Public Notice of Final Action for Suspension of Ambulatory Care Visit Limit

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding the suspension of the ambulatory care visit limit under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective on or after May 11, 2023, SCDHHS will amend the South Carolina Title XIX State Plan to extend the suspension of the annual limit of 12 ambulatory care visits for one-year beyond the end of the current federal public health emergency (PHE) as the agency continues to evaluate data and collect feedback that will be used to establish a new annual limit on ambulatory care visits.

Prior to the COVID-19 PHE, ambulatory care visits for fee-for-service Medicaid members were limited to 12 per year for adult members aged 21 years and over. Fee-for-service ambulatory care visits beyond 12 required SCDHHS prior approval. During the COVID-19 PHE, State Plan Amendment 22-0013 temporarily waived the limit of 12 ambulatory care visits for adult members aged 21 years and over.

Based on the actions above, SCDHHS anticipates a budget impact of approximately $1,000,000 (total dollars) per year.

Copies of this notice are available at each South Carolina Healthy Connections Medicaid county office and at www.scdhhs.gov for public review. Additional information regarding these actions is available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at the SCDHHS, Bureau of Policy, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9 a.m. and 5 p.m.