H4562

Healthcare Services Act regulates prior authorization for healthcare services in South Carolina.

The South Carolina Healthcare Services Act mandates transparency and timely access to healthcare services by regulating prior authorization processes. Health carriers must make prior authorization requirements publicly accessible on their websites, detailing services requiring authorization and clinical review criteria. The act prohibits retroactive denials of claims for services already authorized. It also mandates timely decisions on prior authorization requests and step therapy exceptions, with expedited processes for urgent medical care.