Rate and Policy Updates for COVID-19 Testing, Vaccine Administration and Treatment Services
The South Carolina Department of Health and Human Services (SCDHHS) is announcing the following rate and policy updates effective for dates of service on and after Oct. 1, 2024.
During the federal COVID-19 public health emergency (PHE), SCDHHS created temporary reimbursement methodologies and coverage policies for COVID-19 testing, vaccine administration and treatment services. In this bulletin, SCDHHS is announcing changes to what were previously temporary reimbursement rates and policies.
Rate Updates
During the federal COVID-19 PHE, SCDHHS' reimbursement guidance for COVID-19 testing and vaccine administration followed the Medicare fee schedule under the American Rescue Plan Act authority. SCDHHS will update the reimbursement rates for these services to align with the South Carolina State Plan reimbursement methodology. The updated rates for the COVID-19 testing and vaccine administration will be published in the following provider fee schedules available on SCDHHS' website by Oct. 1, 2024.
- All the physician fee schedules
- Independent Lab and Radiology Fee Schedule
- Outpatient Hospital Fee Schedule
Policy Updates
Effective for dates of service on and after Oct. 1, 2024, SCDHHS is issuing the policy updates, listed below, for COVID-19 testing, vaccine administration and treatment services. These updates include the coverage of services under the State Plan Benefit and the expiration of some services previously allowed under the PHE flexibilities.
Coverage of Services Under the State Plan Benefit
- COVID-19 testing performed by qualified providers will become a covered State Plan service for full-benefit Healthy Connections Medicaid members.
- COVID-19 vaccines and vaccine administration will become a covered State Plan service for full-benefit Healthy Connections Medicaid members, in accordance with the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommendations and guidance issued via Medicaid bulletin MB# 23-044.
- COVID-19 testing will continue to be paid as "bill-above" when performed by Rural Health Clinic (RHC) providers.
- COVID-19 vaccine administration will continue to be paid as a "bill-above" service when delivered by a Federally Qualified Health Center (FQHC) or RHC provider.
Expiration of Services
- Over-the-counter COVID-19 tests will no longer be a covered service.
- COVID-19 testing will no longer be payable as "bill-above" when performed by FQHC providers.
- Coverage requirements related to COVID-19 treatment, outlined in MB# 23-018 for full-benefit members, will sunset as of Sept. 30, 2024. Services related to COVID-19 treatment will be subject to existing coverage limitations as outlined in SCDHHS provider manuals, following the clinical standards of care.
These policy updates will be published in the Physician Services Provider Manual, FQHC Services Provider Manual, RHC Services Provider Manual and the Pharmacy Services Manual by Oct. 1, 2024.
South Carolina's Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement related to the services described in this bulletin for Healthy Connections Medicaid members who are enrolled in an MCO.
Providers should direct any questions related to this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. Providers can also submit an online inquiry at https://www.scdhhs.gov/providers/contact-provider-representative.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.