Representative Tiffany Spann-Wilder For South Carolina Women's Health

Be it enacted by the General Assembly of the State of South Carolina:

SECTION 1.Article 1, Chapter 71, Title 38 of the S.C. Code is amended by adding:

Section 38‑71‑148.(A) For purposes of this section:

(1) “Cost‑sharing requirements” means a deductible, coinsurance, copayment, and any maximum limitation on the application of such a deductible, coinsurance, copayment, or similar out‑of‑pocket expense.

(2) “Diagnostic breast examinations” means a medically necessary and appropriate, in accordance with the National Comprehensive Cancer Network Guidelines, examination of the breast that:

(a) includes, but is not limited to, such examination using contrast‑enhanced mammography, diagnostic mammography, breast magnetic resonance imaging, breast ultrasound, or molecular breast imaging; and

(b) is used to evaluate an abnormality:

(i) seen or suspected from a screening examination for breast cancer; or

(ii) seen or detected by another means of examination.

(3) “Health insurance policy” means a health benefit plan, contract, or evidence of coverage providing health insurance coverage as defined in Section 38‑71‑670(6) and Section 38‑71‑840(14).

(4) “Supplemental breast examination” means a medically necessary and appropriate, in accordance with National Comprehensive Cancer Network Guidelines, examination of the breast that:

(a) includes, but is not limited to, such examination using contrast‑enhanced mammography, breast magnetic resonance imaging, breast ultrasound, or molecular breast imaging; and

(b) is used to screen for breast cancer:

(i) when there is no abnormality seen or suspected; but

(ii) based on personal or family medical history or additional factors that increase the individual’s risk of breast cancer, such as heterogeneously or extremely dense breasts.

(B) All health insurance policies in this State may not impose any cost‑sharing requirements on diagnostic breast examination and supplemental breast examinations furnished to an individual enrolled in the plan.

(C) If under federal law the application of subsection (B) would result in a Health Savings Account ineligibility under Section 223 of the Internal Revenue Code, this requirement only applies for Health Savings Account‑qualified high deductible health plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under Section 223, except with respect to items or services that are preventive care pursuant to Section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of subsection (B) apply regardless of whether or not the minimum deductible under Section 223 has been satisfied.

(D) The provisions of this section are in addition to the provisions of Section 38‑71‑145.

SECTION 2.This act takes effect upon approval by the Governor.

TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY ADDING SECTION 38‑71‑148 SO AS TO PROVIDE HEALTH INSURANCE POLICIES THAT PROVIDE CANCER CHEMOTHERAPY TREATMENT SHALL INCLUDE COVERAGE FOR SCALP COOLING SYSTEM THERAPY USED IN CONNECTION WITH CANCER CHEMOTHERAPY TREATMENT, TO REQUIRE INSURERS PROVIDE CERTAIN NOTICE OF THE AVAILABILITY OF SCALP COOLING SYSTEM THERAPY UNDER THE POLICY, TO PROVIDE CHEMOTHERAPY TREATMENT FACILITIES ARE NOT ELIGIBLE TO RECEIVE PAYMENT OR REIMBURSEMENT FROM INSURANCE CARRIERS FOR CHEMOTHERAPY SERVICES UNLESS THE FACILITY OFFERS SCALP COOLING SYSTEM TREATMENTS TO ALL CHEMOTHERAPY PATIENTS, AND TO DEFINE NECESSARY TERMINOLOGY.

Be it enacted by the General Assembly of the State of South Carolina:

SECTION 1. Article 1, Chapter 71, Title 38 of the S.C. Code is amended by adding:

Section 38‑71‑148. (A) (1) Any health insurance policy issued or renewed in this State that provides coverage which includes cancer chemotherapy treatment shall provide coverage for scalp cooling therapy. This coverage must include both of the following services when used in connection with cancer chemotherapy treatment:

(a) scalp cooling equipment and supplies, including headgear and related components, furnished by a chemotherapy treatment facility for the use of a scalp cooling system; and

(b) the operation, monitoring, and management of a scalp cooling system, when such services are performed by an independent or third‑party entity that is not owned or operated by the chemotherapy treatment facility.

(2) Coverage required under item (1) must:

(a) permit separate billing and reimbursement for the services described in item (1)(a) and (b);

(b) require insurers to establish or recognize distinct billing, coding, or reimbursement mechanisms for each covered service to ensure payment to the appropriate provider; and

(c) prohibit denial of coverage solely because the operation of the scalp cooling system is performed by a third‑party entity rather than the chemotherapy treatment facility.

(3) When an insurer provides written notice to an insured or the insured’s authorized representative that chemotherapy treatment has been approved for payment under the policy, the insurer shall simultaneously provide written notice that scalp cooling therapy is available and covered under the policy pursuant to this section. The notice must:

(a) include a brief description of scalp cooling therapy, its purpose, and instructions for how the insured may obtain the service; and

(b) be provided electronically if the insured has elected to receive electronic communications.

(4) The coverage required under this subsection may be subject to annual deductibles, coinsurance, and copayments, as determined by the Director of the Department of Insurance, consistent with those established for other benefits under the policy.

(B) (1) A chemotherapy treatment facility is not eligible to receive payment or reimbursement from an insurance carrier for chemotherapy services unless it offers scalp cooling system therapy to all chemotherapy patients for whom such therapy is clinically appropriate.

(2) A facility complies with item (1) if it:

(a) maintains or provides access to at least one operational scalp cooling system on site;

(b) makes the system available before, during, or after infusion, as clinically appropriate; and

(c) provides written notice to patients prior to treatment that scalp cooling therapy is available.

(3) Insurance carriers may issue payment for chemotherapy services only upon certification that the facility complies with Section 38‑59‑620.

(4) The Department of Health, acting through its Bureau of Healthcare Quality, shall establish procedures for certification, documentation, and verification of compliance.

(5) Noncompliance may result in administrative penalties, corrective action, license sanctions, or loss of eligibility for insurance reimbursement.

(C) The provisions of this section apply to all individual and group health insurance policies and health maintenance organizations issued, delivered, or renewed in this State, including the State Health Plan.

(D) Except as provided in subsection (B)(4), the Department of Insurance shall enforce the provisions of this section.

(E) For the purposes of this section:

(1) “Chemotherapy treatment facility” or “facility” means any hospital, clinic, physician practice, ambulatory center, or other entity licensed by the State to administer chemotherapy to cancer patients.

(2) “Scalp cooling system” means any device used to cool the human scalp to prevent or reduce chemotherapy‑induced alopecia prevention or related hair loss during cancer chemotherapy treatment, provided that such device is designed and intended for repeated use and is primarily and customarily used to serve a medical purpose.

(3) “Third‑party scalp cooling service provider” means an independent entity that operates, manages, services, or monitors a scalp cooling system on behalf of a chemotherapy patient or chemotherapy treatment facility.

SECTION 2.This act takes effect six months after approval by the Governor.