Bulletins




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Bulletin: SCDHHS Offers Free Provider Workshops Oct-Dec 2012

Post Date: 10/03/2012 - 11:49am

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.

Bulletin: National Correct Coding Initiative

Post Date: 09/27/2012 - 12:50pm

Effective on or after October 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will implement the National Correct Coding initiative (NCCI) Procedure to Procedure (PTP) edits for Durable Medical Equipment (DME). This will affect services related to wheelchair bases (WCB), wheelchair options and accessories (WCOA), and wheelchair seating (WSC).

Bulletin: South Carolina Medicaid Preferred Drug List

Post Date: 09/24/2012 - 3:58pm

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after October 15, 2012.

Bulletin: SCDHHS team highlights initiatives at national Medicaid conference

Post Date: 09/18/2012 - 4:12pm

A team from the South Carolina Department of Health and Human Services (SCDHHS) was awarded a top poster prize at the 2012 Medicaid Enterprise Systems Conference (MESC) in Boston Aug. 19-23

Bulletin: ADDITIONAL SERVICES PERFORMED BY KEPRO

Post Date: 09/12/2012 - 2:20pm

Effective with dates of service on or after October 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will require prior authorization (PA) for the following services and medical record pre-payment review from our Quality Improvement Organization (QIO), KePRO.

Bulletin: SCDHHS Offers Free Provider Workshops

Post Date: 09/07/2012 - 11:16am

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.

Bulletin: Modification to Rehabilitative Therapy Checkpoint

Post Date: 09/06/2012 - 3:52pm

Effective immediately, the South Carolina Department of Health and Human Services (SCDHHS) will be modifying the rehabilitative therapy checkpoint. The checkpoint consists of combined hours of service to include speech-language pathology, occupational, and physical therapy for all individuals under age 21.

Bulletin: Home and Community Based Waivers Rate Increases for Personal Care Services

Post Date: 08/24/2012 - 4:51pm

Effective September 1, 2012, The South Carolina Department of Health and Human Services (SCDHHS) will increase reimbursement for Personal Care Services in the Home and Community Based waiver programs.

Bulletin: Home and Community Based Waivers Rate Increases for Community Long Term Care waiver programs

Post Date: 08/24/2012 - 4:45pm

Effective September 1, 2012, the South Carolina Department of Health and Human Services will increase reimbursement for case management services in two (2) Community Long Term Care waiver programs.

Bulletin: Change in Ramp Specifications for Community Long Term Care Waivers

Post Date: 08/24/2012 - 4:40pm

Effective September 1, 2012, the South Carolina Department of Health and Human Services will change the specifications for building ramps in the Community Long Term Care waiver programs. These modifications include new requirements for all ramp construction. There will no longer be separate requirements for heavy duty and regular ramps.

Bulletin: SCDHHS announces new members of its fiscal team

Post Date: 08/16/2012 - 11:20am

COLUMBIA, S.C. — The South Carolina Health and Human Services (SCDHHS) announced Thursday the addition of two new positions to its Fiscal Affairs division, completing an overhaul of the way the agency manages the state’s $6 billion a year Medicaid budget.

Bulletin: SCDHHS Director Anthony Keck named to national Medicaid board

Post Date: 08/07/2012 - 8:47am

COLUMBIA, S.C. — South Carolina Health and Human services Director Anthony Keck has been named to serve on the board of the National Association of Medicaid Directors (NAMD) representing the Southern region.

Bulletin: Home Again Program Implementation

Post Date: 08/06/2012 - 1:27pm

The South Carolina Department of Health and Human Services (SCDHHS) will implement the Home Again program beginning September 1, 2012. Home Again is part of the national initiative called The Money Follows the Person Rebalancing Demonstration Program administered by the Centers for Medicare and Medicaid Services (CMS).

Bulletin: Credit Balance Recovery

Post Date: 08/03/2012 - 8:41am

The South Carolina Department of Health & Human Services (SCDHHS) is continuing its Credit Balance Review project. We have enlisted our Medicaid Insurance Verification Services (MIVS) contractor, Blue Cross Blue Shield of South Carolina (BCBSSC), to carry out this initiative. A Credit Balance is a positive amount that remains in a patient’s account which may have resulted from multiple reimbursements from several payers, adjustments to previously paid claims of a provider, duplicate payment, or subrogation events due to accidents and other injury cases. When another third party payer reimburses a provider for claims that Medicaid paid, either in part or in full, a refund is due to the Medicaid Program. The Medicaid agency must take all reasonable measures to ascertain the legal liability of third parties to pay for care and services available under the state Medicaid plan. A Credit Balance review is one of many methods that assist the agency in meeting this obligation.

Bulletin: South Carolina Medicaid to fight lawsuit filed by drugmaker; will continue to make “17P” available to expectant mothers who need it

Post Date: 07/31/2012 - 12:01pm

COLUMBIA, S.C. — The South Carolina Department of Health and Human Services (SCDHHS) announced today it will vigorously defend itself against a lawsuit filed in federal court earlier this month by drug manufacturer K-V Pharmaceutical Co. K-V also filed separate suits against Georgia and the U.S. Food and Drug Administration.

Bulletin: Convenient Care Clinics Provider Enrollment and Place of Service Code 17

Post Date: 07/27/2012 - 5:02pm

Effective with dates of service on or after August 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) provider enrollment policy will now allow Convenient Care Clinics (CCC) to enroll as a provider group for billing purposes. CCC’s are located in retail stores, supermarkets and pharmacies and are able to treat uncomplicated minor illnesses and provide preventative healthcare services. They are often referred to as retail clinics, retail-based clinics or walk-in medical clinics.

Bulletin: New Services Performed by KePRO, the Quality Improvement Organization (QIO) for S.C. Medicaid

Post Date: 07/27/2012 - 4:52pm

Effective August 1, 2012 the following will be added to the list of services that require prior authorization (PA) from KePRO.

Bulletin: Four Regional Provider/Stakeholder Meetings To Explore Options For Optional State Supplementation (OSS) Program

Post Date: 07/27/2012 - 11:36am

The South Carolina Department of Health and Human Services (SCDHHS), South Carolina Department of Mental Health (SCDMH), and the Adult Protection Coordinating Council will sponsor four regional stakeholder meetings focusing on issues related to Community Residential Care Facilities (CRCFs). These meetings will explore topics related to program enhancements for OSS, SCDMH funded services for consumers in CRCFs, and future initiatives improving quality of care in these facilities. The purpose of the sessions is to solicit input and program recommendations.

Bulletin: SC Medicaid beneficiaries final week to sign-up for free credit monitoring

Post Date: 07/23/2012 - 3:00pm

COLUMBIA, S.C. — South Carolina Medicaid beneficiaries whose personal information was included in April’s improper release of data are reminded that they have one week left until Tuesday, July 31, to sign up for free credit monitoring offered by the South Carolina Department of Health and Human Services (SCDHHS).

Bulletin: Hospice Care for Children in Medicaid

Post Date: 07/10/2012 - 2:32pm

Effective immediately, the South Carolina Department of Health and Human Services will provide reimbursement for hospice services for children under 21 years of age in conjunction with curative treatment of the child’s terminal illness.

Bulletin: SCDHHS Offers Free Provider Workshops July - September 2012

Post Date: 07/09/2012 - 2:49pm

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.

Bulletin: Birth Outcomes Initiative Modifiers

Post Date: 07/09/2012 - 10:52am

In July 2011, the South Carolina Department of Health and Human Services (SCDHHS) began partnering with the South Carolina Hospital Association (SCHA), the March of Dimes, other state agencies, public and private providers and payors, consumers and advocacy groups in an effort to reduce the number of low birth weight babies born in South Carolina. One of the first steps towards this goal was the elimination of non-medically necessary elective inductions and elective cesareans prior to 39 weeks gestation.

Bulletin: Medicaid Provider Service Center

Post Date: 07/03/2012 - 11:33am

The South Carolina Department of Health and Human Services (SCDHHS) has made important changes to its provider services, support and relations procedures in order to better serve you. SCDHHS consolidated operations to provide a single point of contact through the Medicaid Provider Service Center (PSC) at 1-888-289-0709 and expanded the ways in which providers can contact us. This will allow us to more effectively respond to your requests and track your needs.

Bulletin: Services Performed by KePRO, the Quality Improvement Organization (QIO) for S.C. Medicaid

Post Date: 06/29/2012 - 8:42am

This bulletin is to notify you that the July 1, 2012 effective date to automatically reject claims that require an authorization number from KePRO, if the authorization number is not present on the claim or is invalid, has been delayed until August 1, 2012. The delay is due to required detailed testing of the claims processing system which is necessary to minimize the potential for rejecting claims in error. This policy affects Medicaid Fee-For-Service members including members enrolled in Medical Home Networks (MHNs).

Bulletin: South Carolina Medicaid Preferred Drug List

Post Date: 06/26/2012 - 1:48pm

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after August 1, 2012.

Bulletin: Continuation of the IPC Program

Post Date: 06/22/2012 - 2:39pm

By a letter dated June 6, 2012, you were advised of the ongoing dialogue between the South Carolina Department of Health and Human Services (SCDHHS) and the Centers for Medicare & Medicaid Services (CMS) concerning our Integrated Personal Care (IPC) Service. The letter stated that the IPC program would no longer accept new referrals, effective June 15, 2012. SCDHHS is hereby rescinding the June 6, 2012 letter.

Bulletin: SCDHHS appoints CFO to oversee state Medicaid budget

Post Date: 06/20/2012 - 12:04pm

COLUMBIA, S.C. — The South Carolina Department of Health and Human Services (SCDHHS) announced today the appointment of Ruth Johnson to serve as the agency’s new chief financial officer (CFO). Reporting to the Director, her responsibilities will include financial management of the state’s $5.5 billion Medicaid program, which serves more than 1 million low-income, elderly and disabled South Carolinians. She begins work July 9 after moving her family to Columbia.

Bulletin: Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Periodicity Schedule

Post Date: 06/14/2012 - 1:48pm

Effective with dates of service on or after July 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) is updating the periodicity schedule for EPSDT services to include eight (8) additional preventative visits for recipients under 21 years of age.

Bulletin: Absolute Total Care-Corrective Action Plan to Address Non-compliance

Post Date: 06/14/2012 - 12:23pm

This bulletin is to notify all service providers that effective immediately the South Carolina Department of Health and Human Services (SCDHHS) has placed the Managed Care Organization (MCO) Absolute Total Care (ATC), a subsidiary of Centene Corporation, on notice that a Corrective Action Plan (CAP) is required in accordance with Section 13.7 of the SCDHHS contract.

Bulletin: A. Nursing Facility Bed Locator B. Complex Care Program

Post Date: 06/13/2012 - 4:17pm

The South Carolina Department of Health and Human Services (SCDHHS) will sponsor four regional trainings to introduce two new initiatives, the Nursing Facility Bed Locator (NFBL) and the Complex Care Program (CCP).

Bulletin: Services Performed by KePRO, the Quality Improvement Organization (QIO) for S.C. Medicaid

Post Date: 05/16/2012 - 10:27am

Effective June 1, 2012, KePRO will begin operations as the QIO for the South Carolina Department of Health and Human Services (SCDHHS), Medicaid. KePRO will be responsible for prior authorization (PA) of services as well as pre-payment and/or medical record review of select services. Patients with Medicare as primary payor are only required to obtain a PA if Medicare does not make a payment or the service is not covered by Medicare and Medicaid then becomes primary. Please note that Managed Care Organizations will continue to authorize services according to their specific plans for enrolled beneficiaries (members). Case Managers and Service Coordinators for CLTC and DDSN home and community-based waiver programs will continue to authorize services for their waiver participants.

Bulletin: New Provider Enrollment and Screening Requirements

Post Date: 05/09/2012 - 1:19pm

The South Carolina Department of Health and Human Services (SCDHHS) will be implementing new provider enrollment and screening regulations published by the Centers for Medicare and Medicaid Services (CMS).

Bulletin: SCDuE Proposal Public Comment Period and Meeting

Post Date: 05/09/2012 - 10:15am

The public comment period closes on Wednesday, May 16th at 5:00 PM Eastern. Please visit the SCDuE web site (https://msp.scdhhs.gov/scdue/) to download the proposal. Two of three consumer-focused public meetings remain. These two meetings are scheduled for Wednesday, May 9th in Columbia and Friday, May 11th in North Charleston. Please submit Letters of Support by Wednesday, May 23rd.

Bulletin: SCDHHS joins national payment reform effort

Post Date: 05/07/2012 - 11:08am

COLUMBIA, S.C. — The South Carolina Department of Health and Human Services (SCDHHS) announced Monday that it has joined forces with several of the nation’s largest employers and other health care purchasers in an initiative to create more value in today’s health care system by improving how health care providers are paid.

Bulletin: SCDHHS Offers Free Provider Workshops May - July 2012

Post Date: 05/03/2012 - 4:40pm

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.

Bulletin: SCDHHS working with DSS to improve customer service, access to assistance

Post Date: 04/26/2012 - 1:39pm

Fragile households seeking solid footing in a weak economy will receive reinvigorated support as Colorado, Idaho, Illinois, North Carolina, Rhode Island, and South Carolina take up the challenge of streamlining services aiding low-income working families. The six states have been awarded three-year grants to test and implement easy-to-navigate, quick-to-deliver public benefit systems. The grants, the centerpiece of the Work Support Strategies: Streamlining Access, Strengthening Families (WSS) initiative, average about $460,000 per state for each year.

Bulletin: Improper Release of Beneficiary Information

Post Date: 04/19/2012 - 8:39am

Last week, the South Carolina Department of Health and Human Services (SCDHHS) discovered that a Medicaid employee inappropriately transferred personal information for 228,435 Medicaid beneficiaries to his personal email account, constituting a violation of agency policy.

Bulletin: Quality Improvement Organization (QIO) Training Session

Post Date: 04/17/2012 - 9:27am

The South Carolina Department of Health and Human Services (SCDHHS) will co-sponsor provider/facility training with Keystone Peer Review Organization, Inc. (KePRO), the new QIO for Medicaid. KePRO will offer 4 regional trainings with morning sessions designated for facility staff. Afternoon sessions are designated for physicians and other medical professionals.

Bulletin: SC agencies working together to ensure health, safety of residents from closed North Charleston assisted living facility

Post Date: 04/12/2012 - 8:04pm

COLUMBIA, S.C. — Several state agencies are working with law enforcement to ensure the health and safety of residents of a North Charleston assisted living facility closed on Thursday by police. The closing comes after the owner of Fair Havens Manor on Cosgrove Avenue was arrested by North Charleston police Thursday morning. She is accused of neglecting the residents at the community residential care facility (CRCF), which was home to 15 vulnerable adults.

Bulletin: Clarification of Assumptive Eligibility for Pregnant Women

Post Date: 04/12/2012 - 3:14pm

South Carolina Department of Health and Human Services (SCDHHS) is clarifying that pregnant women applying for Medicaid under Optional Coverage for Pregnant Women and Infants (OCWI) may enter the program under assumptive eligibility provisions. If a woman declares that she is pregnant, and submits an application, she can be determined Medicaid eligible based on her attestation of income, resources, and citizenship for a 30-day period, while she is given the opportunity to return the necessary verification to determine continued eligibility.

Bulletin: New Medicaid Quality Improvement Organization (QIO)

Post Date: 04/12/2012 - 2:19pm

Effective March 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) began implementation of a contract with the Keystone Peer Review Organization, Inc. (KePRO), to serve as the new Quality Improvement Organization with an operational date of June 1, 2012.

Bulletin: SCDHHS Offers Free Provider Workshops - Apr -May -June 2012

Post Date: 04/09/2012 - 11:46am

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.

Bulletin: South Carolina Medicaid ICD-10 Web page

Post Date: 03/28/2012 - 10:30am

The South Carolina Department of Health and Human Services (SCDHHS) is pleased to announce its new web page dedicated to information related to the implementation of the International Classification of Diseases Version 10 (ICD-10), with a mandatory compliance date of October 1, 2013.

Bulletin: Training Workshop SBIRT

Post Date: 03/21/2012 - 1:59pm

The South Carolina Department of Health and Human Services (SCDHHS) is offering training to Medicaid enrolled Federally Qualified Health Clinics, Rural Health Clinics, Family Practice, and OB/GYN providers on Screening, Brief Intervention, and Referral to Treatment (SBIRT). SBIRT is an agency initiative, in partnership with other stakeholders, to help identify and offer treatment to pregnant beneficiaries who may have alcohol or other /substance dependence, depression, or domestic violence.

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