Updates to HCBS Waiver and State Plan In-home Care Services
Effective July 1, 2023, the South Carolina Department of Health and Human Services (SCDHHS) is consolidating multiple personal care and private duty nursing services into single procedure codes for personal care, private duty nursing and enhanced nursing. These service consolidations are being made to reduce the administrative burden for providers and support improved access to care. These changes affect State Plan private duty nursing services and services provided through the following home and community-based service (HCBS) waiver programs administered by SCDHHS:
- Intellectual Disability/Related Disabilities
- Head and Spinal Cord Injury
- Community Supports
- Community Choices
- Mechanical Ventilator
Personal Care Updates
Personal care I and personal care II will become one consolidated service entitled personal care services. All services available in personal care I and personal care II will remain in the consolidated personal care service.
For dates of service on or after July 1, 2023, all claims for personal care services should be submitted using the procedure code T1019. The rate for personal care services will be $25/hr.
Nursing and Enhanced Nursing Updates
Medicaid nursing RN and Medicaid nursing LPN will become one consolidated service entitled nursing services. Enhanced nursing RN and enhanced nursing LPN will become one consolidated service entitled enhanced nursing services. Providers will determine whether an RN or LPN is needed based on the assessed needs of the participant and what is allowable under the scope of practice dictated in the SC Nurse Practice Act Title 40 Chapter 33.
For dates of service on or after July 1, 2023, all claims for private duty nursing should be submitted using the procedure code S9123. The rate for nursing services will be $42/hr. All claims for enhanced nursing services should be submitted using the procedure code T1002. The rate for enhanced nursing services will be $45/hr.
Training is available and tailored for community long-term care (CLTC) and South Carolina Department of Disabilities and Special Needs (DDSN) case management providers and personal care and nursing providers. The training will cover updated policy and procedures for authorizing services and for utilizing electronic visit verification with the consolidated service codes. All training will be conducted via WebEx. Providers can register for the applicable training by clicking the following links:
Training for CLTC and DDSN Case Management Providers
- June 22 at 10 a.m.: Personal Care and Nursing Services Updates and Guidance (For CLTC and DDSN case management providers)
- June 27 at 2 p.m.: Personal Care and Nursing Services Updates and Guidance (For CLTC and DDSN case management providers)
Training for Personal Care and Nursing Providers
- June 22 at 2 p.m.: Personal Care and Nursing Services Updates and Guidance (For Personal Care and Nursing Providers)
- June 27 at 10 a.m.: Personal Care and Nursing Services Updates and Guidance (For Personal Care and Nursing Providers) o
There will be an additional focused training for DDSN case managers that is being scheduled by DDSN. Notification of this additional training will be issued by DDSN.
Any claims submitted via electronic visit verification, including those submitted through both Care Call and Authenticare, prior to July 1, 2023, will be processed without further action required. If claims for dates of service prior to July 1, 2023, are not submitted by July 1, 2023, providers will be required to submit a manual resolution. Providers may refer to the Phoenix Help Documents for additional instructions on resolutions. Instructions on how to access the resolution information are below.
- Access the Phoenix provider portal.
- Click on the question mark icon which will allow access to the Phoenix Help section.
- Click on the Provider Portal User Guide located under Using Provider Portal.
- Slides 59-64 have information on how to submit a resolution.
Questions regarding the information contained in this bulletin should be submitted to MedicaidWaiver@scdhhs.gov.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.