The "Patients' Right to Transparency and Timely Access to Healthcare Services Act" aims to improve transparency and accessibility in healthcare services in South Carolina by reforming the prior authorization process for medications and treatments. Key provisions include the establishment of a fair prior authorization process with specific timelines for decisions, the prohibition of ongoing prior authorization for patients with chronic conditions once granted, and an exemption for healthcare providers with a 90% approval rate from needing prior authorization for a year. The bill also specifies certain healthcare services, such as preventive services rated A or B by the United States Preventive Services Task Force and outpatient mental health treatment, that cannot require prior authorization.

Additionally, the legislation mandates that health carriers provide clear information about prior authorization requirements and ensure that adverse determinations are made by qualified physicians. It requires timely decisions for both urgent and nonurgent care, prohibits prior authorization for emergency medical care, and ensures that prior authorizations for chronic conditions remain valid unless treatment changes. The bill also introduces step therapy protocols, mandates reporting requirements for health carriers, and establishes enforcement mechanisms for compliance. These provisions are set to take effect for health plans issued or renewed after January 1, 2026.

Statutes affected:
04/02/2025: 44-116-10, 44-116-20, 44-116-30, 44-116-40, 44-116-50, 44-116-60, 44-116-70, 44-116-80, 44-116-90, 44-116-100, 44-116-110
Latest Version: 44-116-10, 44-116-20, 44-116-30, 44-116-40, 44-116-50, 44-116-60, 44-116-70, 44-116-80, 44-116-90, 44-116-100, 44-116-110