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Post date: 12/11/2015 - 4:49pm

Post date: 12/10/2015 - 9:30am

The Centers for Medicare and Medicaid Services (CMS) recently amended policies regarding Medicaid reimbursement to Medicaid providers for the delivery of state plan-approved services that are available to Medicaid eligible beneficiaries, without charge to the beneficiary (including services that are available without charge to the community at large, or “free care”).

Post date: 12/04/2015 - 4:46pm

Changes will be effective on or after Jan. 1, 2016. The intent of this bulletin is to provide notice of general revisions; it is not intended to reflect all revisions in the manual.

Post date: 11/17/2015 - 1:53pm

Providers may use one of the methods listed below to verify Medicaid enrollment or verify the status of an individual’s application.

Post date: 11/12/2015 - 10:58am

SCDHHS will implement the following one-time change to the Rehabilitative Behavioral Health Services (RBHS) prior authorization (PA) schedule for beneficiaries age 0-21.

Post date: 10/29/2015 - 4:48pm

Post date: 10/29/2015 - 4:42pm

Post date: 10/28/2015 - 4:53pm

Post date: 10/26/2015 - 12:51pm

All licensed Physician Assistants (PAs) providing services to Healthy Connections beneficiaries must be enrolled as providers with the South Carolina Department of Health and Human Services (SCDHHS). PAs providing services to Medicaid Managed Care enrolled members must also be enrolled and credentialed with the member’s Managed Care Organization (MCO).

Post date: 10/01/2015 - 10:00am

Effective Nov. 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will implement modifications to the Rehabilitative Behavioral Health Services (RBHS) Policy Manual. These manual revisions will strengthen fee-for-service Medicaid requirements related to several areas of the provider manual including:

Post date: 09/29/2015 - 2:10pm

Update to the Hospital Services Provider Manual to reflect the Medicaid policy for immediate inpatient insertion of Long Acting Reversible Contraceptives (LARCs)

Tags: Hospitals
Post date: 09/28/2015 - 10:23am

The South Carolina Department of Health and Human Services (SCDHHS) will implement a review process on Medicaid Targeted Case Management Services (MTCM) rendered by private providers of MTCM. Effective Nov. 1, 2015, SCDHHS will reimburse for no more than 24 units per calendar quarter per beneficiary unless medical necessity has been demonstrated and approved through the prior authorization process defined in the Oct. 1, 2015, edition of the MTCM Provider Manual. The 24-unit allowance applies to any combination of face to face or telephonic MTCM. For the October-December 2015 calendar quarter, payment for services incurred in October 2015 in excess of the 24-unit limit will not be retroactively denied due to this change.

Post date: 09/24/2015 - 5:45pm

Post date: 09/16/2015 - 4:58pm

Post date: 09/15/2015 - 8:35am

Post date: 09/07/2015 - 1:58pm

Pre-eligibility Medical Expenses and Calculations of Recurring Income for Long Term Care Beneficiaries

Post date: 08/28/2015 - 10:44am

Effective Oct. 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will require providers to submit the 2012 American Dental Association (ADA) claim form, or its corresponding Electronic Data Interchange (EDI) format, when filing dental or oral surgical claims services using Common Dental Terminology (CDT) procedure codes. Previously used ADA claim forms and their accompanying EDI formats will be rejected for all claims submitted on or after Oct. 1, 2015.

Tags: Dental
Post date: 08/17/2015 - 6:46pm

Post date: 08/10/2015 - 10:57am

Post date: 07/31/2015 - 2:37pm

Post date: 07/23/2015 - 11:28am

The HIPP program is a cost-containment initiative that maintains premium payments for Medicaid beneficiaries who retain private health insurance when cost-effective to the Medicaid program. HIPP enrollment is contingent upon a HIPP applicant's Medicaid eligibility and cost-effectiveness.

Post date: 07/02/2015 - 4:46pm

Post date: 07/02/2015 - 3:14pm

SCDHHS will implement a policy for nutritional counseling. SCDHHS is currently enrolling Licensed Dietitians (LDs) and these providers will be able to provide nutritional counseling services for obesity, effective with dates of service on or after August 1, 2015.

Post date: 07/01/2015 - 11:54am

Post date: 06/26/2015 - 4:35pm

Post date: 06/25/2015 - 11:11am

Effective Aug. 1, 2015, the provider enrollment application fee will only be applicable to providers that the Centers for Medicare & Medicaid Services (CMS) has identified as institutional providers.

Post date: 06/24/2015 - 3:51pm

Effective Aug. 1, 2015, SCDHHS will amend the delivery method policy for Durable Medical Equipment (DME) providers.

Post date: 06/22/2015 - 9:44am

Beginning Aug. 17, 2015, the electronic claim submission web portal (Webtool) will be enhanced to allow the attachment of documentation to claims

Post date: 06/17/2015 - 1:45pm

Post date: 06/01/2015 - 9:55am

Effective Oct. 1, 2015, claims submitted to the South Carolina Department of Health and Human Services (SCDHHS) must include the ICD-10 diagnosis or procedure codes for any claim with a date of service or date of discharge on or after Oct. 1, 2015.

Post date: 05/26/2015 - 9:58am

This policy applies only to the S.C. Medicaid Fee-for-Service (FFS) benefit.

Post date: 05/26/2015 - 9:52am

Effective for dates of service on or after July 1, 2015, trained staff in a primary care setting must begin billing Current Procedural Terminology (CPT) code 99188 on the CMS-1500 form when applying fluoride varnish.

Post date: 05/22/2015 - 9:16am

Effective July 1, 2015, SCDHHS will no longer require incontinence supply providers to obtain a Medicaid Certificate of Medical Necessity (MCMN) (Form DME001) for gloves provided to Healthy Connections Medicaid members enrolled in the Community Support Waiver, Head and Spinal Cord Injury Waiver and Intellectual Disabilities/Related Disabilities Waiver.

Post date: 05/22/2015 - 9:11am

Effective with dates of service on or after July 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will carve out coverage for medications used to treat Hepatitis C Virus (HCV) from the Managed Care Organization (MCO) benefit.

Post date: 05/21/2015 - 1:31pm

Post date: 05/21/2015 - 1:17pm

Post date: 05/14/2015 - 10:37am

Post date: 05/06/2015 - 11:11am

SCDHHS no longer requires a physical examination during an initial Family Planning visit in order to prescribe hormonal contraception.

Tags: Physicians
Post date: 04/30/2015 - 3:38pm

Post date: 04/22/2015 - 12:54pm

Members 0-21 years old are eligible to submit requests for ASD services, including members currently on the Pervasive Developmental Disorder (PDD) Waiver waiting list as well as those whose PDD Waiver services have expired.

Post date: 04/20/2015 - 2:41pm

Providers enrolled in the South Carolina Healthy Connections Medicaid program must have their enrollment revalidated by SCDHHS on or before March 25, 2016.

Post date: 04/14/2015 - 11:31am

Post date: 04/13/2015 - 7:12pm

The South Carolina Department of Health and Human Services (SCDHHS) will implement the following changes to the Rehabilitative Behavioral Health Services (RBHS) policy. These changes apply to fee for service RBHS only and are effective May 1, 2015, unless otherwise specified in this bulletin.

Post date: 04/13/2015 - 9:52am

Post date: 03/31/2015 - 4:47pm

Effective January 1, 2015, SCDHHS added Current Procedural Terminology (CPT) code 96127 to break out the services of emotional and behavioral assessments from developmental screening reported with CPT code 96110.

Post date: 03/26/2015 - 12:49pm

Post date: 03/13/2015 - 3:57pm

Post date: 03/13/2015 - 12:38pm

On Feb. 20, the South Carolina Department of Health and Human Services (SCDHHS) released a bulletin on changes to the Rehabilitative Behavioral Health Services (RBHS) policy, effective March 1, 2015. These changes, which only apply to fee for service, include medical necessity and prior authorizations, staff credentials, staff to client ratio, frequency limits and reimbursement rates and modifier changes.

Post date: 03/02/2015 - 3:24pm

Changes to Federally Qualified Healthcare Centers (FQHCs) enrollment and claims submission criteria.

Post date: 02/24/2015 - 1:27pm


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