Rate Updates for Home and Community-based Services and State Plan Services
Effective for dates of service on and after July 1, 2024, the South Carolina Department of Health and Human Services (SCDHHS) is increasing reimbursement rates for private duty nursing services and the home and community-based services (HCBS) provided through the state's 1915(c) waiver programs that are listed in this bulletin. The reimbursement rates, procedure codes and any billing modifiers will be updated in the HCBS Waiver Fee Schedule available on SCDHHS' website by July 1, 2024.
Rate Increases for State Plan Services
Updated reimbursement rates for services rendered to Healthy Connections Medicaid members covered by the State Plan are listed in the table below.
| Description | Procedure Code | Current Rate | New Rate |
|---|---|---|---|
| Enhanced Nursing Services* | T1002 | $45/hour | $50/hour |
| Nursing Services | S9123 | $42/hour | $47/hour |
*Enhanced Nursing (for children with complex medical conditions)
Rate Increases for HCBS Waiver Services
Updated reimbursement rates for services rendered to Healthy Connections Medicaid members enrolled in the listed 1915(c) waivers are listed in the table below.
| Description | Affected Waivers* | Procedure Code | Current Rate | New Rate |
|---|---|---|---|---|
| Adult Day Health Care | CC, CS, ID/RD | S5102 | $64/day | $72/day |
| Home-delivered Meals | CC, HIV/AIDS, VENT | S5170 | $6.40/unit | $7.40/unit |
| Nursing (In-home) | ID/RD, HASCI, HIV/AIDS, VENT | S9123 | $42/hour | $47/hour |
| Nutritional Supplements | CC, HIV/AIDS | X1939 | $33/unit, $45/unit - diabetic | $41.25/unit, $56.25/unit - diabetic |
| Nutritional Supplements | VENT | X9202 | $33/unit, $45/unit - diabetic | $41.25/unit, $56.25/unit - diabetic |
| Pest Control | CC, HIV/AIDS, VENT | S5121 | $42.75/ treatment | $66.50/ treatment |
| Pest Control | ID/RD, HASCI | S5121 | $45/ treatment | $66.50/ treatment |
| Residential Habilitation | ID/RD, HASCI | T2016 - U8 | $472.52/day | $514.97/day |
| Residential Habilitation | ID/RD, HASCI | T2016 - U7 | $402.36/day | $439.06/day |
| Residential Habilitation | ID/RD, HASCI | T2016 - U6 | $340.49/day | $370.82/day |
| Residential Habilitation | ID/RD, HASCI | T2016 - U5 | $291.02/day | $316.23/day |
| Residential Habilitation | ID/RD, HASCI | T2016 - U4 | $246.85/day | $267.49/day |
| Residential Habilitation | ID/RD, HASCI | T2016 - U3 | $101.42/day | $104.46/day |
*Waiver acronyms: Acquired Immunodeficiency Syndrome/Human Immunodeficiency Virus (HIV/AIDS); Community Choices (CC); Community Supports (CS); Head and Spinal Cord Injury (HASCI); Intellectual Disability/Related Disabilities (ID/RD); Mechanical Ventilator Dependent (VENT)
The new rates, including procedure codes and modifiers, will be reflected on the HCBS fee schedule by July 1, 2024. 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.