The South Carolina Department of Health and Human Services (SCDHHS) is committed to ensuring the integrity and effectiveness of the Healthy Connections Medicaid program. SCDHHS is announcing updates to the provider revalidation process. 

Under federal regulation 42 CFR § 455.414, state Medicaid agencies are required to revalidate the enrollment of all participating healthcare providers at least every five years. In April 2026, the Centers for Medicare and Medicaid Services (CMS) launched a sweeping federal initiative aimed at eliminating fraud, waste and abuse among Medicaid health providers. State Medicaid agencies were directed to perform a rapid revalidation of high-risk Medicaid providers and submit a comprehensive two-year provider revalidation strategy.

The South Carolina Provider Revalidation Strategy is one component of SCDHHS’ agencywide effort to aggressively combat fraud, waste and abuse. South Carolina has undertaken a comprehensive review of our program integrity environment, enrollment and oversight process, and the factors that shape the fraud and abuse landscape within the state. 

Recognizing the imperative to design a revalidation strategy that is both compliant and thoughtful in approach, SCDHHS has developed two distinct tracks for revalidation. Through this provider revalidation strategy, just under 76,000 providers will be stratified into either the rapid revalidation category or the routine revalidation category. 

SCDHHS has prioritized 5,713 providers to undergo rapid revalidation within the next 12 months. This revalidation includes documentation review, site visits and fingerprint-based criminal history background checks. This timeline reflects the state’s intent to take decisive action consistent with federal guidance while applying a targeted approach that responds to South Carolina’s observed risk environment. 

South Carolina will continue to include the following federally-recognized high‑risk provider types for rapid revalidation:

• Durable medical equipment suppliers
• Home health agencies

Based on existing policy, historical program integrity findings, utilization trends and experience in South Carolina, SCDHHS will continue to include:

• Rehabilitative behavioral health services providers
• Licensed independent practitioners, including groups and multi-specialty practices
• Applied behavior analysis providers

Based on recent utilization trends and experience in South Carolina, SCDHHS will also include: 

• Providers offering personal care services

Revalidation letter mailings have begun for all CMS- and SCDHHS-designated high-risk providers and additional letters will continue to be sent over the next couple weeks. Letters will include a unique revalidation code required to initiate the revalidation process. If you have not received a letter, please wait—revalidation cannot begin until notification is issued. If you have any questions, visit www.scdhhs.gov/providers/revalidation or contact the Provider Service Center at (888) 289-0709, option four.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program. 

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