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. It introduces a new chapter to Title 44 of the South Carolina Code, establishing guidelines for prior authorization requirements. Key provisions include exempting healthcare providers with an eighty percent approval rate from prior authorization for twelve months, mandating annual reviews of prior authorization requests by health carriers, and allowing appeals for exemption status. The bill also prohibits ongoing prior authorization for patients with chronic conditions once initial approval is granted and restricts insurance companies from changing pharmaceuticals during a policy year. Additionally, it specifies healthcare services that cannot require prior authorization, such as preventive services rated A or B by the United States Preventive Services Task Force and outpatient mental health treatment.

Moreover, the legislation aims to enhance patient access by prohibiting prior authorization for prehospital transportation and emergency medical care, ensuring compliance with the Access to Emergency Medical Care Act. It establishes that authorizations for chronic condition treatments will remain valid throughout the treatment period, while prescription drug authorizations will last for the policy year. The bill also sets forth guidelines for step therapy protocols, requiring that clinical review criteria be based on high-quality studies and developed by unbiased expert panels. Health carriers must provide clear processes for requesting exceptions to step therapy and respond in a timely manner. The Department of Insurance will oversee compliance and enforcement, with the act taking effect for health plans issued or renewed after January 1, 2027.