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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.

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