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Post date: 04/15/2013 - 11:32am

Effective for dates of services on or after April 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will cover CPT codes:

Post date: 04/05/2013 - 1:26pm

The South Carolina Department of Health and Human Services (SCDHHS) has implemented policy to assist providers who have attested for the Affordable Care Act (ACA) Enhanced Physician Program. Some providers may need to terminate the effective dates of inclusion into this program, effective January 1, 2013 through December 31, 2014. The following are two instances where a provider may need to end his/her enrollment.

Post date: 04/05/2013 - 1:16pm

In §6407 of the Affordable Care Act (Pub.L. 111-148) Congress added some conditions on the coverage of Durable Medical Equipment (DME). The Centers for Medicare and Medicaid Services (CMS) has proposed implementing changes to the DME regulations which also clarify the federal agency’s position as to the availability of incontinence and other supplies and equipment under the Medicaid State Plan Home Health benefit. See 76 FR 41032–41039 (July 12, 2011).

Post date: 03/27/2013 - 3:14pm

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

Post date: 02/28/2013 - 4:04pm

The South Carolina Department of Health and Human Services (SCDHHS) has updated the fee schedule for long acting reversible contraceptive drug codes A4264, J7302, and J7307. Please refer to the Injectable Drug Fee schedule located at www.scdhhs.gov; this fee schedule is updated quarterly.

Post date: 02/27/2013 - 1:50pm

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented the Affordable Care Act (ACA) increasing Medicaid reimbursements for evaluation and management and immunization services to 100 percent of Medicare reimbursement in 2013 and 2014. The increase applies to both fee­ for-service (FFS) and managed care organization (MCO) plans.

Post date: 02/08/2013 - 4:26pm

SCDHHS has updated its reimbursement calculations for Medicare Deductible, Coinsurance, and Blood Deductibles to reflect the new 2013 Medicare Rates for Dually Eligible Medicaid members.

Post date: 01/08/2013 - 2:14pm

Increased Medicaid Payments for Primary Care

Post date: 12/14/2012 - 10:12am

The South Carolina Department of Health and Human Services (SCDHHS) is announcing the statewide integration of the Community Health Worker (CHW) into eligible primary care practices under the Department’s Health Access at the Right Time (HeART) initiative.

Post date: 12/13/2012 - 4:47pm

Effective January 7, 2013, the Division of Community Long Term Care (CLTC) will centralize intake activities for all programs operated by CLTC. This includes referrals for nursing home placement, nursing home conversion, Pre-Admission Screening Resident Review (PASRR), home and community based waiver services, children’s personal care and nursing services, and Katie Beckett Medicaid Program (TEFRA). When intake activities are centralized, referrals will no longer be accepted at the CLTC Regional Offices. Referrals will only be accepted by one of the methods below.

Post date: 12/13/2012 - 4:20pm

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will exclude coverage for barbiturates “used in the treatment of epilepsy, cancer, or a chronic mental health disorder” and benzodiazepines for dual eligible individuals (Medicare/Medicaid). This exclusion of coverage applies only to dual eligible individuals.

Post date: 12/13/2012 - 4:15pm

Effective for dates of service on or after January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will no longer provide reimbursement for elective inductions or non–medically indicated deliveries prior to 39 weeks to hospitals and to physicians. This change is a result of an extensive effort and partnership by SCDHHS, South Carolina Hospital Association, South Carolina Chapter of the American Congress of Obstetricians & Gynecologists, Maternal Fetal Medicine physicians, BlueCross BlueShield of SC and other stakeholders to reduce non-medically necessary deliveries.

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: 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: 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: 09/12/2012 - 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: 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: 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: 04/12/2012 - 3:14pm

South Carolina Department of Health and Human Services (SCDHHS) is clarifying that pregnant women applying for Medicaid under Optional Coverage for Pregnant Women and Infants (OCWI) may enter the program under assumptive eligibility provisions. If a woman declares that she is pregnant, and submits an application, she can be determined Medicaid eligible based on her attestation of income, resources, and citizenship for a 30-day period, while she is given the opportunity to return the necessary verification to determine continued eligibility.

Post date: 03/21/2012 - 1:59pm

The South Carolina Department of Health and Human Services (SCDHHS) is offering training to Medicaid enrolled Federally Qualified Health Clinics, Rural Health Clinics, Family Practice, and OB/GYN providers on Screening, Brief Intervention, and Referral to Treatment (SBIRT). SBIRT is an agency initiative, in partnership with other stakeholders, to help identify and offer treatment to pregnant beneficiaries who may have alcohol or other /substance dependence, depression, or domestic violence.

Post date: 01/19/2012 - 5:02pm

Effective for dates of services on or after March 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) is updating its policy to include reimbursement for long acting birth control devices provided in a hospital setting. The coverage of this service will be considered an add-on benefit and will not be included in the Diagnostic Related Group (DRG) reimbursement system.

Post date: 01/11/2012 - 4:23pm

Effective with dates of service on or after February 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will cover Tobacco Cessation treatment for all pregnant women in accordance with Section 4107 of the Affordable Care Act, which amended Section 1905 (bb)(2) of the Social Security Act. For the complete policy and billing instructions, please review the Physician, Laboratories and Other Medical Professionals manual located on the SCDHHS website at www.scdhhs.gov.

Post date: 01/11/2012 - 4:20pm

Post date: 11/18/2011 - 2:53pm

II. Modification to Prior Authorization (PA) Requirements for Organ Transplants III. Delivery in Cases of Prolonged Labor

Post date: 10/17/2011 - 11:16am

Effective For Dates Of Service On Or After October 15, 2011, 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%

Post date: 07/01/2011 - 5:43pm

I. Preferred Drug List (PDL) Revisions II. Processing of Claims for Compounded Pharmaceuticals III. Six Month's Supply for Contraceptives

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