JANUARY 8, 2021


Eliminate Certificates of Need (CON) to increase supply and generate competition among medical providers. That means better quality and lower prices. There’s no other way to explain it. Certificates of Need laws require medical providers to obtain the approval of the state government and their competitors if they wish to open a new service or expand an existing one. Governor McMaster set CON aside temporarily during COVID due to the possibility that hospitals would need beds on an emergency basis but would be forbidden to add them.

Expand Scope of Practice for Nurse Practitioners (NPs), as was done for Physicians Assistants (PAs). The General Assembly expanded Scope of Practice just this past year when it passed S.132 (now Act 32) covering Physicians Assistants (PAs). Some states have passed similar legislation or adopted regulations with the same effect for Nurse Practitioners (NPs). Steps like this allow medical professionals to practice at the top of their education and training by removing barriers that artificially limit medical practice. Removing these restrictions would be a godsend to rural and other areas facing shortages of medical professionals.

Make certain COVID-19 Executive Actions Permanent. Governor Henry McMaster and his cabinet agency heads took a number of steps in the first few weeks of COVID-19 to make practicing medicine and seeing a doctor easier. These included speeding up the process of honoring Out of State Medical Licenses, clearing the way for more Access to Telemedicine and speeding up the process for renewing Professional Licenses.

Make Agency and Licensing Board actions permanent. Actions taken during the early stage of the pandemic that set aside regulations for a number of professions should also be made permanent. These professions include: Pharmacy (Strep testing), Marriage & Family Therapy, Optometry, Speech Pathology, and Dentistry. Last session, a bipartisan bill was introduced into the S.C. House that would allow close contact providers regulated by the Department of Labor, Licensing and Regulation to be “exempt from renewal fees and continuing education requirements for their continued licensure until a period of one year after the date on which they are allowed to return to work by the Governor…” Only providers licensed before COVID would qualify. Such a move would take one more worry off the backs of workers still reeling from COVID. Enact COVID-19 responses from neighboring states. There were at least three initiatives that several states enacted that are not too late to pass here in South Carolina. They include:

Fast track inactive physicians & nurses and medical student licenses to cover

Provide Continuing Medical Education (CME) credit for COVID-related

Pass the Uniform Emergency Volunteer Health Practitioner Act to allow physicians from other states full reciprocity

Protect Direct Primary Care (DPC) to keep it growing. Direct Primary Care is nothing more than good old-fashioned cash for care. A growing number of medical practices in South Carolina are built on a model that offers their patients 24/7/365 treatment in return for a reasonable monthly subscription fee. This could be a game-changer for uninsured, underinsured, or government insured patients who need access to care.

Don’t regulate Christian Healthcare Sharing–a more affordable way for some families to cover major medical expenses-as insurance. Instead of insurance, which pools risk, members of a healthcare sharing ministry simply pay each other’s medical bills. Government should stay out of their ministries.



Enact a Price Transparency/Surprise Billing law (following Oklahoma’s example) so that patients can know the good faith cost of a service before it is performed. South Carolinians are frustrated that they can’t get a straight answer  in advance on what their medical procedure will cost. One patient reported to the PPI office that a large provider told her that she could not be provided this information until the day before the procedure. Oklahoma has pioneered legislation to put an end to this, and a groundswell is breaking out nationwide. Recent polling shows that an incredible 87% of citizens favor legislation to ban surprise medical bills.

Oppose insurance coverage mandates. One of the most egregious flaws of Obamacare (ACA) was the attempt by Washington to determine whether a health insurance policy were good or adequate. Federal or state governments should not load up insurance policies with mandated coverages that people don’t want and certainly don’t wish to pay for.

Allow patients the right to price shop for healthcare procedures, with both the shopper and the insurance carrier sharing in the potential savings.

Seek a Section 1332 Waiver. Also known as ACA Innovation waivers, if approved, a waiver would loosen some of the Federal Affordable Care Act (Obamacare) strings and allow South Carolina to test certain innovations. Since 2017, 15 states have had waivers approved and 6 more states have enacted legislation authorizing waiver submission. One state, Georgia, is awaiting federal approval on their submission. In 2018, the Trump Administration issued new guidance that relaxed some of the stricter guidance issued by the Obama Administration in 2015. The new guidance is welcome relief to those Americans who have had to deal with high premiums and limited choice as a result of Obamacare. It may be more challenging to obtain a waiver under a Biden Administration, but South Carolina should still seek it to address this broken program. Among the “waiver concepts” that the HHS indicated would be approved, South Carolina should consider including the following:

New plan options. South Carolinians who are eligible for subsidies would then be able to buy the coverage of their choice.

Risk Stabilization Program to lower premiums. This program would direct public resources to those with the greatest needs by creating a separate pool for those consumers, pro- viding relief to healthier individuals. 7 states have already enacted similar programs and seen premiums decrease as a result.

Send subsidies to individuals. This waiver concept would allow for the disbursement of subsidies directly to individuals instead of to insurance companies. South Carolina should seize this opportunity to lower costs and increases choices for patients under 1332.

APRIL 13, 2020


Note: The regulatory environment during COVID-19 is a quickly developing issue, so we will update this post regularly with new information. 

The medical necessities of the COVID-19 pandemic have identified regulations—some perhaps legitimate, many unnecessary—which have been suspended to boost South Carolina’s healthcare capabilities, and respond to the pressing needs of workers, small businesses, and our economy.

Many actions have been by Executive Order of the Governor. Others have come directly from state agencies adapting to our new reality as citizens are required to limit their movements and contact with others.

What has South Carolina done so far to cut red tape? What is left to do?

Here is the short list of key regulatory and fiscal relief already accomplished, along with new ideas for additional flexibility that could make a real difference. This situation is evolving rapidly, with new executive and agency orders being issued on a nearly daily basis. Palmetto Promise will work to keep this list fresh with additional actions and entrepreneurial policy solutions as they happen.

6 Key Medical Barriers Down

Out-of-state Medical Licenses. As the National Conference of State Legislatures applauded, and WBTV reported, the Board of Medical Examiners and the Board of Nursing through the Governor are guaranteeing a 24-hour turn around on temporary licenses for out-of-state physicians, physician assistants, and respiratory care practitioners. The state also waived application fees.

The state department of Health & Human Services, following federal initiatives, expanded access to telemedicine. In one case, the State Board of Medical Examiners agreed to accept as a group thousands of physicians affiliated with one telemedicine provider, Teladoc. Additionally, the SC LLR Department suspended enforcement of the prohibition on prescribing schedule II and III medications via telemedicine.

Certificate of Need (CON) Bed Limits. In a move to ensure an adequate supply of hospital beds in critical areas should there be a COVID-19 surgeGovernor McMaster directly suspended hospital bed limits and allowed temporary facilities, giving them flexibility for expansion during the crisis.

Professional License Renewals. For South Carolinians with professional or occupational licenses that expire between March and August, the new expiration date is September 30th according to the Department of Labor Licensing and Regulation (LLR).

Emergency Medical Technicians and Nurses. South Carolina has a number of deregulatory policies put into permanent law prior to COVID-19. For instance, South Carolina has joined two compacts that allow professionals to cross state lines more easily (EMT Licensure and Nurse Licensure).

Scope of Practice. The SC Department of Labor, Licensing and Regulation Board of Medical Examiners suspended the requirement that a nurse practitioner or physician assistant licensed in good standing in North Carolina and/or Georgia enter into a practice agreement with a physician licensed in South Carolina.  South Carolina could take this one step further, following the lead of Arizona Governor Ducey who temporarily suspendied the requirement that Certified Registered Nurse Anesthetists (CRNAs) to be supervised by a physician.

5 Other Notable Steps Taken

South Carolina Department of Labor, Licensing and Regulation through its staff and professional boards has adopted a wide range of waivers for NursingPharmacyMarriage & Family TherapyMedicineOptometry, Speech Pathology, and Dentistry.

Driver Licenses and Vehicle Fees. The SCDMV will treat all driver licenses, commercial vehicle registrations, and temporary license plates that expired between March and June as valid until July 1, 2020. They will also waive late fees for vehicle registration renewals.

Alcohol Sales. Governor McMaster suspended regulations allowing the SC Department of Revenue to waive any regulation prohibiting curbside, in-vehicle, or to-go sales of sealed wine and beer on carry-out menus to aid struggling restaurants.

Tax filing. Governor McMaster announced that the state’s income tax filing deadline would be pushed to July 15, 2020.

Transport & Safety. Governor McMaster has waived certain trucking limits to allow for expedited shipment of needed medical supplies, among any other goods. The Governor, in conjunction with SLED, has also temporarily loosened restrictions on private security firms to allow for more temporary licenses to keep businesses and property safe.

9 NEW Action Items to Consider

Childcare Licenses. Tennessee Governor Lee waived some requirements for child care licenses, loosening restrictions to allow more temporary childcare facilities so parents can continue to work whenever possible.

Medical Student Licenses. Iowa Governor Reynolds issued an Executive Order to reduce number of hours of experience needed for medical students to be licensed. This would allow for more students to begin working right away, increasing capacity for medical providers.

Inactive Practitioners. Maryland Governor Hogan issued an Executive Order allowing for previously licensed healthcare practitioners to work without needing to re-instate their expired licenses.

Allow for beer and wine delivery to save South Carolina’s breweries. According to a survey done by the South Carolina Brewers Guild, 65% of South Carolina breweries say they’ll only be able to last between one and three months without extra relief. Many SC breweries have said that waiving restrictions on beer delivery would be help them survive. States such as California and Alaska have already implemented similar measures.

Hunting & Fishing Licenses. Indiana Department of Natural Resources has extended the expiration date on all basic hunting and fishing licenses from the end of March to May 22, 2020. Fishing and hunting can mean food for families in South Carolina.

CME Credit for Battling COVID-19. Michigan Governor Whitmer signed an Executive Order allowing their Department of Licensing and Regulatory Affairs (LARA) to recognize hours worked responding to the COVID-19 crisis as applicable toward their Continuing Medical Education (CME) credits.

State hiring freeze and limiting unnecessary spending. Ohio Governor DeWine ordered a hiring freeze for State Agencies, Boards, and Commissions along with orders that state agencies work to cut unnecessary spending up to 20 percent for the remainder of this fiscal year and next fiscal year.

Join UEVHPA Compact. South Carolina is not among the eighteen states that have joined the Uniform Emergency Volunteer Health Practitioner Act (UEVHPA) for physicians. This compact is a long-term solution to emergency management that will allow physicians and practitioners to enter states with declared emergencies and perform services without getting licensed in that state. The legislature should take a good look at the possibilities joining that compact would open in the Palmetto State.

Allow for at-home barbering and hair styling. The Virginia Department of Professional and Occupational Regulation has told salon owners that they are allowed to visit client’s homes and perform services. Palmetto Promise spoke to a couple South Carolina hairdressers who support this safe and convenient option that is currently illegal under South Carolina law.