Copyright Charleston Post and Courier
South Carolina’s restrictions on how some health care providers deliver care could weaken its appeal for billions in new rural health care funding in a proposal due next week, a state senator warned. Legislators are also taking aim at a restriction insurers impose on prescriptions and other services South Carolina patients receive. Palmetto Care Connections, a nonprofit aiming to expand access to care, hosted a legislative panel Oct. 30 at its annual Telehealth Summit in downtown Charleston at the Francis Marion Hotel. There was bipartisan consensus the state was doing a good job of expanding health care access through virtual means, particularly to rural and underserved areas. But legislators conceded more could be done there, as well. Virtual care can help overcome key barriers of time and transportation that many face when trying to get health care, said S.C. Sen. Deon Tedder, D-North Charleston. “People in the rural areas who just simply can't get to a primary physician's office, or the people who work low-wage jobs, and they just can't take the time off to go to the doctor” and lose pay, he said. “Those are real issues that real people are facing.” With mental health care, virtual care can help remove a stigma many patients feel about being seen accessing therapy or asking for help. “You can get this care from your home,” Tedder said. “You can even do it from the workplace. You can go out to your car, get on your phone and log in with your health care professional. And nobody knows that you went to see your counselor or your therapist.” The problem is potentially less payment to medical providers for a telehealth visit compared to an office appointment. “These are medical professionals providing the same services, and so we have to incentivize them for actually doing that,” to provide that access, Tedder said to applause from the providers in the audience. Not all of those providers will be doctors, but nurse practitioners, physician assistants and others, and they face unnecessary restrictions on being able to see patients and practice, said Sen. Tom Davis, R-Beaufort. Those limits could cost South Carolina, he said. To help offset the impact of upcoming cuts to Medicaid that were part of the One Big Beautiful Bill passed by Congress this summer, the legislation created the $50 billion Rural Health Transformation Program specifically to help rural providers. About $10 billion will be distributed from the program each year. Half will go to states based on population, but the other half will be awarded through a competitive process reflecting how well states meet certain goals the Trump administration set. Applications are due Nov. 5. One of the stated goals is to help “rural providers practice at the top of their license and develop a broader set of providers to serve a rural community’s needs,” the federal Centers for Medicare and Medicaid Services said in announcing the application program. That “top of license” is often referred to as scope of practice issues, or limits on what services advanced nurse practitioners, physician assistants, pharmacists and dental hygienists are allowed to provide, particularly in their own practice. Davis said South Carolina’s application could be hurt by the way the state curbs those providers. Federal health officials, including Health Secretary Robert F. Kennedy Jr. and Dr. Mehmet Oz, have said they are looking at how states treat those providers and what they are allowed to do, Davis said, and states that enable them to do more “will be scored higher” and get a greater share of the $25 billion. The American Medical Association, in reviewing the Rural Health Transformation Program goals, said it has “significant concerns” about the program pushing changes that free up those disciplines to provide more services. Davis is sponsoring legislation that would do away with some of what he sees as restrictions that don’t result in better care. For instance, nurse practitioners have to have a collaborative agreement with a physician to oversee their care and review it occasionally. But Davis said his subcommittee heard testimony that about 80 percent of the time there is not really collaboration so the patient care is unchanged. And physicians can be paid tens of thousands of dollars for those arrangements for simply reviewing charts. “I'm OK with providing money to a physician if they're rendering something to the health care outcome that improves it” Davis said, but not requiring those providers “to pay money for situations where physicians are not even involved.” Also, if that physician dies or moves out of state, the other provider has to stop practicing immediately until they find another to take them on, he said. Legislation next session will also take aim at prior authorization, an insurance company practice where a prescription or treatment has to be reviewed before it can be fulfilled. It is a practice Rep. Heath Sessions, R-Rock Hill, knows only too well. His 9-year-old son Asher takes daily medication for a seizure disorder, medication that requires an annual authorization from the insurance company. But Sessions said at times when he’s seeking to pick up a 30-day supply at the pharmacy, he will be told it has been flagged to undergo an audit for authorization again, a process that can take days. It can happen on a Friday, Sessions said, when “we only have two days of the drug left.” He understands that companies need to cut down on needless and wasteful treatment. The new legislation, modeled on one in Texas, would look at the provider’s record, and those whose orders were approved 80 percent of the time over the past year would be exempt from prior authorization from the next year.
