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Post date: 12/07/2012 - 9:27am

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after January 1, 2013.

Post date: 12/05/2012 - 10:16am

The South Carolina Department of Health and Human Services (SCDHHS) will be implementing a Quality Weighted Assignment algorithm for enrollments that begin on or after January 1, 2013. Beneficiaries who are managed-care-assignable, but have not selected a health plan, will be assigned to a health plan by the enrollment broker based on this algorithm.

Post date: 12/03/2012 - 1:33pm

In the Medicaid Bulletin dated May 9, 2012, the South Carolina Department of Health and Human Services (SCDHHS) began the process of addressing provider enrollment regulations published by the Centers for Medicare and Medicaid Services (CMS). SCDHHS has addressed the CMS regulations and will implement the following on December 3, 2012:

Post date: 12/03/2012 - 1:26pm

On June 13, 2012, the South Carolina Department of Health and Human Services (SCDHHS) placed the Managed Care Organization (MCO) Absolute Total Care (ATC) on notice that a Corrective Action Plan was required in accordance with Section 13.7 of its contract with SCDHHS.

Post date: 11/15/2012 - 10:22am

This bulletin is to notify all service providers that the South Carolina Department of Health and Human Services (SCDHHS) has placed Logisticare on notice that a Corrective Action Plan (CAP) is required in accordance with the SCDHHS Non-Emergency Medical Transportation (NEMT) contract.

Post date: 11/02/2012 - 3:16pm

This bulletin is to notify all service providers that, effective immediately, the South Carolina Department of Health and Human Services (SCDHHS) has placed BlueCross BlueShield of South Carolina (BCBSSC) Third Party Liability (TPL) Services on notice that a Corrective Action Plan (CAP) is required in accordance with the third party liability SCDHHS contract.

Post date: 11/02/2012 - 2:06pm

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.

Post date: 10/26/2012 - 5:19pm

This Medicaid bulletin is being re-sent because the rate cited for adult day health care transportation was incorrectly stated in the original bulletin dated October 2nd. We have corrected this information below and we apologize for any inconvenience this may have caused.

Post date: 10/26/2012 - 5:12pm

As stated in the July 31, 2012 bulletin, the South Carolina Department of Health and Human Services (SCDHHS) is continuing its Credit Balance Review project. Our Medicaid Insurance Verification Services (MIVS) contractor, Blue Cross Blue Shield of South Carolina (BCBSSC) will carry out this initiative. To help providers with this initiative the provider outreach staff of BCBSSC has developed training to assist with credit balance reporting. This training is now accessible as classroom and online learning at http://Medicaidelearning.com. First-time users will need to register at http://Medicaidelearning.com and then log in.

Tags: Hospitals
Post date: 10/18/2012 - 10:41am

The South Carolina Department of Health and Human Services (SCDHHS) will co-sponsor provider/facility training with Keystone Peer Review Organization, Inc., (KePRO), the Medicaid Quality Improvement Organization (QIO).

Post date: 10/15/2012 - 3:51pm

The Foster Care Health Initiative is a collaborative effort, between the South Carolina Department of Social Services (SCDSS) and the South Carolina Department of Health and Human Services (SCDHHS), to better address healthcare delivery to our foster children. As the legal custodian, SCDSS has determined that it is in the best interest of foster children to be enrolled in coordinated care. Currently, there are two types of coordinated care models operating in South Carolina: Managed Care Organizations (MCOs) and Medical Homes Networks (MHNs). More than 627,000 South Carolina Medicaid beneficiaries are now enrolled in either an MHN or MCO.

Post date: 10/12/2012 - 9:05am

Effective for dates of service on or after October 15, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will increase the rate for Synagis® to the current Average Wholesale Price (AWP) minus 18%. The new rate for the 100mg vial will be $2,339.98 up from $2,192.89. The 50mg vial will be reimbursed at $1,239.20 up from $1,161.31.

Post date: 10/04/2012 - 10:22am

COLUMBIA, S.C. — Approximately 65,000 children who are currently eligible for South Carolina’s Medicaid program but are not signed up will be enrolled and immediately able to receive services through a coordinated care health plan, the South Carolina Department of Health Human Services (SCDHHS) announced Thursday.

Post date: 10/03/2012 - 3:30pm

Effective November 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will increase reimbursement for Adult Day Health Care (ADHC) services in the Community Long Term Care and Disabilities and Special Needs waiver programs.

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.

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).

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.

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

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.

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.

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.

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.

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.

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.

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.

Tags: Leadership
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.

Tags: Leadership
Post date: 08/06/2012 - 1:50pm

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).

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.

Tags: Hospitals
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.

Post date: 07/31/2012 - 10:05am

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.

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.

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.

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).

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.

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.

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.

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.

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).

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.

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.

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.

Tags: Leadership
Post date: 06/14/2012 - 5:06pm

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.

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.

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).

Post date: 06/01/2012 - 3:45pm

Post date: 05/18/2012 - 3:50pm

Post date: 05/18/2012 - 3:44pm

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