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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.

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