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Public Notice of Final Action for the Supplemental Teaching Physician (STP) Payment Program

The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of Section 1902(a)(13)(A) of the Social Security Act, gives notice of the following action regarding its methods and standards for setting payments for the Supplemental Teaching Physician (STP) Payment Program under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective for payments beginning on or after April 1, 2020, SCDHHS will compute payments under the Centers for Medicare and Medicaid Services (CMS) approved STP Payment Program using calendar year (CY) 2019 Medicaid fee-for-service claims data, commercial payer rates, and updated teaching physician listings. The Medicaid fee-for-service claims data will be adjusted by an incurred but not reported (IBNR) factor to account for any incurred CY 2019 claims that may pay during CY 2020.

In an unrelated action to the STP Payment Program, SCDHHS will also replace the former psychotherapy code 90804 with replacement psychotherapy codes 90832, 90834, and 90837. Additionally, SCDHHS will adjust the unit measurement of E&M code 99214 from 30 minutes to 25 minutes. This change is being made only to the Mental Health Clinic Services section of Attachment 4.19-B.

SCDHHS is making this change in order to update the STP payments using more current claim and commercial payer data as well as updated teaching physician listings. The agency is also making this change to replace the former CPT code 90804 with the new replacement CPT codes 90832, 90834, and 90837 as well as update the new unit measurement for CPT code 99214.

SCDHHS projects that based upon the STP payment action, annual aggregate Medicaid fee-for-service expenditures will increase by approximately four million ($4,000,000) total dollars. The agency expects the CPT code changes outlined above to be budget neutral to the agency.

Copies of this notice are available at each South Carolina Healthy Connections Medicaid county office and at www.scdhhs.govfor public review. Additional information regarding this action is available upon request at the address cited in this public notice.

Any submitted written comments may be reviewed by the public Monday through Friday between 9 a.m.-5 p.m. at the Reimbursement Methodology and Policy Department, SCDHHS, Room 1219, 1801 Main Street, Columbia, SC.

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