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Post date: 11/03/2014 - 9:26am

The South Carolina Department of Health and Human Services (SCDHHS) currently contracts with six (6) Managed Care Organizations (MCOs). Each MCO currently operating in South Carolina has a small percentage of contracted network providers that have not enrolled directly with SCDHHS. The most recent contract between SCDHHS and each MCO requires that their contracted provider network also be enrolled directly with SCDHHS. This requirement was implemented to provide for accuracy in MCO reporting and to assist SCDHHS in monitoring and ensuring ongoing provider compliance.

Post date: 10/30/2014 - 2:41pm

Post date: 10/23/2014 - 11:43am

Effective with dates of service beginning December 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will implement an Adult Preventative Dental benefit. Medicaid enrolled dentists may seek reimbursement from the Fee-for-Service Healthy Connections program for preventative dental benefit services. These services are available to members age 21 and over that have full Healthy Connections benefits. Covered services include diagnostics, extractions, fillings and an annual cleaning, up to a maximum benefit of $750 per state fiscal year (July 1 through June 30). The $750 maximum benefit will be based on claim payments under the SCDHHS dental fee schedule.

Tags: Dental
Post date: 10/17/2014 - 11:01am

Effective for dates of service on or after November 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will implement a new program that offers Healthy Connections Medicaid coverage to persons with latent tuberculosis (TB) or active TB infection/disease who are uninsured or underinsured and who do not meet the eligibility criteria for full Healthy Connections Medicaid. This program will be administered through the South Carolina Department of Health and Environmental Control (SCDHEC).

Post date: 10/07/2014 - 4:11pm

Medicaid Basics, Comprehensive Web Tool, Overview of Third Party Liability and Overview of Claim-level Adjustments.

Post date: 09/30/2014 - 5:04pm

The following revisions will be incorporated into the South Carolina Department of Health and Human Services (SCDHHS) Community Long Term Care (CLTC) Scope of Service for Case Management effective November 1, 2014.

Post date: 09/26/2014 - 3:10pm

Post date: 09/24/2014 - 12:47pm

Post date: 09/18/2014 - 3:24pm

Post date: 09/16/2014 - 10:33am

Post date: 09/05/2014 - 10:08am

Post date: 08/29/2014 - 9:53pm

The South Carolina Department of Health and Human Services (SCDHHS) will add another component to the services of Mental Health Service Plan Development by a Non-physician. Effective for dates of service on or after October 1, 2014, Service Plan Development will include an Interdisciplinary Team component. This will allow providers to conduct service plan development meetings with an interdisciplinary team that may or may not include the client and/or family member.

Post date: 08/28/2014 - 4:04pm

Effective October 1, 2014, SCDHHS will begin to conduct medical assessments of Optional State Supplementation (OSS) residents. These medical assessments will be required of all residents within the program. The assessments will be in the form of a survey. Please note that the new medical assessment policy will not affect any resident’s standing within the program. To learn more about the new assessment policy please review the OSS Provider Manual on the South Carolina Department of Health and Human Services website.

Post date: 08/27/2014 - 9:56am

Attached is a schedule of the free provider workshops offered by the SCDHHS to include Medicaid Basics, Comprehensive Web Tool, Overview of Third Party Liability and Overview of Claim-level Adjustments.

Post date: 08/18/2014 - 2:43pm

Effective October 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) Estate Recovery Department will increase the minimum estate asset value upon which SCDHHS can file claims to $25,000 or more.

Post date: 08/11/2014 - 2:39pm

Post date: 08/11/2014 - 1:57pm

Effective August 1, 2014, The South Carolina Department of Health and Human Services (SCDHHS) will implement changes to the benefit structure for the Family Planning Eligibility Category, now to be known as Healthy Connections Checkup (Checkup).

Post date: 07/31/2014 - 9:17am

Post date: 07/31/2014 - 9:05am

Effective for dates of service on or after September 1, 2014, the South Carolina Department of Health and Human Services will begin covering most of the recommended preventive services defined by U. S. Preventive Services Task Force (USPSTF). The USPSTF recommended preventive services will be provided to Medicaid beneficiaries without cost sharing (co-payments).

Post date: 07/25/2014 - 12:40pm

Post date: 07/22/2014 - 2:57pm

Effective August 1, 2014, The South Carolina Department of Health and Human Services (SCDHHS) will implement changes to the benefit structure for the Family Planning Eligibility Category, now to be known as Healthy Connections Checkup (Checkup).

Post date: 07/03/2014 - 2:00pm

Schedule of the free provider workshops offered by theSCDHHS to include Medicaid Basics, Comprehensive Web Tool, Overview ofThird Party Liability and Overview of Claim-level Adjustments.

Post date: 07/03/2014 - 1:53pm

SCDHHS will partner with participating Family Practice (FP) physicians in Allendale, Bamberg, Barnwell, & Hampton counties for the provision of prenatal care up to, but excluding delivery for low risk pregnancies.

Post date: 07/02/2014 - 11:23am

The notice that was posted regarding Medicaid Targeted Case Management (MTCM) providers on June 26, 2014, pertaining to Medicaid Targeted Case Management was intended only for newly enrolled private providers of MTCM. The intent was to advise newly enrolled private providers of MTCM of potential policy changes reflecting “conflict free” care management. Below is the updated correspondence distributed to newly enrolled private providers of MTCM. We apologize for any inconvenience.

Post date: 06/25/2014 - 4:44pm

This bulletin is to provide clarification regarding the election of the Hospice benefit for beneficiaries currently receiving the Optional Supplemental Care for Assisted Living Participants (OSCAP) service. Beneficiaries of Hospice and OSCAP may only receive personal care through one service or the other; therefore, they must choose either Hospice or OSCAP. An OSCAP participant residing in a Community Residential Care Facility (CRCF) has the right to choose which service they receive, as well as the option to choose the provider who delivers that service, if all medical necessity criteria are met.

Tags: Hospice
Post date: 06/23/2014 - 3:01pm

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after August 1, 2014.

Post date: 06/05/2014 - 11:08am

On April 1, 2014, it was announced that the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the DHHS Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.

Post date: 05/29/2014 - 4:28pm

Effective on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will update its policy to recognize the South Carolina Department of Health and Environmental Control (DHEC) Pulse Oximetry Screening test on newborns to detect congenital heart defects. Pulse oximetry is a noninvasive test that estimates the percentage of hemoglobin in blood that is saturated with oxygen.

Post date: 05/29/2014 - 4:11pm

Effective for services provided on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will allow for coverage of inpatient psychiatric care for beneficiaries of Medicare and Medicaid who are 65 or older.

Post date: 05/28/2014 - 1:13pm

Effective on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) has amended its Hospital Services Provider Manual and revised the section regarding Hospital Acquired Conditions (HACs). This section of the Hospital Services Provider Manual will apply to all Provider Preventable Conditions (PPCs) to include not only Hospital Acquired Conditions (HACs), but also Never Events (NEs) and Other Provider Preventable Conditions (OPPCs). The HACs section of the manual has been clarified to include a listing of all codes for HACs, NEs, and OPPCs, the criteria for non-payment, and how these codes will be captured in Medicaid’s reporting systems. In addition, the section has been amended to add the following eight OPPCs to the non-payment policy:

Post date: 05/23/2014 - 12:54pm

Effective with dates of service on or after July 1, 2014, the following codes and billing procedures must be utilized in order to receive payment for the Screening, Brief Intervention and Referral to Treatment (SBIRT) services.

Tags: Physicians
Post date: 05/23/2014 - 11:57am

Effective July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) has reinstated the Psychiatric and Psychotherapy Services section of the Physicians, Laboratories, and Other Medical Professionals Manual. This section applies to all physicians, psychiatrists, and psychiatric nurse practitioners providing psychiatric services, as well as allied professionals who may provide psychotherapy services under the supervision of these professionals. The Psychiatric and Psychotherapy Services section has been revised to reflect 2013 Current Procedural Terminology (CPT) guidelines and outlines the guidelines for supervision of services provided by allied professionals.

Post date: 05/23/2014 - 11:43am

Effective July 1, 2014, incontinence supply providers will be responsible for obtaining the Physician Certification of Incontinence SCDHHS Form 168IS prior to delivering Incontinence supplies. This policy replaces the June 18, 2013, memo titled Changes in Incontinence Supplies Authorizations, section 2 Physician’s Orders.

Post date: 05/21/2014 - 2:46pm

On January 16, 2014, the Centers for Medicare and Medicaid Services (CMS) published the final rule related to home and community based services under Section 1915 of Title XIX. The final rule addresses long-term care services and supports through home and community-based service programs under the 1915(c), 1915(i), and 1915(k) Medicaid authorities in the most integrated setting appropriate. The rule will require considerable work to comply with, and we believe by working together it presents an opportunity to enhance the quality of life for the individuals and families we mutually serve.

Post date: 05/20/2014 - 11:12am

Schedule of the free provider workshops offered by the SCDHHS to include Medicaid Basics, Comprehensive Web Tool, Overview of Third Party Liability and Overview of Claim-level Adjustments.

Post date: 05/12/2014 - 5:04pm

Effective with dates of service on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will implement policy changes to the Referral and Authorization process for acquiring Rehabilitative Behavioral Health Services (RBHS) and Inpatient Psychiatric Services for Children Under 21. These changes are being made in an effort to increase beneficiary access to medically necessary services and to increase efficiency of the current referral and authorization process for behavioral health services.

Post date: 05/02/2014 - 4:00pm

Effective June 1, 2014, South Carolina Department Health and Human Services will amend the non-emergency transportation policy for self- administered oxygen dependent beneficiaries discharged from inpatient hospitals or emergency rooms. This policy change affects Hospitals, Physicians, Ambulance and Durable Medical Equipment (DME) providers. This policy change will also be posted in the Hospital, Physicians Laboratories and Medical Professional, Ambulance and Durable Medical Equipment manuals located on the SCDHHS website: www.scdhhs.gov.

Post date: 05/02/2014 - 3:55pm

Medicaid Basics, Comprehensive Web Tool, Overview ofThird Party Liability and Overview of Claim-level Adjustments.

Post date: 04/29/2014 - 1:28pm

In May, South Carolina Healthy Connections Medicaid will host a series of training sessions on upcoming changes in the referral process for RBHS and PRTF. The training will cover the changes to the manual including the new referral processes for RBHS and PRTF services. A Medicaid Bulletin announcing the new policy change will be published prior to the trainings. Please monitor the SCDHHS website at https://www.scdhhs.gov/Medicaid-Bulletins for this proposed change.

Post date: 04/11/2014 - 4:38pm

All providers should disregard the South Carolina Department of Health and Human Services’ (SCDHHS) Bulletin with release date of March 27, 2014 regarding a change in the Screening, Brief Intervention and Referral to Treatment (SBIRT) codes and billing procedures effective May 1, 2014.

Post date: 04/11/2014 - 9:22am

Medicaid Basics, Comprehensive Web Tool, Overview of Third Party Liability and Overview of Claim-level Adjustments.

Post date: 03/28/2014 - 2:30pm

The South Carolina Department of Health and Human Services (SCDHHS) is issuing this bulletin to offer guidance to Rehabilitative Behavioral Health and Local Education Agency Providers. A Licensed Bachelor’s Social Worker can sign the Individual Plan of Care (IPOC) for a Medicaid beneficiary when the IPOC is not used for the purpose of medical necessity. Effective May 1, 2014, this policy will be retroactive to August 1, 2013.

Post date: 03/28/2014 - 9:43am

KEPRO’s, the QIO, primary role is to prior authorize (PA) select Medicaid services including, but not limited to inpatient admissions, therapy services for adults and children and Durable Medical Equipment (DME). Effective April 1, 2014, the number of days required for providers to submit requests to the QIO as well as response times for the QIO to render determinations have been changed or revised as indicated below.

Post date: 03/28/2014 - 9:28am

Medicaid Targeted Case Management (MTCM) is an available Medicaid covered service that helps individuals in gaining access to doctors, social services, educational resources, jobs and other services. Anyone who is Medicaid eligible and meets one of the following categories may qualify for MTCM:

Post date: 03/28/2014 - 9:23am

The South Carolina Department of Health and Human Services (SCDHHS) will implement a change to the billing frequency for Family Training and Counseling services. Effective with dates of service on or after April 1, 2014, the maximum billing frequency for Procedure Code T1027 will increase to 16 units or 4 hours daily.

Post date: 03/14/2014 - 4:21pm

Effective on April 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will reinstate the Adult Emergency Dental benefit. Medicaid enrolled dentists may seek reimbursement from the Fee-for-Service Healthy Connections program for emergency dental services to adults. The new adult benefit adds extractions for the relief of severe and acute pain or an infectious process in the mouth for adults age 21 and over that are eligible for Healthy Connections dental benefits. This new benefit is in addition to the services currently covered for the treatment of exceptional medical services (Section 4.07 of the Dental Office Reference Manual) and for the provision of emergency medical CPT procedures by oral surgeons (Section 4.06 of the Dental Office Reference Manual).

Tags: Dental
Post date: 03/07/2014 - 11:17am

This April MTCM providers will be able to select from the following dates and times:

Post date: 02/28/2014 - 3:33pm

On February 21, 2014, SCDHHS notified providers that 1099s for the week of October 29, 2013 were overstated. SCDHHS has resolved the issue, and the agency mailed corrected 1099s on March 3, 2014 to the approximately 5,000 providers whose original 1099 was not correct.

Post date: 02/28/2014 - 10:49am

Beginning with dates of service on or after March 17, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will reimburse for outpatient utilization of long acting reversible contraceptives (LARC) through the pharmacy program. Any LARC billed to SCDHHS by a pharmacy will be shipped directly to the provider’s office for insertion. Providers should take extra care to ensure that they bill Medicaid only for reimbursement of the insertion of the device, and not the device itself, when it is obtained and billed through the pharmacy benefit.

Post date: 02/21/2014 - 4:46pm

It has come to our attention that SCDHHS incorrectly overstated payment on the IRS Form 1099 for some enrolled providers. Only providers included in the October 29, 2013 payment cycle are affected. We are working with our technical teams and have consulted with the IRS about the best approach to correct this information on your behalf.

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