Updates to Limitations on Non-covered Medical Expenses for Nursing Facility Residents
Effective for dates of service on or after Oct. 1, 2023, the South Carolina Department of Health and Human Services (SCDHHS) has updated the current limitations on non-covered medical expenses for Medicaid members who reside in a nursing facility. Medical expenses are allowable deductions from monthly recurring income. Providers can find a list of these services in the Nursing Facility Services provider manual.
The updated State Plan language references reimbursement for non-covered medical and remedial care expenses in accordance with the reimbursement methodology section of the State Plan. References that are no longer applicable and have been removed from the Nursing Facility Services provider manual include the 12-visit annual limit on physician visits and monthly prescription limitations.
Providers should direct 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 http://www.scdhhs.gov/contact-us.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.