Bulletins




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Provider Alert: FINAL NOTICE Address Change for SFTP-Based Medicaid Claims

Post Date: 12/30/2014 - 1:08pm

Provider Alert: Intensive Family Services (Procedure Code H0046)

Post Date: 12/19/2014 - 11:23am

Provider Alert: Provider Enrollment and Screening

Post Date: 12/18/2014 - 4:46pm

Bulletin: Sickle Cell Disease Management Program

Post Date: 12/18/2014 - 12:44pm

Effective on or after January 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will update its Disease Management program to include sickle cell disease. Sickle Cell Disease Management (SCDM) is available to Medicaid eligible individuals determined to have a confirmed diagnosis of sickle cell disease as defined by the Centers for Disease Control and Prevention (CDC) and are not simultaneously receiving Targeted Case Management or any other coordination/management service for sickle cell disease.

Provider Alert: SCDHHS and KEPRO to Hold Provider Quality Improvement Training

Post Date: 12/10/2014 - 3:47pm

Bulletin: SCDHHS Offers Free Provider Workshops

Post Date: 12/08/2014 - 11:43am

Medicaid Basics, Comprehensive Web Tool, Overview of Third Party Liability and Overview of Claim-level Adjustments.

Provider Alert: Deemed Baby Process

Post Date: 12/05/2014 - 5:14pm

Bulletin: Healthy Connections Now Provides Adult Dental Benefits

Post Date: 12/01/2014 - 4:17pm

Dental health is a key part of improving and maintaining your health. The health of your teeth and gums can affect the health of the rest of your body.

Provider Alert: Co-payments

Post Date: 12/01/2014 - 10:03am

Bulletin: ACA Enhanced Physician Payment Reimbursement Discontinued. Primary Care Fee Schedule Enhancement

Post Date: 12/01/2014 - 9:38am

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented a portion of the final rule under the Affordable Care Act (ACA) that increased Medicaid reimbursements for evaluation, management and immunization procedure codes for two years. The increase applied to both fee-for-service (FFS) and Medicaid Managed Care Organizations (MCOs).

Provider Alert: Intensive Family Services Contact

Post Date: 11/26/2014 - 1:28pm

Bulletin: Intensive Family Services (Procedure code H0046)

Post Date: 11/17/2014 - 3:50pm

The South Carolina Department of Health and Human Services will add Intensive Family Services (IFS) to the Rehabilitative Behavioral Health Services Manual and the Licensed Independent Practitioners Rehabilitative Services Manual effective January 1, 2015.

Bulletin: Claim Reconsideration Policy-Fee For Service (FFS) Medicaid

Post Date: 11/14/2014 - 9:11am

Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy.

Bulletin: Policy Revisions to the Local Education Agency (LEA) Services Manual for Rehabilitative Behavioral Health Services (RBHS)

Post Date: 11/13/2014 - 4:45pm

1. Discontinue the requirement of the FORM 255 2. Relocate the Psychological Testing and Evaluation policy to the RBHS section of the manual

Bulletin: Update to Section 1 of All Provider Manuals

Post Date: 11/03/2014 - 9:26am

The South Carolina Department of Health and Human Services (SCDHHS) currently contracts with six (6) Managed Care Organizations (MCOs). Each MCO currently operating in South Carolina has a small percentage of contracted network providers that have not enrolled directly with SCDHHS. The most recent contract between SCDHHS and each MCO requires that their contracted provider network also be enrolled directly with SCDHHS. This requirement was implemented to provide for accuracy in MCO reporting and to assist SCDHHS in monitoring and ensuring ongoing provider compliance.

Bulletin: Adult Preventative Dental Service

Post Date: 10/23/2014 - 11:43am

Effective with dates of service beginning December 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will implement an Adult Preventative Dental benefit. Medicaid enrolled dentists may seek reimbursement from the Fee-for-Service Healthy Connections program for preventative dental benefit services. These services are available to members age 21 and over that have full Healthy Connections benefits. Covered services include diagnostics, extractions, fillings and an annual cleaning, up to a maximum benefit of $750 per state fiscal year (July 1 through June 30). The $750 maximum benefit will be based on claim payments under the SCDHHS dental fee schedule.

Bulletin: New Tuberculosis Benefit

Post Date: 10/17/2014 - 11:01am

Effective for dates of service on or after November 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will implement a new program that offers Healthy Connections Medicaid coverage to persons with latent tuberculosis (TB) or active TB infection/disease who are uninsured or underinsured and who do not meet the eligibility criteria for full Healthy Connections Medicaid. This program will be administered through the South Carolina Department of Health and Environmental Control (SCDHEC).

Bulletin: SCDHHS Offers Free Provider Workshops

Post Date: 10/07/2014 - 4:11pm

Medicaid Basics, Comprehensive Web Tool, Overview of Third Party Liability and Overview of Claim-level Adjustments.

Bulletin: CLTC Case Management Scope Revisions

Post Date: 09/30/2014 - 5:04pm

The following revisions will be incorporated into the South Carolina Department of Health and Human Services (SCDHHS) Community Long Term Care (CLTC) Scope of Service for Case Management effective November 1, 2014.

Provider Alert: Healthy Connections Checkup card correction

Post Date: 09/26/2014 - 3:10pm

Provider Alert: ICD-10 CM/PCS Compliance Date Revision

Post Date: 09/18/2014 - 3:24pm

Provider Alert: Four Regional Provider Trainings OSS program and OSCAP Service Updates

Post Date: 09/16/2014 - 10:33am

Provider Alert: Healthy Connections Checkup card distribution and letters

Post Date: 09/05/2014 - 10:08am

Bulletin: Service Plan Development

Post Date: 08/29/2014 - 9:53pm

The South Carolina Department of Health and Human Services (SCDHHS) will add another component to the services of Mental Health Service Plan Development by a Non-physician. Effective for dates of service on or after October 1, 2014, Service Plan Development will include an Interdisciplinary Team component. This will allow providers to conduct service plan development meetings with an interdisciplinary team that may or may not include the client and/or family member.

Bulletin: Medical Assessment of all OSS Residents

Post Date: 08/28/2014 - 4:04pm

Effective October 1, 2014, SCDHHS will begin to conduct medical assessments of Optional State Supplementation (OSS) residents. These medical assessments will be required of all residents within the program. The assessments will be in the form of a survey. Please note that the new medical assessment policy will not affect any resident’s standing within the program. To learn more about the new assessment policy please review the OSS Provider Manual on the South Carolina Department of Health and Human Services website.

Bulletin: SCDHHS Offers Free Provider Workshops

Post Date: 08/27/2014 - 9:56am

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: Estate Recovery

Post Date: 08/18/2014 - 2:43pm

Effective October 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) Estate Recovery Department will increase the minimum estate asset value upon which SCDHHS can file claims to $25,000 or more.

Provider Alert: Notification of change to Medicaid Bulletin #14-020

Post Date: 08/11/2014 - 2:39pm

Bulletin: Coverage of New Screening Services for Healthy Connections Checkup

Post Date: 08/11/2014 - 1:57pm

Effective August 1, 2014, The South Carolina Department of Health and Human Services (SCDHHS) will implement changes to the benefit structure for the Family Planning Eligibility Category, now to be known as Healthy Connections Checkup (Checkup).

Provider Alert: ICD-10 CM/PCS Compliance Date Strategic Planning

Post Date: 07/31/2014 - 9:17am

Bulletin: Preventative Health Screens Policy Update

Post Date: 07/31/2014 - 9:05am

Effective for dates of service on or after September 1, 2014, the South Carolina Department of Health and Human Services will begin covering most of the recommended preventive services defined by U. S. Preventive Services Task Force (USPSTF). The USPSTF recommended preventive services will be provided to Medicaid beneficiaries without cost sharing (co-payments).

Bulletin: SCDHHS Offers Free Provider Workshops

Post Date: 07/25/2014 - 12:40pm

Bulletin: Coverage of New Screening Services for Healthy Connections Checkup

Post Date: 07/22/2014 - 2:57pm

Effective August 1, 2014, The South Carolina Department of Health and Human Services (SCDHHS) will implement changes to the benefit structure for the Family Planning Eligibility Category, now to be known as Healthy Connections Checkup (Checkup).

Bulletin: SCDHHS Offers Free Provider Workshops

Post Date: 07/03/2014 - 2:00pm

Schedule of the free provider workshops offered by theSCDHHS to include Medicaid Basics, Comprehensive Web Tool, Overview ofThird Party Liability and Overview of Claim-level Adjustments.

Bulletin: OB/GYN Telemedicine Demonstration Project

Post Date: 07/03/2014 - 1:53pm

SCDHHS will partner with participating Family Practice (FP) physicians in Allendale, Bamberg, Barnwell, & Hampton counties for the provision of prenatal care up to, but excluding delivery for low risk pregnancies.

Bulletin: Correction Regarding The Medicaid Targeted Case Management Providers Notice Posted June 26, 2014

Post Date: 07/02/2014 - 11:23am

The notice that was posted regarding Medicaid Targeted Case Management (MTCM) providers on June 26, 2014, pertaining to Medicaid Targeted Case Management was intended only for newly enrolled private providers of MTCM. The intent was to advise newly enrolled private providers of MTCM of potential policy changes reflecting “conflict free” care management. Below is the updated correspondence distributed to newly enrolled private providers of MTCM. We apologize for any inconvenience.

Bulletin: Interaction between the Optional Supplemental Care for Assisted Living Participants (OSCAP) service and the Hospice Benefit

Post Date: 06/25/2014 - 4:44pm

This bulletin is to provide clarification regarding the election of the Hospice benefit for beneficiaries currently receiving the Optional Supplemental Care for Assisted Living Participants (OSCAP) service. Beneficiaries of Hospice and OSCAP may only receive personal care through one service or the other; therefore, they must choose either Hospice or OSCAP. An OSCAP participant residing in a Community Residential Care Facility (CRCF) has the right to choose which service they receive, as well as the option to choose the provider who delivers that service, if all medical necessity criteria are met.

Bulletin: South Carolina Medicaid Preferred Drug List

Post Date: 06/23/2014 - 3:01pm

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after August 1, 2014.

Bulletin: ICD-10 CM/PCS Compliance Date Clarification

Post Date: 06/05/2014 - 11:08am

On April 1, 2014, it was announced that the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the DHHS Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.

Bulletin: Pulse Oximetry Policy

Post Date: 05/29/2014 - 4:28pm

Effective on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will update its policy to recognize the South Carolina Department of Health and Environmental Control (DHEC) Pulse Oximetry Screening test on newborns to detect congenital heart defects. Pulse oximetry is a noninvasive test that estimates the percentage of hemoglobin in blood that is saturated with oxygen.

Bulletin: Inpatient Psychiatric Coverage for beneficiaries 65 or older

Post Date: 05/29/2014 - 4:11pm

Effective for services provided on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will allow for coverage of inpatient psychiatric care for beneficiaries of Medicare and Medicaid who are 65 or older.

Bulletin: Provider Preventable Conditions Policy

Post Date: 05/28/2014 - 1:13pm

Effective on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) has amended its Hospital Services Provider Manual and revised the section regarding Hospital Acquired Conditions (HACs). This section of the Hospital Services Provider Manual will apply to all Provider Preventable Conditions (PPCs) to include not only Hospital Acquired Conditions (HACs), but also Never Events (NEs) and Other Provider Preventable Conditions (OPPCs). The HACs section of the manual has been clarified to include a listing of all codes for HACs, NEs, and OPPCs, the criteria for non-payment, and how these codes will be captured in Medicaid’s reporting systems. In addition, the section has been amended to add the following eight OPPCs to the non-payment policy:

Bulletin: Screening, Brief Intervention and Referral to Treatment (SBIRT)

Post Date: 05/23/2014 - 12:54pm

Effective with dates of service on or after July 1, 2014, the following codes and billing procedures must be utilized in order to receive payment for the Screening, Brief Intervention and Referral to Treatment (SBIRT) services.

Bulletin: Psychiatric and Psychotherapy Services section of the Physicians, Laboratories, and Other Medical Professionals Manual

Post Date: 05/23/2014 - 11:57am

Effective July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) has reinstated the Psychiatric and Psychotherapy Services section of the Physicians, Laboratories, and Other Medical Professionals Manual. This section applies to all physicians, psychiatrists, and psychiatric nurse practitioners providing psychiatric services, as well as allied professionals who may provide psychotherapy services under the supervision of these professionals. The Psychiatric and Psychotherapy Services section has been revised to reflect 2013 Current Procedural Terminology (CPT) guidelines and outlines the guidelines for supervision of services provided by allied professionals.

Bulletin: Incontinence Supplies Updates

Post Date: 05/23/2014 - 11:43am

Effective July 1, 2014, incontinence supply providers will be responsible for obtaining the Physician Certification of Incontinence SCDHHS Form 168IS prior to delivering Incontinence supplies. This policy replaces the June 18, 2013, memo titled Changes in Incontinence Supplies Authorizations, section 2 Physician’s Orders.

Bulletin: Home And Community-Based Setting Requirements

Post Date: 05/21/2014 - 2:46pm

On January 16, 2014, the Centers for Medicare and Medicaid Services (CMS) published the final rule related to home and community based services under Section 1915 of Title XIX. The final rule addresses long-term care services and supports through home and community-based service programs under the 1915(c), 1915(i), and 1915(k) Medicaid authorities in the most integrated setting appropriate. The rule will require considerable work to comply with, and we believe by working together it presents an opportunity to enhance the quality of life for the individuals and families we mutually serve.

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