The "Patients' Right to Transparency and Timely Access to Healthcare Services Act" is designed to improve the transparency and efficiency of the healthcare authorization process in South Carolina. The bill introduces a new chapter to Title 44 of the South Carolina Code, which includes definitions of key terms and establishes 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 further authorization for twelve months. Additionally, health carriers are required to implement a fair prior authorization process, including clear timelines for decisions and prohibitions against ongoing authorization for patients with chronic conditions once initial approval is granted.

The legislation also includes several provisions aimed at enhancing patient access to healthcare services. It prohibits health benefit plans from requiring prior authorization for prehospital transportation and emergency medical care, ensuring compliance with the Access to Emergency Medical Care Act. Furthermore, once a patient is authorized for a healthcare service or prescription drug for a chronic condition, that authorization remains valid for the duration of treatment or the policy year, unless specific conditions arise. The bill restricts health carriers from removing covered prescription drugs from their lists or reclassifying them during the policy year, except under certain circumstances. It also mandates timely responses from health carriers regarding authorization requests and establishes reporting requirements to the Department of Insurance, with enforcement and compliance regulations to be promulgated. The act will take effect upon approval by the Governor and will apply to health plans renewed on or after January 1, 2027.