S.C. Code Ann. § 1-11-760 – 063)[Repealed effective January 1, 2005] State health insurance plan; mental health, alcohol and substance abuse coverage

(A) As used in this section:
1. (1) "Alcohol or substance abuse" means a condition or disorder involving alcohol or substance abuse that falls under any of the categories listed in the Diagnostic and Statistical Manual IV or subsequent editions.
2. (2) "State health insurance plan" means health insurance plans offered or administered by the State Budget and Control Board. This definition does not include dental insurance, accidental death and dismemberment insurance, disability insurance, long-term care insurance, or any other supplemental health insurance plan offered or administered by the State Budget and Control Board.
3. (3) "Mental health condition" means any mental or nervous condition that is caused by a biological disorder of the brain and results in a clinically significant or psychological syndrome or pattern that substantially limits the functioning of the person with that illness, limited to: schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, pervasive developmental disorder or autism, panic disorder, obsessive-compulsive disorder, social anxiety disorder, anorexia, bulimia, asperger's disorder, intermittent explosive disorder, post-traumatic stress disorder, psychosis not otherwise specified when diagnosed in a child under seventeen years of age, Rett's disorder, or Tourette's disorder.
4. (4) "Term or condition" means any lifetime or annual payment limits, deductibles, copayments, coinsurance, out-of-pocket limits, visit limits, or any other cost-sharing requirements.
(B) The state health insurance plan shall provide coverage for medically necessary treatment of a mental health condition and alcohol or substance abuse and shall not establish any term or condition that places a greater financial burden on an insured for access to treatment for a mental health condition or alcohol or substance abuse than for access to treatment for a physical health condition. Any deductible or out-of-pocket limits required under the state health insurance plan must be comprehensive for coverage of mental health conditions, alcohol or substance abuse, and physical health conditions.
(C) If the state health insurance plan does not otherwise provide for management of care under the plan or does not provide for the same degree of management of care for all health conditions, it may provide management of care for medically necessary treatment of mental health conditions and alcohol or substance abuse as long as the management of care does not diminish or negate the purpose of this section. The management of care must also ensure that timely and appropriate access to care is available, that the quantity, location, and specialty distribution of health care providers is adequate, and that administrative or clinical protocols do not reduce access to medically necessary treatment for any insured.
(D) To be eligible for coverage under this section for the treatment of a mental health condition or alcohol or substance abuse, the treatment must be rendered by a licensed health professional who is acting within the scope of his or her license and in accordance with the provisions of the plan or contract.
(E) A portion of the increase in total health insurance costs resulting from the application of the provisions of the section must be borne by persons covered by the state health insurance plan.
(F) The state health insurance plan may opt out of the requirements of this section if, as a result of the application of this section, the total health insurance costs of the state health insurance plan increase by more than:
1. (1) one percent by the end of the three-year period beginning January 1, 2002, and ending December 31, 2004; or
2. (2) 3.39 percent at any time beginning January 1, 2002, and ending December 31, 2004.