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Post date: 06/18/2013 - 9:55am

SCDHHS is hosting a follow up meeting on June 28, 2013 from 10:00 AM to 12:00 PM at the Blue Cross Blue Shield of South Carolina facility at 8901 Farrow Road, Building 200, in Columbia.

Post date: 06/17/2013 - 8:38am

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after July 22, 2013.

Post date: 06/17/2013 - 8:29am

Effective for services provided on or after July 1, 2013, The South Carolina Department of Health and Human Services (SCDHHS) will increase reimbursement for Adult Day Health Care Services.

Post date: 06/12/2013 - 3:20pm

The South Carolina Department of Health and Human Services (SCDHHS) hosted Open Forums to receive input on the future of how SCDHHS provides Non-Emergency Medical Transportation (NEMT) services on January 28, 2013 and April 15, 2013.

Post date: 06/11/2013 - 2:44pm

As part of the South Carolina Department of Health and Human Services (SCDHHS) focus on providing the most health for beneficiaries at the least cost to taxpayers, SCDHHS reintroduces its Health Insurance Premium Payment (HIPP) program.

Post date: 06/07/2013 - 11:33am

The South Carolina Department of Health and Human Services (SCDHHS) is a 2013 National Committee for Quality Assurance (NCQA) Recognition Program Sponsor for Patient Centered Medical Homes (PCMH).

Post date: 05/31/2013 - 3:18pm

South Carolina Department of Health and Human Services (SCDHHS) will be making important changes to the South Carolina State-approved Nurse Aide Training Program (NATP) requirements. These changes will be effective as of July 1, 2013.

Post date: 05/17/2013 - 2:55pm

The South Carolina Department of Health and Human Services (SCDHHS) is pleased to announce that Health Management Systems, Inc., (HMS) has been awarded a contract to act as the agency’s Recovery Audit Contractor. Federal regulations (42 CFR 455.500 et. Seq.) require States to establish a recovery audit contract (RAC) program as a measure to promote the integrity of the Medicaid program. HMS previously was the SCDHHS recovery audit contractor and will continue in this role under the new procurement. HMS was founded in 1974 and is a national corporation specializing in healthcare cost containment and program integrity.

Post date: 05/17/2013 - 12:55pm

The South Carolina Department of Health and Human Services (SCDHHS) is expanding the availability of behavioral health pediatric screening tools and providing guidance on the utilization of these tools. Best practice indicates that standardized screenings of this type are recommended to be done during the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) visits or as dictated by clinical need. This recommendation is in alignment with the American Academy of Pediatrics (AAP) recommendations regarding screening and surveillance of family and social environment for risk factors and mental health screening of children and adolescents in primary care settings.

Post date: 05/16/2013 - 3:06pm

This session will inform individual practitioners on the basics of Stage 1 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Learn if you are eligible, and if so, what you need to do to earn an incentive. This is the first in a series of 6 National Provider Calls on the Medicare and Medicaid EHR Incentive Programs. Other topics include: Stage 2, clinical quality measures, hardship exceptions, payment adjustments, and a discussion on certification by the Office of the National Coordinator for Health Information Technology.

Post date: 05/08/2013 - 11:01am

Health and Human Services (HHS) released new data showing significant variation across the country and within communities in what hospitals charge for common inpatient services.

Post date: 05/03/2013 - 1:11pm

The Centers for Medicare and Medicaid Services (CMS) has informed SCDHHS that the State Plan amendment must be approved before these enhanced payments can be made. Along with most states, SCDHHS is awaiting CMS approval and therefore cannot make payments for this program.

Post date: 05/02/2013 - 10:01am

The South Carolina Department of Health and Human Services will host an open forum to receive input on the administration and management of the Medicaid Pharmacy program. The current Administrative Services contract with Magellan Health will expire on March 18, 2014.

Post date: 04/30/2013 - 3:59pm

The South Carolina Department of Health and Human Services will host an open forum to receive input on the administration and management of the Medicaid Vision program. The current Administrative Services contract with Robertson Optical will expire on January 1, 2014.

Post date: 04/19/2013 - 7:29pm

For providers who have been impacted by the 775 edit (Early Delivery <39 weeks not medically necessary), we have identified an internal processing error causing properly billed claims to be rejected. This issue has been corrected and all previously submitted claims will be reviewed and reprocessed for payment date of May 3. There is no additional action necessary from providers. We apologize for any inconvenience this has caused and appreciate your participation in SC Medicaid.

Post date: 04/15/2013 - 11:32am

Effective for dates of services on or after April 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will cover CPT codes:

Post date: 04/08/2013 - 9:14am

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: 04/05/2013 - 1:26pm

The South Carolina Department of Health and Human Services (SCDHHS) has implemented policy to assist providers who have attested for the Affordable Care Act (ACA) Enhanced Physician Program. Some providers may need to terminate the effective dates of inclusion into this program, effective January 1, 2013 through December 31, 2014. The following are two instances where a provider may need to end his/her enrollment.

Post date: 04/05/2013 - 1:16pm

In §6407 of the Affordable Care Act (Pub.L. 111-148) Congress added some conditions on the coverage of Durable Medical Equipment (DME). The Centers for Medicare and Medicaid Services (CMS) has proposed implementing changes to the DME regulations which also clarify the federal agency’s position as to the availability of incontinence and other supplies and equipment under the Medicaid State Plan Home Health benefit. See 76 FR 41032–41039 (July 12, 2011).

Post date: 04/04/2013 - 4:18pm

The South Carolina Department of Health and Human Services (SCDHHS) hosted an Open Forum to receive input on the future of how SCDHHS provides Non-Emergency Medical Transportation (NEMT) services on January 28, 2013.

Post date: 03/27/2013 - 3:14pm

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented the Affordable Care Act (ACA) final rule, increasing Medicaid reimbursements for evaluation and management and immunization services to 100 percent of Medicare reimbursement in 2013 and 2014. The increase applies to both fee-for-service (FFS) and managed care organization (MCO) plans.

Post date: 03/27/2013 - 3:07pm

On January 16, 2009, the U.S. Department of Health and Human Services (HHS) published a final rule on the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10 CM/PCS), requiring all HIPAA-covered entities to adopt the ICD-10- CM/PCS (diagnosis/inpatient procedure codes) by October 1, 2014.

Post date: 03/27/2013 - 1:35pm

The South Carolina Department of Health and Human Services (SCDHHS) was notified by the Centers for Medicare and Medicaid Services (CMS) in July 2010 the IPC program had to be reconfigured in order to comply with federal guidelines. SCDHHS is submitting an amendment to delete the program from the State Medicaid Plan with an effective date of July 1, 2013.

Post date: 03/27/2013 - 1:30pm

Three Regional Provider Training Events to Review Provider Enrollment and Requirements for the Optional Supplemental Care for Assisted Living Program (OSCAP).

Post date: 03/20/2013 - 9:58am

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: 03/18/2013 - 12:47pm

On January 12, 2013, Governor Nikki Haley filed an Executive Order to establish a Regulatory Review Task Force to evaluate South Carolina's current regulatory burdens on businesses and to propose recommendations to relieve those burdens. As part of this review, the Task Force will evaluate reports submitted by agencies that identify current and proposed statutes, rules, regulations and policies that are a burden on South Carolina's economy. All Cabinet agencies must submit a written report to the Task Force by May 15, 2013.

Post date: 03/01/2013 - 1:47pm

The South Carolina Department of Health and Human Services (SCDHHS) is pleased to announce the PRTF Alternative CHANCE Waiver Provider Manual. This manual is effective April 1, 2013, and is to be used for program information and requirements, billing procedures, and provider services guidelines. Providers should carefully review this manual in order to be compliant with policy guidelines.

Post date: 02/28/2013 - 4:04pm

The South Carolina Department of Health and Human Services (SCDHHS) has updated the fee schedule for long acting reversible contraceptive drug codes A4264, J7302, and J7307. Please refer to the Injectable Drug Fee schedule located at www.scdhhs.gov; this fee schedule is updated quarterly.

Post date: 02/27/2013 - 1:50pm

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented the Affordable Care Act (ACA) increasing Medicaid reimbursements for evaluation and management and immunization services to 100 percent of Medicare reimbursement in 2013 and 2014. The increase applies to both fee­ for-service (FFS) and managed care organization (MCO) plans.

Post date: 02/26/2013 - 9:59am

The South Carolina Department of Health and Human Services will host an open forum to receive input on the administration and management of the Medicaid dental program. The current Administrative Services contract with DentaQuest will expire on June 7, 2014.

Tags: Dental
Post date: 02/21/2013 - 11:42am

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: 02/08/2013 - 4:26pm

SCDHHS has updated its reimbursement calculations for Medicare Deductible, Coinsurance, and Blood Deductibles to reflect the new 2013 Medicare Rates for Dually Eligible Medicaid members.

Post date: 02/01/2013 - 2:16pm

The Centers for Medicare and Medicaid Services (CMS) revises the nomenclature within the HCPCS/CPT each quarter. When a HCPCS/CPT code is deleted, the SC Medicaid program will discontinue coverage of the deleted code and new procedure codes for behavioral health services may be added. The SC Medicaid program will not accept billing of discontinued codes for dates of service on the date on which the code is discontinued.

Post date: 01/31/2013 - 9:32am

Post date: 01/28/2013 - 4:18pm

Effective immediately the following National Drug Codes (NDCs) may be billed through the Point of Sale (POS) system and do not require Prior Authorization:

Post date: 01/16/2013 - 2:22pm

As the South Carolina Department of Health and Human Services (SCDHHS) nears the expiration date of the Broker contracts for Non-Emergency Medical Transportation (NEMT), the agency will host an Open Forum to receive input on the future of how SCDHHS provides the NEMT service. The meeting is open to the public and will be held on January 28, 2013 from 10:00 AM to 12:00 PM at the Department of Juvenile Justice Bill Rogers Community Connections Center

Post date: 01/14/2013 - 10:30am

The Centers for Medicare and Medicaid Services (CMS) have announced that the Enrollment Application fee for calendar year 2013 will increase to $532.00. This fee is required with any applicable enrollment application submitted on or after January 1, 2013 and on or before December 31, 2013.

Post date: 01/14/2013 - 10:21am

The new approved Administrative Day Rates have been posted and can be viewed on the South Carolina Department of Health and Human Services website at www.scdhhs.gov under the Hospital Services Provider Manual. The rates are as follows:

Post date: 01/08/2013 - 2:14pm

Increased Medicaid Payments for Primary Care

Post date: 01/07/2013 - 9:56am

Post date: 12/19/2012 - 9:36am

Race to the Date is a South Carolina Department of Health and Human Services (SCDHHS) initiative through our Birth Outcomes Initiative project to incentivize hospitals to become “Baby-Friendly” by promoting breast milk as the standard for infant feeding. The goal of the project is to increase the number of Baby-Friendly hospitals in South Carolina. All infants in the facility should be considered to be breastfeeding infants unless, after giving birth and being offered help to breastfeed, the mother has specifically stated that she has no plans to breastfeed.

Tags: Hospitals
Post date: 12/14/2012 - 4:41pm

Effective February 1, 2013 the South Carolina Department of Health and Human Services (SCDHHS) will implement the following changes to the Federally Qualified Healthcare Center (FQHC) and Rural Health Center (RHC) enrollment and claims submission criteria. These changes are being made in accordance with the implementation of new Medicaid provider enrollment and screening regulations, as published by the Centers for Medicare and Medicaid Services (CMS). These regulations have been developed under standards established by the Affordable Care Act.

Post date: 12/14/2012 - 4:29pm

The South Carolina Department of Health and Human Services (SCDHHS) in collaboration with our Coordinated Care Improvement Group has identified and targeted key withhold and incentive categories to assist us in measuring and supporting quality outcomes.

Post date: 12/14/2012 - 2:15pm

In a further effort to provide beneficiaries with comprehensive care, effective February 1, 2013, alcohol, drug, and substance abuse treatment services provided by the Department of Alcohol and Other Drug Abuse Services (DAODAS), and its thirty-three (33) subcontracted county authorities, will be part of the Managed Care Organizations (MCOs) core benefit package.

Post date: 12/14/2012 - 10:12am

The South Carolina Department of Health and Human Services (SCDHHS) is announcing the statewide integration of the Community Health Worker (CHW) into eligible primary care practices under the Department’s Health Access at the Right Time (HeART) initiative.

Post date: 12/13/2012 - 4:47pm

Effective January 7, 2013, the Division of Community Long Term Care (CLTC) will centralize intake activities for all programs operated by CLTC. This includes referrals for nursing home placement, nursing home conversion, Pre-Admission Screening Resident Review (PASRR), home and community based waiver services, children’s personal care and nursing services, and Katie Beckett Medicaid Program (TEFRA). When intake activities are centralized, referrals will no longer be accepted at the CLTC Regional Offices. Referrals will only be accepted by one of the methods below.

Post date: 12/13/2012 - 4:20pm

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will exclude coverage for barbiturates “used in the treatment of epilepsy, cancer, or a chronic mental health disorder” and benzodiazepines for dual eligible individuals (Medicare/Medicaid). This exclusion of coverage applies only to dual eligible individuals.

Post date: 12/13/2012 - 4:15pm

Effective for dates of service on or after January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will no longer provide reimbursement for elective inductions or non–medically indicated deliveries prior to 39 weeks to hospitals and to physicians. This change is a result of an extensive effort and partnership by SCDHHS, South Carolina Hospital Association, South Carolina Chapter of the American Congress of Obstetricians & Gynecologists, Maternal Fetal Medicine physicians, BlueCross BlueShield of SC and other stakeholders to reduce non-medically necessary deliveries.

Post date: 12/07/2012 - 3:21pm

Effective with dates of service on or after January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will require prior authorization (PA) for Inpatient Psychiatric Services for Children Under 21 from our Quality Improvement Organization (QIO), KePRO. PA requests must meet the requirements for Certification of Need (CON) for Children Under 21 admitted for psychiatric services.

Post date: 12/07/2012 - 9:43am

Effective for dates of service on or after January 1, 2013, the following procedure codes will no longer be accepted by the South Carolina Department of Health and Human Services (SCDHHS).

Tags: Dental

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