(A) The director or his designee may make an examination of the affairs of a health maintenance organization and providers with whom the organization has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this State but not less frequently than once every five years. The director or his designee may accept the report of an examination made by the state where the health maintenance organization is domiciled.
(B) The director or his designee may make an examination concerning the quality of health care service of a health maintenance organization and providers with whom the organization has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this State but not less frequently than once every five years.
(C) Every health maintenance organization and provider shall submit its relevant books and records for the examinations and facilitate them. For the purpose of examinations, the director or his designee and the department may administer oaths to and examine the officers and agents of the health maintenance organization and the principals of the providers concerning their business.
(D) The expenses of examinations under this section are assessed against the organization being examined and remitted to the director or his designee for whom the examination is being conducted.
HISTORY: Enacted as 1976 Code Section 38-25-170 by 1987 Act No. 83, Section 1; recodified as Section 38-33-170 by 1987 Act No. 155, Section 24; 1992 Act No. 403, Section 5; 1993 Act No. 181, Section 633; 2018 Act No. 219 (H.4657), Section 3, eff May 18, 2018.
Effect of Amendment
2018 Act No. 219, Section 3, in (A), in the first sentence, substituted "five years" for "three years"; and in (B), substituted "five years" for "three years".
Structure South Carolina Code of Laws
Chapter 33 - Health Maintenance Organizations
Section 38-33-10. Short title.
Section 38-33-20. Definitions.
Section 38-33-30. Necessity of certificate of authority; foreign corporation.
Section 38-33-50. Powers of health maintenance organization; notice prior to exercise of powers.
Section 38-33-60. Members of governing body; advisory panels, etc.
Section 38-33-70. Fiduciary relationship in handling of funds.
Section 38-33-90. Statements and reports.
Section 38-33-120. Investment of funds.
Section 38-33-150. Agent for organization; exemption from licensing requirements.
Section 38-33-180. Suspension or revocation of certificate of authority.
Section 38-33-200. Implementation of regulations.
Section 38-33-250. Records of organization as public documents; trade secrets, etc.
Section 38-33-260. Confidentiality of health records.
Section 38-33-300. Liability for participation in quality of care or utilization review.
Section 38-33-310. HMO may contract with out-of-state provider.