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Waiver Renewal for the Mechanical Ventilator Dependent Waiver and Waiver Specific Transition Plan


The South Carolina Department of Health and Human Services (SCDHHS) intends to file waiver renewal with the Centers for Medicare and Medicaid Services (CMS) for the Mechanical Ventilator Dependent (SC.40181) Home and Community-based (HCB) Waiver operated through the Community Long Term Care (CLTC) program.  The effective date for the proposed waiver renewal changes is Dec. 1, 2017 or upon CMS approval. 


The following is a summary of changes included in the proposed waiver renewal:

1.      Addressed the CMS 1915(i) State Plan HCBS, 5-Year Period for Waivers, Provider Payment Reassignment, Setting Requirements for Community First Choice and 1915(c) HCBS Waivers (Final Rule).

a.      All HCB settings where services are provided must meet the final rule setting requirements, which can be found in the Mechanical Ventilator Dependent Transition Plan. This transition plan will be submitted with the proposed Mechanical Ventilator Dependent waiver renewal and posted on the SCDHHS website, , for review and comments.

2.      Person-centered planning process and service plan requirements.

a.      Service planning for participants in Medicaid HCBS programs must be developed through a person-centered planning process that addresses health and long-term services and support needs in a manner that reflects individual preferences and goals.

3.      Incorporated CMS’s required quality improvement project.

a.      To monitor the quality of services provided to waiver participants, CMS requires states to investigate any performance measure that does not meet the required rate of compliance. Systemic remediation, which is written in a quality improvement project (QIP), must be conducted until the required rate of compliance is met.

4.      Clarified the definition of specialized medical equipment and supplies.

a.      This service was defined more clearly to identify the other medical equipment and supplies that are available to the participants in this waiver.

5.      Clarified the service package for pest control.

a.      The waiver service package was updated to include the enhanced pest control service (bed bug treatment).

b.      Clarified the limitations on the amount, duration and frequency of this service.

6.      Removed the limitation on the amount and frequency of private duty nursing.

a.      This service was limited to 60 hours per week. Nursing services are based on the participant’s assessed need, allowing for more hours if necessary.

7.      Removed the extra prescription drugs benefit from this waiver.

a.      Effective July 1, 2017, the state plan will no longer limit the benefit for prescription medications to four prescriptions, making this service redundant.


Although these are substantial changes, waiver participants will not be adversely impacted. 



These changes to the waiver renewal were shared during the monthly Indian Health Services conference call on June 28, 2017, and will be presented to the Medical Care Advisory Committee (MCAC) meeting Aug. 29, 2017, at 10 a.m. at 1801 Main Street, Columbia, SC.


Additionally, communication on the proposed waiver renewal and the waiver specific transition plan will be shared at the following webinar:


Webinar:  Mechanical Ventilator Dependent Waiver Webinar

    Wednesday, Aug. 9, 2017, 1:30 p.m.



A copy of this notice and the PCSC draft waiver application are available at the following locations:

1.      Electronic Access: (under the “Public Notice” and “Waiver” sections)

2.      Hardcopies:

a.      SCDHHS lobby at 1801 Main Street, Columbia, S.C.

b.      SCDHHS CLTC Regional Offices



Greenville CLTC

               620 North Main Street, Suite 300

               Greenville, SC  29601


               Spartanburg CLTC

               945 East Main Street, Suite 3

               Spartanburg, SC 29302


Greenwood CLTC

               617 South Main Street

               Greenwood, SC  29646


               Rock Hill CLTC

               454 South Anderson, Suite 10

               Rock Hill, SC  29730


               Columbia CLTC

               7499 Parklane Road, Suite 164

               Columbia, SC  29223


               Orangeburg CLTC

               191 Regional Parkway, Bldg. A

               Orangeburg, SC  29118


               Sumter CLTC

               30 Westmark Court

               Sumter, SC  29150


Florence CLTC

               201 Dozier Boulevard

               Florence, SC  29501


               Conway CLTC

               1201 Creel Street

               Conway, SC  29526


               Charleston CLTC

               4130 Faber Place Drive, Suite 303

               North Charleston, SC  29405


               Anderson CLTC

               3215 Martin Luther King Jr. Blvd., Suite H

               Anderson, SC  29625


               Aiken CLTC

               6170 Woodside Executive Court

               Aiken, SC  29803


               Ridgeland CLTC

               10175 South Jacob Smart Blvd.

               Ridgeland, SC  29936





Public Comments and Responses

If you have a question or comment, please send it to the following email or mailing address before Aug. 29, 2017:




Mail:      Community Long Term Care

               ATTN:  Lisa Ragland

               South Carolina Department of Health and Human Services

               Post Office Box 8206

               Columbia, SC  29202-8206


Any written comments submitted may be reviewed by the public at SCDHHS, Division of Community Long Term Care, Jefferson Square Building, 1801 Main Street, Columbia, SC, Monday through Friday between the hours of 8 a.m.-4:30 p.m.

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