SCHA’s 2024 End-of-Session Legislative Wrap-up
It was a busy session! SCHA made much progress on our legislative priorities in 2024 while also supporting a number of other impactful bills that were enacted. We would of course be remiss not to mention major initiatives that did not make the finish line and will likely resurface in some form or fashion next year, particularly the market reform study committee, behavioral health restructuring, and itemized billing.
The Market Reform Study Committee measure in particular was important to us for a number of reasons. We advocated the study committee language (both Proviso 117.183 and S.855 sponsored by Beaufort Republican Sen. Tom Davis) because it was a platform to share our policy recommendations while improvements are being studied by policy makers. In preparation for that work, SCHA set up ad hoc committees to develop comments on the topics outlined in the language: healthcare workforce development & scope of practice, health insurance reforms, financial stability of rural providers, affordability & price transparency, telemedicine, regulatory reform, and how additional coverage would fit into those areas.
With the sweep of a pen, however, the Governor eliminated it from the state appropriation package. In his veto message, McMaster raised two objections: the study’s six-month time frame, which he said was too short, and the inclusion of Medicaid expansion that was one of the 30 market reforms to be examined.
Another major initiative on our radar screen active until the last minute was healthcare restructuring legislation, S.915 (Peeler) Executive Office of Health Policy. That bill, also ushered by Sen. Tom Davis, failed to reach the 5pm sine die deadline despite Davis’s efforts on the floor of the House chamber, pleading his case about combining six state health agencies into one. The House Freedom Caucus members quashed that on a procedural vote.
Healthcare Wins in the FY24-25 State Government Spending Package
The General Assembly approved both *H.5100, the FY 24-25 Appropriation Bill, and H.5101, the FY 24-25 Capital Reserve Fund, after much anticipation. Conference Committee members, Reps. Bannister, Stavrinakis, Lowe and Sens. Peeler, Setzler and Benett were finally able to hammer out differences between the $14.4 billion spending package.
Budget writers acknowledged and responded to the need for both behavioral health and workforce funding. Several issues that we worked on included amending the use of lottery funds appropriated for nursing recruitment and retention, Proviso 3.6. (Lottery Expenditure Account FY 2024-25 Lottery Funding). As amended, the use of funds is expanded to enable an eligible individual to pursue other advanced education programs suitable for nursing faculty roles, i.e. MSN, and still access the loan repayment funds. It also expands eligibility of reimbursement beyond graduate-level nurse educator programs, Doctor of Nursing Practice, or Ph.D. programs; and revises and clarifies commitment to teach.
We were also supportive of a new initiative, the Rural Behavioral Health Professional Incentive, that was put forward by Sen. Brad Hutto and Rep. Heath Sessions. The graduate medical education (GME) program was funded with $5M recurring dollars. DHHS Director Robbie Kerr is currently studying a plan for the administration of these dollars. The goal is to ensure South Carolina is receiving value from the distribution of GME dollars to meet the future physician needs of the state. The General Assembly will be encouraged to increase this funding in future budgets.
The Department of Mental Health (DMH) was appropriated funds to enable local community mental health centers to pay for indigent patient psychiatric bed days in community hospitals. This funding, $4m recurring, gives acute psychiatric patients the ability to stay in their community while alleviating stress in emergency departments and increasing their capacity to serve other patients. It also provides more rapid access to treatment and more appropriate care for psychiatric patients.
DMH also received $2.54m non-recurring for the Alternative Transportation program that transports nonviolent adults who are the subject of an involuntary psychiatric emergency admission statewide. Transports are provided by a private contractor utilizing specially equipped unmarked vehicles and drivers with extensive mental health training wearing professional civilian attire. Now in its third year, the program is in all 46 counties. While the program does not replace the need for law enforcement to provide some patient transports, it has proven to significantly reduce the number of law enforcement transports and provides a more appropriate means of transportation that alleviates the stigma and reduces patient anxiety and stress for those nonviolent patients who have committed no crime.
NOTE: DMH and SCHA will be hosting a webinar for hospitals and others to learn about the availability of the program for adults who are the subject of an emergency psychiatric admission. In addition to the contractor, AUS, Henry Lewis from the EMS Association will be as a presenter. We want to remind hospitals that the availability of the alternative transportation program doesn’t preclude the use of non-emergency ambulance transports, which are authorized by statute and which in some cases may be more appropriate.
USC and Clemson both came out winners with the Gamecocks receiving $100m for the Health Sciences Campus Building (Proviso 118.20) and the Tigers receiving $133m for the next and final phases of the College of Veterinary Medicine.
Below are highlights of healthcare related funding outside of what is shared above:
- DHHS: Maintenance of effort, $36.1M recurring
- DHHS: Provider Rates, Medical $50.5M recurring
- DHHS: Provider Rates, Behavioral Health $16.5M recurring
- DHHS: Children’s Hospital Collaborative $5M nonrecurring (Proviso 33.36. Children’s Hospital and Healthcare Innovation)
- DPH: Colon Cancer Prevention Network $1M recurring (Proviso 31.51. Best Chance Network/Colon Cancer Prevention)
- DPH: Prostate Cancer Awareness Campaign $2M non-recurring (Proviso 117.176. Prostate Cancer Study Committee), continued from last year (unrelated to funding)
- DSS: Working Families Child Care Scholarships and Support $2.5M recurring (see also S.862)
- Lottery Proceeds (Proviso 3.6. Lottery Expenditure Account (LEA): FY 2024-25 Lottery Funding)
- CHE: $10M nursing initiative
- TECH Board: SC WINS $78.6M
- Tech Board and CHE: $51.1M tuition assistance
- Lottery unclaimed prizes
- TECH BOARD: SC WINS $15.1M
Behavioral Health Acts
S. 445 (Garrett) Voluntary Certification Program for Recovery Housing. Act 160 establishes a voluntary certification program for recovery housing. The Department of Alcohol and Other Drug Abuse Services will set protocols and guidance for credentialing entities to certify recovery housing according to national quality standards like those of the National Alliance for Recovery Residences (NARR) or Oxford House. SCHA Position: monitor, support
Date effective: 5/20/24 (however Sections 44-49-340 and 44-49-350 take effect eighteen months after 5/20/24)
S.408 (Shealy) Suicide Prevention Training for Health Professionals. Act 158 requires suicide assessment, training, and management training as a requirement for continuing education of licensed Professional Counselors, Marriage and Family Therapists and Licensed Psychoeducational Specialists and Social Workers. This training may be completed virtually. SCHA Position: monitor, support
Date effective: 5/20/24 (however Sections 1, 2, and 3 apply to license renewal cycles ending after 2025)
H.4617 (Hixson) Xylazine. Act 177 adds Xylazine, a legal tranquilizing drug used on large animals by veterinarians, to the list of Scheduled III controlled substances and prohibits the production, manufacture, or possession of Xylazine. The Act allows exceptions for use by veterinarians. (Xylazine is being mixed with other illegal street drugs, placing users at a higher risk of fatal drug poisoning.) SCHA Position: monitor, support
Health/Medical Acts
S.558 (Verdin) TB Testing and Admissions to Nursing Homes. Act 162 requires a nursing home or community residential care facility, prior to the admission of a new resident, to request and receive a written declaration from an authorized healthcare provider that the applicant resident has no signs or symptoms of active tuberculosis. Additionally, if the applicant resident is admitted directly from a hospital, the nursing home or community residential care facility must administer the first and second steps of a tuberculin skin test to the resident within three and fourteen days, respectively. SCHA Position: priority, support
Date effective: 5/20/24
H.4113 (Herbkersman) DHHS/Ambulance Service Assessment Fees (AF). Act 139 requires DHHS to establish and charge private ambulance services providers an ambulance assessment fee and penalize the providers that do not pay the assessed fees. These fees will be held in an established trust AF Trust Fund and will be used solely for supplemental Medicaid payments for ambulance services. The assessment fees would be used as the State match funds to draw down the federal dollars for the supplemental payments. Private ambulance service providers that only provide emergency ambulance services (basic life support) would be the only class of provider assessed the fee and the only class of provider receiving the supplemental payment. SCHA Position: monitor
Date effective: 5/13/24
H.4867 (Lawson) 911 Telecommuter CPR Training. Act 179 requires all 911 telecommunicators providing dispatch for emergency medical conditions to be trained in high-quality Telecommunicator Cardiopulmonary Resuscitation (T-CPR) annually beginning January 1, 2025. The training must include recognition protocols for out-of-hospital cardiac arrest, compression-only CPR instruction for callers, and continuous education on an annual basis. All agencies employing 911 telecommunicators will be responsible for providing this training. SCHA Position: of interest to healthcare policy
Date effective: 5/20/24
S.455 (Verdin) Bloodborne Diseases. Act 161 adds Hepatitis C to the list of bloodborne diseases and includes dentists in the definition of health care professionals. SCHA Position: of interest to healthcare policy
Date effective: 5/20/24
S.968 (Peeler and Rankin) Drivers License Blood Type. Act 167 allows an applicant for a driver’s license or permit to voluntarily disclose his or her blood type on a form prescribed by the Department of Motor Vehicles (DMV) with a certification from a physician or medical provider. Blood type must be indicated by a symbol designated by DMV on the driver’s license and contained in the driver’s record. SCHA Position: of interest to healthcare policy
Date effective: 11/20/24
Licensure & Regulation Acts
H.5458 Approves DHEC Regulation 5264 regarding Regulations 61-91 | Standards for Licensing Ambulatory Surgical Facilities (R.236) SCHA Position: priority, support
Date effective: 6/28/24 (state register publication of state register)
H.5459 Approves DHEC Regulation regarding Regulations 61-16 | Minimum Standards for Licensing Hospitals and Institutional General Infirmaries (R.237) SCHA Position: priority, support
Date effective: 6/28/24 (state register publication of state register)
S.858 (Davis) Acute Hospital Care at Home. Act 164 exempts Acute Hospital Care at Home Programs and services from Certificate of Need Programs and directs DPH to promulgate regulations for licensing Acute Hospital Care at Home agencies. Additionally, patients enrolled in such a program shall not be considered within the licensed bed capacity of the hospital participating in the program. The Act also directs licensure considerations for home health agencies. SCHA Position: priority, support
Date effective: 5/20/24
S.241 (Garrett) Creates the Board of Genetic Counselors under LLR. Act 187 seeks to protect the public through the regulation of professionals who educate and communicate with the public regarding genetic disorders by creating the Board of Genetic Counselors to license genetic counselors and further provides for the regulation of genetic counselors under the administration of LLR. SCHA Position: monitor, support
Date effective: 5/21/24
Pharmacy Acts
H.3592 (Hyde) Compounding Pharmacies. Act 158 makes changes to the Pharmacy Practice Act by removing specified definitions related to the compounding of medications and revises requirements for compounding pharmacies. The bill also requires the Board of Pharmacy to develop regulations for the compounding of drugs and to promulgate the regulations within eighteen months after the effective date of the bill. SCHA Position: monitor
Date effective: 5/13/24
H.3988 (Davis) Pharmacists and Pharmacy Technicians. Act 221 amends the Pharmacy Practice Act to address the responsibilities of pharmacists and pharmacist technicians by making permanent some of the 2020 pharmacy provisions allowed during the pandemic under the “Pharmacy Practice Act.” The bill allows for flu and COVID-19 testing in the pharmacy. It also provides for: supervision of interns, externs, and pharmacy technicians; written protocol for administration of vaccines and creates the Joint Pharmacist Administered Vaccines Committee. SCHA Position: monitor, support
Date effective: 7/2/24
Workforce Acts
H.5183 (MM Smith) Certified Medical Assistants (CMAs) and Unlicensed Assistive Personnel (UAP). Act 209 revises the certification standards for CMAs to prevent the lapse of existing standards and to expand the number of approved certification programs. By including provisions for existing CMAs and outlining additional responsibilities for UAP, the Act aims to maintain the integrity and effectiveness of the CMA profession. The Act also allows a physician or other medical professionals to designate additional nursing tasks to CMAs. SCHA Position: priority, support
Date effective: 5/21/24
H.4159 (Herbkersman) Enacts the SC Telehealth and Telemedicine Modernization Act. Act 120 broadens telehealth access to all licensed practitioners, setting standards for telehealth care equivalent to in-person care, including for APRNs. It redefines “telehealth” to encompass various electronic and technological means for healthcare delivery. to allow physicians, advanced practice registered nurses, and physician assistants to provide telehealth and telemedicine services to patients. SCHA Position: priority, support
Date effective: 3/11/24
S.610 (Cromer) Professional Counseling Compact Act. Act 189 authorizes South Carolina to enter into the compact to facilitate the interstate practice of licensed professional counselors to improve public access to professional counseling services. The compact requires member states to recognize licenses for professional counselors issued by any other member state as well as allow for the practice of telehealth between member states. The bill specifies the structure, function, powers, and duties of the Counseling Compact Commission, the collective governing instrumentality of the compact states. SCHA Position: monitor, support
Date effective: 5/21/24
Youth/Minors Acts
H.4624 (Hiott) Prohibits Gender Transition Procedures on Minors. Act 203 prohibits the use of public funds or Medicaid funds for gender transition procedures on individuals under 18 and requires a public-school principal, vice principal, or counselor to provide written notification to the parent of a minor if the student is acting in a way that is contrary to his/her sex. This excludes mental health providers offering mental health services. “Gender transition procedures” include puberty-blocking drugs, cross-sex hormones, and gender reassignment surgeries. For treatments started before August 1, 2024, health care professionals can gradually reduce these treatments by January 31, 2025. However, medical services for minors with medically verifiable disorders of sexual development are still permitted. SCHA Position: monitor for unintended consequences
Date effective: 5/21/24
S.862 (Shealy) Child Caregiver Requirements. Act 216 relates to caregiver requirements and provides for educational and pre-service training requirements. New childcare workers have 30 days to complete their training instead of just 5. In an effort to address labor needs and accommodate otherwise qualified workers, the Act removes the requirement that an individual must have at least six months experience as a caregiver or be directly supervised. GED and other high school equivalency credentials, along with Certificates of Completion, would be accepted as acceptable credentials for caregivers. The bill also provides that childcare facility licenses are valid for three years instead of two. SCHA Position: monitor, support
Date effective: 7/9/24
H.3309 (Gilliam) Seizure Safe Schools Act. Act 128 requires each school district and charter school to adopt a “Seizure Action Plan” and to provide individual health care plans for students who have seizure disorders. Additionally, it outlines detailed procedures and requirements for schools to manage and support students with seizure disorders. School districts are required to adopt a “Seizure Action Plan” that addresses the basics regarding epilepsy and its impact on student learning. SCHA Position: of interest to healthcare policy
Date effective: 7/1/25
Gearing Up for Next Year
Conversations about SCHA’s legislative agenda for next year are evolving. The SCHA Board will meet mid-October to discuss and formally approve what that agenda will entail. You can bet it will include themes similar to this past session as they remain top issues for our members including workforce, workplace safety, behavioral health and reimbursement. We expect legislative issues left hanging from last session to re-surface and we are building strategies to support our positions. (Think itemized billing for one, H.4622 (Sessions)). Other bills that did not reach the finish line included legislation to allow anesthesiologists to supervise more assistants (H.3877 (West) and 340b legislation (S.1239 Talley).
Thanks for your support of our efforts. Your involvement is critical to the accomplishment of our goals. We are a large industry and policy makers must hear from those who are providing healthcare as you continue to provide top-notch care for our fellow citizens across this state. For that, we salute our healthcare workforce and will continue to advocate on their behalf!