Bill
H 4069
Hospitals and other health facilities must provide patients with a plain-language, itemized bill within 30 days of final payment, and cannot pursue collection without compliance.
Status & key dates
- Introduced in the South Carolina House: February 20, 2025 (read first time).
- Committee report (House Medical, Military, Public & Municipal Affairs): Favorable with amendment (Mar 20, 2025).
- House amended and passed (Mar 25–26, 2025); sent to Senate.
- Senate concurred May 5, 2025.
- Subsequent committee referral/hearing scheduling listed for October 8, 2025.
- Effective date in text: upon Governor’s approval; substantive compliance required beginning January 1, 2026.
- Note: the packet includes unrelated Massachusetts docket language (apparently clerical); the substantive bill adds Section 44‑7‑327 to the South Carolina Code.
Purpose / intent
- Require certain health care facilities to provide patients an accessible, itemized bill for services and supplies, reduce surprise/confusing bills, and prevent debt collection unless billing transparency requirements are met.
Who is covered / affected
- Covered “healthcare facilities” (list in amended text): acute care hospitals, psychiatric hospitals, alcohol/substance‑use disorder hospitals, ambulatory surgical facilities, hospice, radiation therapy, rehabilitation, residential treatment for children/adolescents, intermediate care for individuals with intellectual disabilities, and narcotic treatment programs.
- Affects patients receiving post‑visit bills, third‑party payers (insurers) insofar as explanations of benefits must be reflected, debt collection agencies, and licensing authorities that enforce facility compliance.
Key provisions
- Itemized billing requirement (Section 44‑7‑327(B)):
- Beginning Jan 1, 2026, facilities that bill patients after a visit must provide an itemized bill (electronic or written) listing each service/supply and amount alleged due.
- Itemized bill must be made available no later than 30 days after the facility receives final payment (if any) from a third party.
- Content and format:
- Plain‑language descriptions for each distinct service/supply consistent with current CMS reading‑level guidance.
- The amount alleged due for each item.
- If a third party was billed or is being billed, include any billing codes submitted and the patient’s responsibility amount as shown on the insurer’s explanation of benefits (EOB), with specificity about deductible, coinsurance, or noncovered charges.
- Patient notice, preferences, and waivers:
- Primary bill must prominently notify patients of their right to an itemized bill and let them indicate preferred delivery format (electronic or paper).
- Patients may waive the right by marking/initialing; an initial waiver does not bar later requests for an itemized bill.
- Collections and liability:
- Facilities may not pursue debt collection against a patient for a provided service/supply unless they have complied with the itemized‑bill requirement or the patient has waived receipt.
- Collection agencies are not liable for inaccuracies originating with the facility, but if inaccuracies are found the agency must stop collection and return the account to the facility.
- Enforcement:
- The appropriate licensing authority may take disciplinary action against facilities for violations as if they violated applicable licensing law.
Fiscal impacts (as reported in committee analysis)
- Department of Mental Health: one‑time IT conversion cost estimated ~$1,200 (convert codes/abbreviations to plain language).
- Department of Health & Human Services (Medicaid): no fiscal impact (Medicaid patients generally owe $0).
- Department of Veterans’ Affairs: estimated vendor staffing costs ≈ $360,000 annually beginning FY2025‑26 to process itemized statements for six state veteran nursing homes (agency expects to request appropriations).
- Other agencies (DAODAS, VR) report minimal/no fiscal impact; overall costs vary by facility depending on current billing practices and vendor arrangements.
Practical effect
- Increases transparency for patients by requiring plain‑language, line‑item bills and tying debt collection eligibility to compliance. May require changes to billing systems, vendor contracts, and patient‑portal workflows at many facilities.
Compiled from official sources — confirm details with the bill’s official record.
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