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.
H4972 would require South Carolina health insurance policies that cover cancer chemotherapy to also cover scalp cooling therapy, sometimes called cold cap therapy, when used in connection with chemotherapy treatment. The bill specifies that coverage must include both the scalp cooling equipment and supplies provided by a chemotherapy treatment facility, as well as the operation, monitoring, and management of the system when performed by an independent third-party provider. It also requires insurers to give patients written notice that scalp cooling therapy is available and covered when chemotherapy is approved, and to explain what the therapy is and how to obtain it.
The bill goes beyond insurance coverage by tying reimbursement for chemotherapy services to facility participation. A chemotherapy treatment facility would not be eligible for payment or reimbursement for chemotherapy services unless it offers scalp cooling therapy to all patients for whom it is clinically appropriate, maintains access to an operational system, and notifies patients in advance. The Department of Health would handle certification and compliance procedures, while the Department of Insurance would enforce the coverage requirements. The bill applies to individual and group policies, HMOs, and the State Health Plan, and would take effect six months after gubernatorial approval.
H4972 would add a new section, Section 38-71-148, to Title 38 of the South Carolina Code, creating a statewide mandate for insurance coverage of scalp cooling therapy in chemotherapy cases. It would require insurers to establish billing and reimbursement mechanisms for separate components of the service, prohibit denial of coverage solely because a third-party provider performs the scalp cooling functions, and allow standard cost-sharing such as deductibles, copayments, and coinsurance. It also creates a compliance framework for chemotherapy facilities, including certification, documentation, verification, and potential administrative penalties or loss of reimbursement for noncompliance.
Based on the bill text and the absence of recorded committee debate or votes, the overall sentiment appears supportive of expanding patient access to a cancer-related supportive therapy. The measure is framed as a patient-access and consumer-notice bill, with a strong emphasis on ensuring that insured patients are informed of a covered option that may reduce chemotherapy-induced hair loss. No recorded opposition, amendments, or vote history is available in the provided materials.
The main points of potential contention are the mandate imposed on chemotherapy treatment facilities and the administrative burden placed on insurers and state agencies. Facilities would be required to offer scalp cooling therapy to all clinically appropriate patients in order to remain eligible for reimbursement, which could raise concerns about equipment costs, staffing, operational feasibility, and compliance oversight. Insurers may also object to the requirement to create distinct billing and reimbursement systems and to provide mandatory notice to patients. The bill’s inclusion of the State Health Plan and its enforcement provisions could also draw scrutiny from stakeholders concerned about costs and implementation.