The "Patients' Right to Transparency and Timely Access to Healthcare Services Act" aims to improve the transparency and efficiency of the healthcare services authorization process in South Carolina. The bill introduces a new chapter to the South Carolina Code of Laws, defining key terms and establishing guidelines for prior authorization requirements. A significant provision allows healthcare providers with an eighty percent approval rate for prior authorization requests to be exempt from these requirements for twelve months. The legislation also mandates annual reviews of prior authorization requests by health carriers and provides a mechanism for healthcare providers to appeal decisions regarding their exemption status. Additionally, it specifies conditions under which prior authorization cannot be required, such as for certain preventive services, outpatient mental health treatments, and pain medication for terminally ill patients.

Moreover, the bill enhances patient access to healthcare services by prohibiting prior authorization for emergency medical care and ensuring that authorizations for chronic conditions remain valid throughout treatment or the policy year, barring changes in treatment or care standards. It establishes strict guidelines for step therapy protocols, requiring that clinical review criteria be based on established guidelines and high-quality studies. The bill also mandates clear processes for requesting exceptions to step therapy requirements and requires health carriers to report annually on prior authorization requests and outcomes. The Department of Insurance will enforce these provisions, with the act set to take effect for health plans issued or renewed after January 1, 2027.