Public Notice of Final Action for Inclusion of Developmental Evaluation Center (DEC) Services and Organ Transplants in the Coordinated Care Benefit
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding the inclusion of DEC services and organ transplants under the coordinated care benefit under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Effective on or after Feb. 1, 2024, SCDHHS will amend the South Carolina Title XIX State Plan to include all DEC services and organ transplants under the coordinated care benefit. SCDHHS is making these changes to align the continuation of direct care management for these services currently administered under fee-for-service (FFS) to services administered by managed care organizations (MCOs) and those of the agency.
DECs
Currently, services provided through DECs are reimbursed by SCDHHS’ FFS Medicaid program, however, after Feb. 1, 2024, these services will be reimbursed by the MCO for Medicaid members that are enrolled in that MCO. DECs are defined as independent freestanding facilities that furnish a comprehensive array of developmental pediatric services.
Organ Transplants
Currently, medically necessary transplants and transplant-related services rendered for all transplant types (except corneal), during the pre-transplant and post-transplant event periods are reimbursed by MCOs for Medicaid members enrolled in an MCO. The transplant event is reimbursed by FFS regardless of the member’s enrollment status. After Feb. 1, 2024, reimbursement of the entire transplant event period(s) will be reimbursed by an MCO for members enrolled in the MCO.
Based on the actions above, SCDHHS anticipates a budget neutral impact.
Copies of this notice are available at each South Carolina Healthy Connections Medicaid county office and at www.scdhhs.gov for public review. Additional information regarding these actions is available upon request at the address cited below.
Any written comments submitted may be reviewed by the public at the SCDHHS, Office of Health Programs, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9 a.m. and 5 p.m