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Post date: 12/06/2017 - 4:43pm

The South Carolina Department of Health and Human Services will be amending its autism spectrum disorder (ASD) manual to include additional providers that will be allowed to complete the comprehensive psychological assessment/testing report to determine if Medicaid beneficiaries meet medical necessity criteria for ASD services.

Post date: 12/06/2017 - 1:53pm

Effective for dates of service on or after Jan. 1, 2018, and pursuant to South Carolina Budget Proviso 117.135, Section A, the South Carolina Department of Health and Human Services (SCDHHS) will accept Act 301 Behavioral Health Centers (301 Centers) as approved referring sites for Medication Assisted Treatment (MAT) services rendered via telemedicine consultation.

Post date: 09/29/2017 - 10:17am

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.

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.

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 .

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.

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.

Post date: 01/17/2017 - 1:59pm

Post date: 01/13/2017 - 9:47am

Post date: 10/21/2016 - 5:44pm

Post date: 09/26/2016 - 2:47pm

Effective Nov. 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will limit payment for Current Procedural Terminology (CPT) code 96127 to a maximum of two units per date of service.

Post date: 08/08/2016 - 4:18pm

Post date: 07/18/2016 - 1:33pm

Post date: 04/12/2016 - 11:58am

Post date: 02/01/2016 - 8:49am

Post date: 12/11/2015 - 4:59pm

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.

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: 05/26/2015 - 9:58am

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

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: 05/06/2015 - 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: 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: 02/04/2015 - 10:33am

On July 3, 2014, the Food and Drug Administration issued updated guidance in regards to hydroxyprogesterone caproate.

Post date: 01/16/2015 - 10:03am

SCDHHS’ payment for dual-eligible (Medicaid and Medicare) members is equal to the allowed amount minus the Medicare payment or the sum of the Coinsurance, Deductible and Blood Deductible (up to three units), whichever is less.

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.

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.

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.

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.

Tags: Physicians
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.

Post date: 05/02/2014 - 4:00pm

Effective June 1, 2014, South Carolina Department Health and Human Services will amend the non-emergency transportation policy for self- administered oxygen dependent beneficiaries discharged from inpatient hospitals or emergency rooms. This policy change affects Hospitals, Physicians, Ambulance and Durable Medical Equipment (DME) providers. This policy change will also be posted in the Hospital, Physicians Laboratories and Medical Professional, Ambulance and Durable Medical Equipment manuals located on the SCDHHS website: www.scdhhs.gov.

Post date: 02/28/2014 - 10:49am

Beginning with dates of service on or after March 17, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will reimburse for outpatient utilization of long acting reversible contraceptives (LARC) through the pharmacy program. Any LARC billed to SCDHHS by a pharmacy will be shipped directly to the provider’s office for insertion. Providers should take extra care to ensure that they bill Medicaid only for reimbursement of the insertion of the device, and not the device itself, when it is obtained and billed through the pharmacy benefit.

Post date: 02/06/2014 - 5:07pm

Effective for dates of service on or after March 1, 2014, the South Carolina Department of Health and Human Services will expand the place of service that recipients age 21 and over are authorized to receive outpatient physical, occupational, and speech therapies (PT/OT/ST) services. In addition to receiving PT/OT/ST services in an outpatient hospital, beneficiaries can now receive these services in a physician’s office or outpatient rehabilitation facility. Services provided in a physician’s office or outpatient rehabilitation facility are limited to ambulatory therapies performed in an outpatient setting.

Post date: 12/31/2013 - 12:24pm

The South Carolina Department of Health and Human Services (SCDHHS) has updated its reimbursement calculations for Medicare Deductible, Coinsurance, and Blood Deductibles to reflect the new 2014 Medicare Rates for Dually Eligible Medicaid members.

Post date: 12/20/2013 - 10:56am

Effective immediately, the South Carolina Department of Health and Human Services (SCDHHS) will cover both Makena® and compounded hydroxyprogesterone caproate without prior authorization. SCDHHS will provide reimbursement directly to pharmacy providers for these products ordered by a prescriber.

Post date: 12/02/2013 - 9:34am

Effective for dates of services on or after January 1, 2014, Robertson Optical will no longer be the contracted provider of eye wear for South Carolina Medicaid fee for service (FFS) participants. The South Carolina Department of Health and Human Services (SCDHHS) will no longer be acquiring this service through an exclusive contract. Beginning with dates of service on or after January 1, 2014, any enrolled and qualified provider producing eye wear may bill for this service.

Post date: 12/02/2013 - 9:13am

I. Preferred Drug List Update II. Exceptions to Prescription Limit III. Update to Synagis® (palivizumab) Reimbursement IV. Preferred Brand Medications V. Certificate of Medical Necessity for Home Infusion Pharmacies

Post date: 11/26/2013 - 10:01am

The South Carolina Department of Health and Human Services (SCDHHS) is pleased to announce changes to the Licensed Independent Practitioners Rehabilitative Behavioral Health Services Provider Manual.

Post date: 11/15/2013 - 9:56am

The South Carolina Department of Health and Human Services (SCDHHS) expanded the availability of behavioral health pediatric screening tools in a Medicaid Bulletin, dated May 17, 2013.

Post date: 10/14/2013 - 1:46pm

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented a portion of a final rule under the Affordable Care Act (ACA) that increases Medicaid reimbursements for evaluation, management and immunization services to 100 percent of Medicare reimbursement for 2013 and 2014. The increase applies to both fee-for-service (FFS) and Managed Care Organization (MCO) plans.

Tags: Physicians
Post date: 09/13/2013 - 5:11pm

Effective for dates of service on or after October 15, 2013, 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 $2,429.18. The 50mg vial will be reimbursed at $1,286.44.

Post date: 08/30/2013 - 4:21pm

Effective October 1, 2013, as mandated by section 6407 (d) of the Affordable Care Act, prior to certifying a beneficiary’s eligibility for the home health benefit, the certifying physician must document that he or she, or an allowed non-physician practitioner (NPP) has had a face-to-face encounter with the beneficiary. The state plan Home Health benefit includes skilled nursing, home health aide and therapeutic services such as physical therapy, occupational therapy and speech therapy.

Post date: 08/08/2013 - 2:38pm

South Carolina Department of Health and Human Services (SCDHHS) is implementing a new provider-administered injectable drug program in conjunction with ICORE Healthcare, LLC SCDHHS and ICORE will be providing webinar trainings for providers on the PA process. The following dates and times are being offered.

Post date: 07/22/2013 - 12:35pm

The South Carolina Department of Health and Human Services (SCDHHS) recently received final CMS approval for its proposed payment methodology for the Affordable Care Act (ACA) Primary Care Physician rate increase for both the Fee for Service (FFS) and Managed Care Organizations (MCOs). SCDHHS continues its work on this project to ensure that it is implemented accurately, quickly and within the CMS mandates for these enhanced payments.

Post date: 07/10/2013 - 2:05pm

Tuesday, July 23; 1:30-3pm ET This call will give eligible professionals an in-depth overview of clinical quality measures (CQMs) included in the final rule for Stage 2 of Meaningful Use for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program. Details on the measures, the recommended core set for reporting purposes, and the 2014 electronic specifications for the Medicare EHR Incentive Program will be provided. Participants will be given an opportunity to engage CMS subject matter experts with questions on CQMs.

Post date: 06/17/2013 - 8:38am

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after July 22, 2013.

Post date: 06/07/2013 - 11:33am

The South Carolina Department of Health and Human Services (SCDHHS) is a 2013 National Committee for Quality Assurance (NCQA) Recognition Program Sponsor for Patient Centered Medical Homes (PCMH).

Post date: 05/31/2013 - 3:18pm

South Carolina Department of Health and Human Services (SCDHHS) will be making important changes to the South Carolina State-approved Nurse Aide Training Program (NATP) requirements. These changes will be effective as of July 1, 2013.

Post date: 05/17/2013 - 12:55pm

The South Carolina Department of Health and Human Services (SCDHHS) is expanding the availability of behavioral health pediatric screening tools and providing guidance on the utilization of these tools. Best practice indicates that standardized screenings of this type are recommended to be done during the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) visits or as dictated by clinical need. This recommendation is in alignment with the American Academy of Pediatrics (AAP) recommendations regarding screening and surveillance of family and social environment for risk factors and mental health screening of children and adolescents in primary care settings.

Post date: 05/16/2013 - 3:06pm

This session will inform individual practitioners on the basics of Stage 1 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Learn if you are eligible, and if so, what you need to do to earn an incentive. This is the first in a series of 6 National Provider Calls on the Medicare and Medicaid EHR Incentive Programs. Other topics include: Stage 2, clinical quality measures, hardship exceptions, payment adjustments, and a discussion on certification by the Office of the National Coordinator for Health Information Technology.

Post date: 05/02/2013 - 10:01am

The South Carolina Department of Health and Human Services will host an open forum to receive input on the administration and management of the Medicaid Pharmacy program. The current Administrative Services contract with Magellan Health will expire on March 18, 2014.

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