Bulletins

The Centers for Medicare and Medicaid Services (CMS) will measure the accuracy of Medicaid and CHIP payments made by states for services rendered to recipients through the Payment Error Rate Measurement (PERM) program.

Effective immediately the South Carolina Department of Health and Human Services (SCDHHS) is imposing a moratorium on the enrollment of Medicaid Targeted Case Management (MTCM) providers.

The South Carolina Department of Health and Human Services (SCDHHS) is revising the Rehabilitative Behavioral Health Services (RBHS) Policy Manual. Changes will be effective on or after April 1, 2016.

Beginning with dates of service on or after April 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will require that providers verify Medicaid members' controlled substance prescription history through the South Carolina Reporting & Identification Prescription Tracking System (SCRIPTS) before issuing a prescription for any Schedule II through IV controlled substance.

An update to sections three and four of the Ambulance Services Provider Manual will make a clear distinction between the current requirements for submitting claims with modifiers and origin/destination codes.

Effective Feb. 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will initiate an improved interim process by which its members are evaluated for and receive Autism Spectrum Disorder (ASD) services that are identified as medically necessary based on an Early and Periodic Screening Diagnosis and Treatment (EPSDT) encounter.

Effective immediately the South Carolina Department of Health and Human Services (SCDHHS) is rescinding the policy, bulletin 14-001 released Feb. 6, 2014, that allowed services delivered to recipients 21 years and over in place of service (62) Outpatient Rehabilitation Facility. Beneficiaries will continue to receive outpatient physical, occupational and speech therapies (PT/OT/SP) services in an outpatient hospital, clinic or office setting.

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”).

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

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:

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.

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

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.