South Carolina lawmakers have finalized a medical billing transparency measure that drops the collection-specific provisions debt collectors had been tracking, leaving a law aimed squarely at healthcare facilities rather than the agencies that pursue their accounts.
Why it matters: Earlier versions of H. 4069 would have barred collection activity on medical bills flagged as inaccurate and required agencies to return those accounts. The conference report adopted June 25 contains none of that language, narrowing the bill to patient-facing billing obligations enforced through facility licensing.
The latest: A conference committee of House and Senate members signed off on the final text, which now heads to the governor. It takes effect upon his approval, with substantive requirements beginning Jan. 1, 2027.
The details: Beginning in 2027, a healthcare facility seeking payment from a patient after providing a service or supply must:
- Provide an electronic itemized bill; and
- Provide a written copy on request.
Facilities must notify patients in “clear and conspicuous” language that itemized bills are available, let patients choose electronic or paper delivery, and inform them they may request a bill later even if they initially waived the right.
Each itemized bill must carry a plain-language description meeting CMS reading-level guidance, the amount the facility alleges is owed, and, where a third-party payer was billed, the patient responsibility amount reflected in the electronic remittance advice. Facilities may issue the bills electronically, including through patient portals.
“Healthcare facility” is defined broadly, covering acute care and psychiatric hospitals, ambulatory surgical centers, hospice and rehabilitation facilities, radiation therapy providers, residential treatment centers for children, narcotic treatment programs and other licensed types.
What changed: The most consequential edits for the ARM industry came in committee. Gone is earlier language stating a collection agency must stop collecting on a medical bill once notified of inaccuracies and return the account to the facility, along with a clause shielding agencies from liability for facility billing errors. Also removed is a provision barring facilities from pursuing collection until an itemized bill was furnished.
Lawmakers also loosened the itemization standard from “each service and supply” to a general department or service level, dropped a requirement to disclose billing codes and explanation-of-benefits detail, and pushed the effective date back a year.
The bottom line:
