The General Assembly appropriated a $14.5 billion budget which allocated $79 million state recurring funds for Medicaid Maintenance-of-Effort, increased provider rated related to include behavioral health and substance abuse, and included a $100 million allocation to the Department of Health & Human Services for a state-of-the-art neurological care and rehabilitation hospital to be built in Columbia in partnership with the University of South Carolina School of Medicine.

For questions about SCAHP’s position on any of the bills addressed in this report, please contact Jim Ritchie, Executive Director.

PASSED LEGISLATION

SCAHP High Priority Bills 

Executive Office of Health and Policy:  S.2 (Peeler - R) consolidates multiple health-related departments into a new entity, the Executive Office of Health and Policy. Establishes an oversight committee to monitor the transition and ensure accountability in the new structure. The goal of the new consolidation is to streamline operations, improve coordination of services, and enhance efficiency in administering Medicaid and other related health services. S.2 was signed by Governor McMaster on 4/28/25 and immediately went into effect.

Insurance Holding Company Regulatory Act:  H.220 (Cromer - R) revises financial stability requirements and other provisions of South Carolina’s Insurance Holding Company Regulatory Act to allow for greater transparency, provide for enhanced oversight by the Department of Insurance, and bring state provisions into alignment with the standards of the National Association of Insurance Commissioners. S.220 was signed by the Governor on 5/8/2025 and immediately went into effect.

Wellness Reimbursement Programs:  H.4305 (Herbkersman - R) establishes provisions governing the operation of wellness reimbursement programs, a type of employee benefits program available that employers may offer under federal provisions to provides their employees with financial incentives to engage in healthy behaviors by reimbursing them for eligible health and wellness expenses, such as gym memberships, fitness classes, wellness coaching, and wearable fitness trackers. Provides guardrails in state law for the operation of wellness reimbursement programs that establish consumer protection provisions, provide penalties for violations, and require registration with the South Carolina Department of Insurance. H.4305 was perfected with an amendment provided to the Chairman by the SCAHP and passed out of the House and has been assigned to the Senate Labor Commerce and Industry Committee.

Doula Services:  H.3108 (Garvin - D) mandates reimbursement coverage under Medicaid and private insurance for doula services. Sets parameters for doula certification and defines scope of practice. A House Labor Commerce and Industry subcommittee was held in early May on H.3108 where the SCAHP was prepared to testify in opposition, but time expired. A vote was not taken.

Claims Notifications:  H.3164 (Wooten - R) requires insurers to confirm receipts of certain claims-related information by mail, email or fax upon request and based on the preference of the insured or beneficiary. The receipt must be provided within seven days. Referred to the House Labor, Commerce and Industry Committee.

Mammograms:  H.3202 (Davis - R) establishes mandated requirements for health insurance policies in this state to provide diagnostic and supplemental breast examinations coverage without cost-sharing requirements. Referred to the House Labor, Commerce and Industry Committee.

Dependent and Maternity Care: H.3249 (McCravy - R) establishes requirements for all health insurers operating in South Carolina that provide coverage for dependents up to age 26 to include maternity care coverage for those dependents, to the extent not preempted by federal law. Referred to the House Labor, Commerce and Industry Committee.

Premium Rate Restrictions: H.3257 (Pope – R) prohibits health and life insurers from requesting or requiring individuals to take a genetic test as a precondition for insurability. Referred to the House Labor, Commerce and Industry Committee.

Prior Authorization / Surprise Billing: H.3302 (Garvin - D) prohibits health insurers and providers from engaging in surprise billing practices. Sets reimbursement amounts for emergency care received from out-of-network providers and bans prior authorization requirements for emergency services, including laboratory tests and services for insured individuals. Referred to the House Labor, Commerce and Industry Committee.

Mandated Coverage of Hearing Aids: H.3342 (Gavin - D) establishes requirements for all health insurance and group health benefit plans to cover hearing aids and replacement hearing aids for insureds with impaired hearing. Referred to the House Labor, Commerce and Industry Committee.

Claim Disputes: H.3566 (Garvin - D) establishes the Healthcare Claims Consumer Assistance Program to support consumers in filing complaints and appeals with health insurance claims. Prohibits insurers from insufficiently covering or wrongfully denying claims and imposes financial penalties and license suspensions for such violations. Referred to the House Labor, Commerce and Industry Committee.

Copay Coupons/Copay Accumulator Bans: H.3575 (Hardee - R) and S.100 (Gambrell - R) requires PBMs and insurers to count any cost sharing paid by the enrollee or on behalf of the enrollee towards the enrollee’s cost sharing requirements. Prohibits insurers from altering health plan coverage, including the benefit design, based on the availability or amount of financial or product assistance for a prescription drug. Cost sharing for HSA-qualified HDHPs must be counted after the enrollee meets the minimum deductible. Requires that cost-sharing does not apply to prescription drugs with a medically appropriate generic equivalent unless the brand-name drug was already accessed through exceptions. H.3575 was referred to the House Labor, Commerce and Industry Committee and S.100 was referred to Senate Banking and Insurance Committee.

Advanced Practice Registered Nurses: H.3580 (M.M. Smith - R) and S.45 (Davis - R) makes conforming changes and grants full practice authority to the Board of Nursing to an APRN who meets certain requirements. An APRN who is granted such full practice authority may independently perform certain medical acts without a practice agreement. H.3580 was referred to the House Committee on Medical, Military, Public and Municipal Affairs. S.45 was referred to the Senate Medical Affairs Committee.

Market Reform Study: H.3610 (Henderson-Myers - D) establishes the Health Care Market Reform Measures Study Committee to assess, evaluate and recommend health reform initiatives that would benefit South Carolina consumers. Referred to the House Labor, Commerce and Industry Committee.

Copay Coupon/Accumulators/Cost Sharing Definitions: H.3934 (Hardee – R) and S.330 (Gambrell – R) amends South Carolina Code of Laws to update cost-sharing requirements under health plans, ensuring PBMs and insurers count all cost-sharing amounts paid for or on behalf of an enrollee in their cost sharing contribution. H.3934 was referred to the House Labor, Commerce and Industry Committee. A House Labor Commerce and Industry subcommittee held a hearing at the request of the sponsors in early May. SCAHP was prepared to testify in opposition to the bill, but the clock expired before a vote was taken. S.330 was referred to Senate Banking and Insurance Committee.

Vision Care Plans: H.4135 (M.M. Smith) and S.402 (Gambrell - R) provides for the regulation of vision care insurance plans. H.4135 was referred to the House Labor Commerce and Industry Committee and S.402 was referred to the Senate Banking and Insurance Committee. SCAHP has been involved in several stakeholder meetings on this issue over the years. A Senate subcommittee was held in April where SCAHP spoke in opposition and the bill was carried over.

Pharmacy Reimbursement: S.342 (Rankin - R) requires PBMs to reimburse pharmacies for less than 104% of the National Average Drug Acquisition Cost plus a professional dispensing fee, which must be at least equal to Medicaid reimbursement rates. Prohibits PBMs from reimbursing their affiliated pharmacies at higher rates than independent pharmacies. Referred to the Senate Banking and Insurance Committee. Senator Rankin chairs the Senate Judiciary Committee, and is reportedly interested in the ERISA data required by PBM legislation which was enacted in 2023. That legislation set requirements and restrictions on PBMs around reimbursement, claims denials, network participation, accreditation, and steering. That bill did not apply to ERISA plans, but required the Department of Insurance to study the cost of applying the bill to ERISA plans by January 1, 2024. The Department sent a PBM data call notice in October 2023, and is still seeking the requested cost data. SCAHP has attended several stakeholder meetings and testified on the issue and remains engaged in the matter.

Pharmacists Scope and Provider Matters: S.378 (Davis - R) provides requirements for determining if acts are within the scope of pharmacy practice or are delegable under supervision of a licensed pharmacist to include prescribing drugs, drug categories, and devices in certain circumstances. Referred to the Senate Medical Affairs Committee.

Prior Authorization/Gold Carding: S.531 (Johnson - R) and H.4562 (Sessions - R) establishes the Patients’ Right to Transparency and Timely Access to Healthcare Services Act to prohibit prior authorization for specific health care services, mandate transparency requirements on prior authorization and adverse determination decisions, ban insurance companies from switching pharmaceuticals during a policy year, and addresses practices related to step therapy. S.531 was referred to the Senate Medical Affairs Committee and H.4562 was referred to the House Labor, Commerce and Industry Committee.

 SCAHP Medium Priority Bills

Medical Billing: H. 3089 (Pope - R) requires hospitals, healthcare facilities, and other medical providers who have provided treatment or another service to an insured patient for a personal injury must initiate a claim with the patient's health insurer within 30 days of the treatment or service. H.3089 passed out of the House and has been assigned to the Senate Medical Affairs Committee.

Non-Opioid Pain Management: H.4165 (Davis - R) requires healthcare practitioners prior to prescribing, ordering, dispensing, or administering an opioid drug listed as a Schedule II controlled substance for the treatment of pain to inform patients of available non-opioid treatment for pain management. Requires a healthcare physician to inform patients of available non-opioid alternatives for the treatment of pain, which may include, but not limited to, non-opioid medicinal drugs, acupuncture, chiropractic treatments, physical therapy, or massage therapy. Physicians must discuss the advantages and disadvantages of the use of non-opioid alternatives. H.4165 passed out of the House Medical, Military, Public and Municipal Committee, but remains on the House calendar in adjourned debate status until January 2026.

Preferred Drug List: S.161 (Verdin - R) adopts a state preferred drug list that does not favor opioid treatments to non-opioid alternatives. Prohibits health insurance from denying coverage for non-opioid medications in favor of opioids. Passed the Senate Medical Affairs Committee with amendments on 3/11/25 and remains on the calendar.

Pharmacist/Physician Collaborative Practice Agreements: S.449 (Verdin - R) authorizes physicians to enter into collaborative practice agreements with pharmacists. "Collaborative practice agreement" means a written agreement between a pharmacist and a physician, actively practicing, to provide evidence-based medication management services. S.449 has been passed by the Senate and assigned to the House Medical, Military, Public and Municipal Committee.

Medicaid Expansion: H.3109 (Garvin - D) expands Medicaid to those age 65 or younger with an income at or below 133% FPL, with a 5% income disregard. Referred to the House Ways and Means Committee.

Off-label Medications: H.3117 (Burns - R) outlines that a pharmacist shall dispense an off-label drug, prescribed by a physician, to a patient, with conditions and exceptions. Referred to the House Committee on Medical, Military, Public and Municipal Affairs.

Parental Rights: H.3638 (M.M. Smith - R) provides for parents to have the fundamental right to direct the upbringing, education and care of their minor children and provide for these rights to extend to the minor’s healthcare decisions and access to medical records. Referred to the House Committee on Medical, Military, Public and Municipal Affairs.

Mandated Lactation Care (State Plan): H.3243 (Gilliard - D) establishes requirements for the State Health Plan to provide coverage for lactation care and services. Referred to the House Committee on Ways and Means.

Mental Health Screenings: H.3478 (Garvin - D) establishes a goal of offering annual mental health screenings to students in grades six through twelve, aiming to address unmet mental and behavioral health needs and improve health outcomes. The Department of Health and Human Services shall provide Medicaid reimbursement for any student enrolled in Medicaid. Referred to the House Education and Public Works Committee.

Physician Assistants: H.3579 (M.M. Smith - R) makes revisions to provisions governing physician assistants that include: authorizing physician assistants who meet certain postgraduate clinical experience and practice experience to practice pursuant only to an attestation statement; providing for physician assistant representation on the State Board of Medical Examiners; the expansion of acts and duties authorized to be performed by physician assistants; provisions for disciplining physician assistants for misconduct; provisions that insurance companies and third-party payers may not impose more restrictive or contradictory practice, education, or collaboration requirements; and, revisions to the concussion protocol for student athletes to include physician assistants among persons authorized to remove student athletes suspected of having sustained a concussion from competition. Referred to the House Committee on Medical, Military, Public and Municipal Affairs.

Medicaid Study Committee: H.3611 (Henderson-Myers - D) creates a study committee to assess the impacts of Medicaid expansion. Referred to the House Ways and Means Committee.

SCAHP Low Priority Bills

Supervision of Anesthesiologist Assistants: H.3996 (Sessions - R) changes the anesthesiologist’s supervisory ratio, from two to four, of anesthesiologist's assistants at any one time. Removes the in-person interview requirement for anesthesiologist assistants. H.3996 was signed by the Governor on 5/12/2025 and immediately went into effect.

DHEC Restructuring: H.4189 (Davis - R) provides for the conforming of statutes to address the restructuring of the former agency South Carolina Department of Health and Environmental Control provided by Act 60 of 2023. Also repeals various statutes related to the restructure of DHEC. H.4189 passed out of the House, but has yet to be received by the Senate and assigned to a committee.

Medicaid Expansion Voter Referendum: H.3377 (Garvin - D) conducts a statewide advisory referendum to ask whether South Carolina should participate in Medicaid Expansion, expanding eligibility to those up to 133% FPL. Provides that the referendum will occur simultaneously with the 2026 General Election. Referred to House Judiciary Committee.

Health Disparities: H.3568 (Henderson-Myers - D) establishes the South Carolina Minority Health Disparities Study Committee to examine and address health disparities among racial and ethnic populations. The Committee will focus on improving health outcomes and reducing health disparities among minority populations. Referred to the House Committee on Medical, Military, Public and Municipal Affairs.