HEALTH CARE PROVIDERS TO RECEIVE SERVICES WITHOUT CHARGE; TO REQUIRE THE BENEFITS PACKAGE TO PROVIDE ADDITIONAL BENEFITS FOR THOSE INDIVIDUALS WHO ARE ELIGIBLE FOR MEDICAID, THE CHILDRENS HEALTH INSURANCE PROGRAM, AND MEDICARE; TO ESTABLISH A DRUG FORMULARY SYSTEM, AS PART OF WHICH THE DEPARTMENT PURCHASES DRUGS WHOLESALE AND PROMOTES THE USE OF GENERIC MEDICATION; TO PROVIDE A PROCESS FOR INDIVIDUALS TO APPEAL ADVERSE COVERAGE DECISIONS; TO PROVIDE A PROCESS FOR THE PUBLIC TO MAKE RECOMMENDATIONS RELATED TO THE BENEFITS COVERED BY THE PROGRAM; TO COMPENSATE HEALTH CARE PROFESSIONALS USING A STANDARD FEE; TO COMPENSATE HOSPITALS, NURSING HOMES, AND COMMUNITY HEALTH CENTERS AS PART OF A GLOBAL PAYMENT SYSTEM; TO PAY PHARMACISTS A REASONABLE DISPENSING FEE AND THE WHOLESALE COST OF PRESCRIPTION DRUGS; TO REQUIRE THE PROGRAM TO BE FUNDED BY PAYROLL ASSESSMENTS AND NONPAYROLL INCOME ASSESSMENTS; TO CREATE A PALMETTO COMPREHENSIVE HEALTH CARE PROGRAM FUND IN WHICH TO DEPOSIT ALL FUNDS COLLECTED THROUGH PAYROLL AND NONPAYROLL INCOME ASSESSMENTS AND OTHER MONIES COLLECTED BY THE DEPARTMENT FOR OPERATION OF THE PROGRAM; TO REQUIRE THE ESTABLISHMENT OF A PROGRAM ADVISORY COMMITTEE TO PERFORM CERTAIN FUNCTIONS; AND TO PROVIDE FOR CERTAIN REPORTING OF THE PROGRAM AND THE DEPARTMENT; TO AMEND SECTION 1135310, AS AMENDED, RELATING TO DEFINITIONS OF TERMS USED IN THE SOUTH CAROLINA CONSOLIDATED PROCUREMENT CODE, SO AS TO EXEMPT THE PROGRAM FROM THE REQUIREMENTS OF THE CONSOLIDATED PROCUREMENT CODE; BY ADDING SECTION 126650 SO AS TO PROVIDE FOR THE COLLECTION OF PAYROLL AND NONPAYROLL INCOME ASSESSMENTS, TO LIMIT THE PAYROLL ASSESSMENTS TO INCOME SUBJECT TO THE MEDICARE TAX, TO REQUIRE THE ASSESSMENTS TO BE GRADUATED TO CHARGE HIGHER RATES TO INDIVIDUALS EARNING HIGHER INCOMES, AND TO TREAT RESIDENTS WORKING OUTSIDE OF THE STATE AS SELFEMPLOYED INDIVIDUALS; TO AMEND SECTION 44630, AS AMENDED, RELATING TO THE POWERS OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, SO AS TO REQUIRE THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO ADMINISTER THE PALMETTO COMPREHENSIVE HEALTH CARE PROGRAM; AND FOR OTHER PURPOSES.

Be it enacted by the General Assembly of the State of South Carolina:

SECTION1.This act may be cited as the Palmetto Comprehensive Health Care Act.

SECTION2.Title 44 of the 1976 Code is amended by adding:

CHAPTER 18

Palmetto Comprehensive Health Care

Article 1

General Provisions

Section 441810.Effective January 1, 2016, there is created the Palmetto Comprehensive Health Care Program. The purpose of the program is to provide comprehensive health insurance benefits to all residents of the State equally in a seamless and equitable manner regardless of income, assets, health status, or availability of other health care coverage.

Section 441820.As used in this chapter:

(1)Affordable Care Act means the federal Patient Protection and Affordable Care Act of 2010, as amended.

(2)Ambulatory patient services means:

(a)health care received without admission to a hospital, including at a physicians office, clinic, or sameday outpatient surgery center, but does not include emergency care; and

(b)home health services and hospice care.

(3)CHIP means the federal Childrens Health Insurance Program.

(4)Chronic care means health care services provided by a health care professional for an established clinical condition that is expected to last a year or more and that requires ongoing clinical management attempting to restore the individual to highest function, minimize the negative effects of the condition, prevent complications related to chronic conditions, engage in advanced care planning, and promote appropriate access to palliative care.

(5)Chronic care management means a system of coordinated health care interventions and communications for individuals with chronic conditions, including significant patient selfcare efforts, systemic supports for licensed health care practitioners and their patients, and a plan of care emphasizing prevention of complications utilizing evidencebased practice guidelines, patient empowerment strategies, and evaluation of clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall health.

(6)Chronic conditions includes diabetes, epilepsy, hypertension, cardiovascular disease, cancer, asthma, pulmonary disease, substance abuse, mental illness, spinal cord injury, and hyperlipidemia.

(7)Department means the South Carolina Department of Health and Human Services.

(8)Director means the Director of the South Carolina Department of Health and Human Services.

(9)Emergency care means medical care to diagnose emergent conditions and stabilize a patient for definitive care that is provided in hospital emergency departments, prehospital settings via emergency medical services, and other locations where initial medical treatment of illness takes place, but does not include urgent care as defined in this section.

(10)Federal health insurance marketplace means the organizations established to facilitate the purchase of health insurance in each state pursuant to the Affordable Care Act, which provide a set of governmentregulated and standardized health care plans and from which individuals may purchase health insurance policies eligible for federal subsidies.

(11)Global payment means a fixed prepayment made to a group of health care professionals or a health care system that covers most or all of a patients care during a specified time period paid monthly for a patient over a year, unlike feeforservice, which pays separately for each service.

(12)Health care professional means an individual, partnership, corporation, facility, or institution licensed or certified or otherwise authorized pursuant to state law to provide health care services.

(13)Health care service means a treatment or procedure delivered by a health care professional to maintain an individuals physical or mental health or to diagnose or treat an individuals physical or mental health condition including, but not limited to, services ordered by a health care professional, chronic care management, preventive care, wellness services, and medically necessary services to assist in activities of daily living.

(14)Hospital service means services provided by a hospital in an inpatient or outpatient setting and associated costs including, but not limited to, health care professional fees and hospital room expenses.

(15)Laboratory services means testing provided to help a physician diagnose an injury, illness, or condition or to monitor the effectiveness of a particular treatment.

(16)Maternity and newborn care means medical care that is provided to a woman during pregnancy throughout labor, delivery, and postdelivery, and care for the newborn.

(17)Mental health services and addiction treatment means inpatient and outpatient care provided to evaluate, diagnose, and treat a mental health condition or substance abuse disorder.

(18)Nonpayroll income assessment means an assessment on upperbracket taxable income not subject to the payroll assessment.

(19)Palliative care means s