Provider Rate Increases for Home and Community Based Waiver Services
*Jan. 5, 2023, Update: SCDHHS is updating its guidance previously published in Medicaid Bulletin 22-033 to clarify that the rate for children’s personal care state plan services (procedure code T1019) was also increased to $25.00/hr. effective Jan. 1, 2023. This change was also described in the Public Notice of Final Action for Personal Care Rate Increase issued on Dec. 30, 2022.*
The South Carolina Department of Health and Human Services (SCDHHS) is increasing specific reimbursement rates for home and community-based services (HCBS) provided through the state’s waiver programs. The rate increases are being made to enhance the network of providers rendering services to members enrolled in South Carolina’s HCBS waiver programs.
The rate increases are effective Jan. 1, 2023. As described below, they include services provided through the SCDHHS-operated community long term care (CLTC) waivers (Community Choices, HIV/AIDS, and Mechanical Ventilator Dependent [VENT] waivers); the Medically Complex Children (MCC) waiver; the Palmetto Coordinated System of Care (PCSC) waiver, which is operated by the South Carolina Continuum of Care; and, the Intellectual Disability/Related Disabilities (ID/RD), Community Supports (CS), and Head and Spinal Cord Injury (HASCI) waivers, which are operated by the South Carolina Department of Disabilities and Special Needs (SCDDSN).
CLTC Waivers
| Service Description | Code | Modifier | Previous Rate per Unit | New Rate per Unit |
|---|---|---|---|---|
| Case Management | G9012 | $72.00/mo. | $86.00/mo. | |
| Medicaid Nursing | S9124 | $29.80/hr. | $35.00/hr. | |
| Personal Care I | S5130 | $14.80/hr. | $22.00/hr. | |
| Personal Care II | T1019 | $19.40/hr. | $25.00/hr. | |
| Medicaid Nursing – RN | S9123 | $39.40/hr. | $42.00/hr. |
Rate increases for CLTC waivers include services provided through the Community Choices, HIV/AIDS and VENT waivers.
MCC Waiver
| Service Description | Code | Modifier | Previous Rate per Unit | New Rate per Unit |
|---|---|---|---|---|
| Enhanced Nursing Services – LPN | T1003 | $8.75/15 min. | $9.50/15 min. | |
| Respite In Home – (unskilled) | S5150 | $4.05/15 min. | $6.25/15 min. | |
| Respite In Home – (skilled) | T1005 | $6.00/15 min. | $8.75/15 min. |
PCSC Waiver
| Service Description | Code | Modifier | Previous Rate per Unit | New Rate per Unit |
|---|---|---|---|---|
| Respite In Home | S5150 | U1 | $3.18/15 min. | $6.25/15 min. |
| Respite In Home (daily) | S5151 | U1 | $88.83/per day | $150.00/per day |
SCDDSN-operated Waivers
| Service Description and Affected Waiver(s) | Code | Modifier | Previous Rate per Unit | New Rate per Unit |
|---|---|---|---|---|
| Adult Attendant Care – ID/RD | S5125 | U1 | $4.21/15 min. | $4.48/15 min. |
| Adult Companion Services – ID/RD | S5135 | $3.76/15 min. | $4.50/15 min. | |
| Medicaid Nursing – LPN – ID/RD & HASCI | S9124 | $29.80/hr. | $35.00/hr. | |
| Enhanced Nursing Services LPN – ID/RD & HASCI | T1003 | $8.75/15 min. | $9.50/15 min. | |
| Personal Care I – ID/RD & CS | S5130 | $3.70/15 min. | $5.50/15 min. | |
| Personal Care II – ID/RD & CS | T1019 | $4.85/15 min. | $6.25/15 min. | |
| ** Respite In Home – ID/RD, CS & HASCI | T1005 | $4.21/15 min. | $6.25/15 min. | |
| Medicaid Nursing – RN – ID/RD & HASCI | S9123 | $39.40/hr. | $42.00/hr. | |
| Attendant Care – Agency – HASCI | S5125 | U2 | $5.02/15 min. | $6.25/15 min. |
| Attendant Care – Boards – HASCI | S5125 | U3 | $3.88/15 min. | $6.25/15 min. |
| Attendant Care UAP – HASCI | S5125 | U1 | $4.21/15 min. | $4.48/15 min. |
| In Home Support – CS | T2025 | $16.82/hr. | $17.90/hr. |
** The DDSN “Respite In Home” service increase only applies to agency-based respite. It does not apply to self-directed respite.
The new rates will be reflected on the CLTC Fee Schedule by Jan. 1, 2023.
Providers should direct any questions related to this bulletin to SCDHHS program staff at MedicaidWaiver@scdhhs.gov.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.