Bulletins




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Bulletin: Ventilator Guidelines

Post Date: 11/14/2017 - 4:22pm

Effective Dec. 1, 2017,SCDHHS will add criteria and prior authorization guidelines for ventilators to the Durable Medical Equipment (DME) Provider Manual for DME providers. This policy will be posted in the DME Provider Manual located on the SCDHHS website.

Bulletin: Updates to the Seclusion and Restraint Reporting Form

Post Date: 09/01/2017 - 4:53pm

The South Carolina Department of Health and Human Services (SCDHHS) will update the form for reporting seclusion and restraint. The form will contain an additional field indicating who ordered the restraint. The manual will also be updated to include this additional requirement. The new form must be used for all seclusion and restraint reports beginning Oct. 1, 2017.

Bulletin: Children’s Private Duty Nursing Staffing Requirement Change

Post Date: 09/01/2017 - 9:37am

Effective Oct. 1, 2017, in lieu of having one year of pediatric nursing experience in a clinical setting, nursing providers may submit a pediatric nurse training program for registered nurses (RNs) and licensed practical nurses (LPNs) to SCDHHS for review and potential approval.

Bulletin: Pervasive Developmental Disorder (PDD) Waiver Termination

Post Date: 06/26/2017 - 2:45pm

The Centers for Medicare and Medicaid Services (CMS) issued an informational bulletin clarifying Medicaid coverage of services to children with autism on July 7, 2014. As a result of that bulletin and extensive consultation with CMS, the Pervasive Developmental Disorder (PDD) Waiver will be terminated Dec. 31, 2017.

Bulletin: Updates to the Autism Spectrum Disorder (ASD) Transition Plan

Post Date: 06/23/2017 - 4:58pm

The South Carolina Department of Health and Human Services (SCDHHS) updated the autism spectrum disorder (ASD) services transition plan for delivery of ASD services. This plan supersedes the bulletin entitled “Transition Guidelines for Autism Services,” published May 4, 2017. The following outlines the instructions for providers of ASD services for services delivered on or after July 1, 2017.

Bulletin: Patient Centered Medical Home (PCMH) Incentive Update

Post Date: 06/22/2017 - 4:57pm

The South Carolina Department of Health and Human Services (SCDHHS) is informing all practices currently recognized by the National Committee for Quality Assurance (NCQA) as a patient-centered medical home (PCMH) or who have applied or are considering applying for PCMH certification that the following modifications are being made to its PCMH incentive program, effective July 1, 2017.

Bulletin: Monthly Prescription Limit

Post Date: 06/15/2017 - 4:17pm

Effective with dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will no longer limit the number of prescriptions available to Medicaid beneficiaries.

Bulletin: Updates to Autism Spectrum Disorder (ASD) Provider Manual

Post Date: 06/09/2017 - 2:43pm

The South Carolina Department of Health and Human Services (SCDHHS) is updating the Autism Spectrum Disorder Services (ASD) Provider Manual. The updated ASD Provider Manual will be published on June 9, 2017 and will include three changes relative to the direct provision of services by applied behavior analysis (ABA) providers.

Bulletin: Changes to the Psychiatric Hospital Services Provider Manual Regarding Psychiatric Residential Treatment Facilities (PRTFs)

Post Date: 06/02/2017 - 4:46pm

Effective with dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will include psychiatric residential treatment facility (PRTF) services and providers in the coordinated care benefit provided by SCDHHS-contracted managed care organizations (MCOs). MCO members will access PRTF services through the MCO they have chosen or to which they have been assigned. Individuals not choosing or not mandatorily assigned to an MCO will continue to access PRTF services through the SCDHHS Medicaid fee-for-service (FFS) benefit. PRTFs serve beneficiaries 21 years of age and younger.

Bulletin: Modification to Codes that require Filing to TPL

Post Date: 06/02/2017 - 4:29pm

Effective for dates of service on or after July 1, 2017, and as required by 1902(a) (25) of the Social Security Act, the South Carolina Department of Health and Human Services (SCDHHS) will implement cost avoidance rules for the procedure codes reflected below. Service providers will be required to file claims to any liable third-party insurer before submitting a claim to SCDHHS for payment. Claims filed with SCDHHS prior to billing all liable third-party insurers and appropriately documenting the third party filing on the claim submitted to Medicaid will receive all applicable claim edits. Resolution of applicable claim edits for the issues described above are outlined in the appendices of each SCDHHS provider manual, located at https://www.scdhhs.gov/provider-manual-list .

Bulletin: Tobacco Cessation Coverage

Post Date: 06/02/2017 - 4:23pm

Effective with dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) is enhancing tobacco cessation coverage for full-benefit Medicaid beneficiaries to align with recommendations from the Centers for Disease Control and Prevention (CDC) and the American Lung Association (ALA). This update applies to both the fee-for-service and managed care Medicaid benefits.

Bulletin: Therapeutic Child Care (TCC) Requirements

Post Date: 06/02/2017 - 4:14pm

Effective with dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will allow therapeutic child care (TCC) providers to fulfill the requirement of parallel work with the primary caregiver by rendering family psychotherapy twice per month in conjunction with the TCC service. Family psychotherapy services provided to meet this requirement must be rendered within the stated frequency limits as outlined in the Rehabilitative Behavioral Health Services manual.

Bulletin: Adult Immunizations

Post Date: 05/26/2017 - 4:45pm

Effective for dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will cover the following vaccinations for Medicaid beneficiaries 19 years of age and older:

Bulletin: Coverage for Centering Pregnancy Group Prenatal Care

Post Date: 05/26/2017 - 4:41pm

Effective July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will update coverage for CenteringPregnancy group prenatal care services.

Bulletin: Transition Guidelines for Autism Services

Post Date: 05/04/2017 - 10:35am

As previously announced in a March 31, 2017, provider bulletin, autism spectrum disorder (ASD) treatment services will be added to the South Carolina Medicaid State Plan effective for dates of service on or after July 1, 2017.

Bulletin: Medicaid Policy Manual for Autism Spectrum Disorder

Post Date: 05/04/2017 - 10:31am

The South Carolina Department of Health and Human Services (SCDHHS) announces the new Medicaid Autism Spectrum Disorder (ASD) Provider Manual. This manual is effective July 1, 2017, and is to be used for program information and requirements, billing procedures and provider services guidelines.

Bulletin: CHANCE Waiver Services

Post Date: 05/01/2017 - 1:48pm

The Children's Health Access in Community Environments (CHANCE) waiver manual will be withdrawn from the South Carolina Department of Health and Human Services (SCDHHS) website effective June 1, 2017. The CHANCE waiver was a Psychiatric Residential Treatment Facilities (PRTF) community alternatives demonstration waiver. This waiver was discontinued in September 2014.

Bulletin: Autism Services

Post Date: 03/31/2017 - 1:36pm

Effective on or after July 1, 2017, Autism Spectrum Disorder (ASD) treatment services will be added to the South Carolina Medicaid State Plan.

Bulletin: Pre-fabricated Crown Benefits and Criteria

Post Date: 03/27/2017 - 9:53am

Effective for dates of service on or after May 1, 2017, there is no limitation to the number of pre-fabricated crowns that may be placed on a patient per day. This change aligns the South Carolina Department of Health and Human Services (SCDHHS) policy with the provisions of the South Carolina Dental Sedation Act of 2014, which allows administration of sedation or anesthesia, or both, in a dentist’s office.

Provider Alert: HEDIS® Tips

Post Date: 02/16/2017 - 3:26pm

Bulletin: State Plan Autism Spectrum Disorder Services Line Therapy Credential Requirements

Post Date: 12/01/2016 - 5:03pm

Effective July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will require that all applied behavior analysis (ABA) line therapists, providing treatment services to beneficiaries who have been diagnosed with Autism Spectrum Disorder (ASD) and approved for ASD services via the ASD Interim Process and/or the SC Medicaid State Plan, hold a Registered Behavior Technician (RBT) credential.

Bulletin: Inclusion of Advanced Practice Registered Nurses in ordering Medical Management Only

Post Date: 11/16/2016 - 11:10am

Effective Jan. 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will include Advanced Practice Registered Nurses (APRNs) as ordering providers of Medical Management Only (MMO) for providers under the Community Mental Health provider manual.

Bulletin: Policy Changes to SCDHHS LIPs Manual

Post Date: 11/10/2016 - 3:42pm

Individual Psychotherapy Frequencies & Clinical Service Notes Time Frame

Bulletin: Modification To Codes That Require Filing To Third-Party Insurers

Post Date: 11/08/2016 - 4:31pm

Effective for dates of service on or after Jan. 1, 2017, and as required by federal regulation, the South Carolina Department of Health and Human Services (SCDHHS) will implement cost-avoidance rules for the procedure codes reflected below.

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