H 4972

South Carolina General Assembly
126th Session, 2025-2026
Bill 4972
Indicates Matter Stricken
Indicates New Matter
(Text matches printed bills. Document has been reformatted to meet World Wide Web specifications.)
A bill
TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY ADDING SECTION
38-71-148 SO AS TO PROVIDE HEALTH INSURANCE POLICIES THAT PROVIDE CANCER
CHEMOTHERAPY TREATMENT SHALL INCLUDE COVERAGE FOR SCALP COOLING SYSTEM THERAPY
USED IN CONNECTION WITH CANCER CHEMOTHERAPY TREATMENT, TO REQUIRE INSURERS
PROVIDE CERTAIN NOTICE OF THE AVAILABILITY OF SCALP COOLING SYSTEM THERAPY
UNDER THE POLICY, TO PROVIDE CHEMOTHERAPY TREATMENT FACILITIES ARE NOT ELIGIBLE
TO RECEIVE PAYMENT OR REIMBURSEMENT FROM INSURANCE CARRIERS FOR CHEMOTHERAPY
SERVICES UNLESS THE FACILITY OFFERS SCALP COOLING SYSTEM TREATMENTS TO ALL
CHEMOTHERAPY PATIENTS, AND TO DEFINE NECESSARY TERMINOLOGY.
Be it enacted by the
General Assembly of the State of South Carolina:
SECTION 1.  Article 1, Chapter 71, Title 38 of the S.C. Code is
amended by adding:
    Section
38-71-148. (A)(1) Any health
insurance policy issued or renewed in this State that provides coverage which
includes cancer chemotherapy treatment shall provide coverage for scalp cooling
therapy. This coverage must include both of the following services when used in
connection with cancer chemotherapy treatment:
  (a)
scalp cooling equipment and supplies, including headgear and related
components, furnished by a chemotherapy treatment facility for the use of a
scalp cooling system; and
  (b)
the operation, monitoring, and management of a scalp cooling system, when such
services are performed by an independent or third-party entity that is not
owned or operated by the chemotherapy treatment facility.
       (2)
Coverage required under item (1) must:
  (a)
permit separate billing and reimbursement for the services described in item
(1)(a) and (b);
  (b)
require insurers to establish or recognize distinct billing, coding, or
reimbursement mechanisms for each covered service to ensure payment to the
appropriate provider; and
  (c)
prohibit denial of coverage solely because the operation of the scalp cooling
system is performed by a third-party entity rather than the chemotherapy
treatment facility.
       (3)
When an insurer provides written notice to an insured or the insured's
authorized representative that chemotherapy treatment has been approved for
payment under the policy, the insurer shall simultaneously provide written
notice that scalp cooling therapy is available and covered under the policy
pursuant to this section. The notice must:
  (a)
include a brief description of scalp cooling therapy, its purpose, and
instructions for how the insured may obtain the service; and
  (b)
be provided electronically if the insured has elected to receive electronic
communications.
       (4)
The coverage required under this subsection may be subject to annual
deductibles, coinsurance, and copayments, as determined by the Director of the
Department of Insurance, consistent with those established for other benefits
under the policy.
    (B)(1) A chemotherapy treatment facility
is not eligible to receive payment or reimbursement from an insurance carrier
for chemotherapy services unless it offers scalp cooling system therapy to all
chemotherapy patients for whom such therapy is clinically appropriate.
       (2)
A facility complies with item (1) if it:
  (a)
maintains or provides access to at least one operational scalp cooling system
on site;
  (b)
makes the system available before, during, or after infusion, as clinically
appropriate; and
  (c)
provides written notice to patients prior to treatment that scalp cooling
therapy is available.
       (3)
Insurance carriers may issue payment for chemotherapy services only upon
certification that the facility complies with Section 38-59-620.
       (4)
The Department of Health, acting through its Bureau of Healthcare Quality,
shall establish procedures for certification, documentation, and verification
of compliance.
       (5)
Noncompliance may result in administrative penalties, corrective action,
license sanctions, or loss of eligibility for insurance reimbursement.
    (C)
The provisions of this section apply to all individual and group health
insurance policies and health maintenance organizations issued, delivered, or
renewed in this State, including the State Health Plan.
    (D)
Except as provided in subsection (B)(4), the Department of Insurance shall
enforce the provisions of this section.
    (E)
For the purposes of this section:
       (1)
"Chemotherapy treatment facility" or "facility" means any hospital, clinic,
physician practice, ambulatory center, or other entity licensed by the State to
administer chemotherapy to cancer patients.
       (2)
"Scalp cooling system" means any device used to cool the human scalp to prevent
or reduce chemotherapy-induced alopecia prevention or related hair loss during
cancer chemotherapy treatment, provided that such device is designed and
intended for repeated use and is primarily and customarily used to serve a
medical purpose.
       (3)
"Third-party scalp cooling service provider" means an independent entity that
operates, manages, services, or monitors a scalp cooling system on behalf of a chemotherapy
patient or chemotherapy treatment facility.
SECTION 2.  This act takes effect six months
after approval by the Governor.
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This web page was last updated on January 15, 2026 at 11:15 AM