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  Division of Communities and Facilities 

The Division of Community and Facility Services is responsible for oversight for the following Medicaid programs: home health, hospice, integrated personal care, intermediate care facilities for the mentally retarded, nurse aide training and testing, nursing facilities, preadmission screening and resident review (PASARR) and swing bed hospitals. The Division also provides oversight to the Optional State Supplementation Program, (OSS) a non-Medicaid program

For more information regarding the services listed below, please contact your program representative.

Eligibility Guidelines and Application for Medicaid Nursing Facility Services:

Guidelines

Income Limitations

Services Defined:


Home Health:
Provides intermittent skilled nursing services, physical therapy, speech therapy, occupational therapy, home health aide and medical supplies to eligible recipients. Services must be ordered by a physician, rendered in accordance with a written plan and must be delivered in the patient's residence.

Hospice:
Available to individuals who choose to elect the benefit and who have been certified by a physician as having a terminal illness with a life expectancy of six (6) months or less if the illness runs its normal course.

Integrated Personal Care (IPC):
Additional personal care services available to promote and sustain the health of OSS sponsored residents in licensed Community Residential Care Facilities (CRCFs).

Intermediate Care Facilities for the Mentally Retarded (ICF/MR):
Provides active treatment, health and rehabilitative services to persons with mental retardation or related conditions at the intermediate level. Services are provided by a licensed, certified and contracted institutional facility and include 24-hour supervision, evaluation and coordination of services to help individuals function optimally.

ManagedCare Information:


Nursing Facilities:
Provides nursing, therapy, and personal care services to individuals who do not require acute hospital care, but whose mental or physical condition requires services that are above the level of room and board and can be made available through licensed, certified and contracted institutional facilities.

Optional State Supplementation (OSS): Program
Elgibility

A state-funded program designed to help low income persons meet basic living needs not fully covered by the Federal Supplemental Security Income (SSI) program provided in licensed CRCFs. OSS is not a Medicaid program.

Paid Feeding Assistants:
Policy
Information
Federal regulations for long-term care facilities were updated on September 26, 2003 to permit the use of paid feeding assistants (PFAs) to supplement the services of certified nursing assistants under certain conditions.

Nurse Aide Testing and Training: Registry
Policy

Per federal regulations, direct care staff employed in a Medicaid certified nursing facility, must be listed on the State's Nurse Aide Registry as a Certified Nurse Aide, (CNA). The primary purpose of the certification program is to ensure that only those nurse aides who have demonstrated competency based upon standardized training and/or testing are employed. Link to the SC Nurse Aide Program page: http://www.asisvcs.com/indhome_fs.asp?CPCAT=0741NURSE

Preadmission Screening and Resident Review (PASARR):
A federally required process that prohibits a Medicaid certified nursing facility from admitting any new resident who has a serious mental illness (MI) or is mentally retarded (MR), unless it has been determined whether the individual requires a level of service provided by the nursing facility and the individual is in need of specialized services for the MI or MR.

Swing Beds:
A hospital that also provides nursing facility skilled, intermediate and subacute levels of care. Swing bed hospitals must be located in a rural area, have fewer than 100 inpatient beds, exclusive of newborn and intensive care type beds and must meet both Federal and State requirements.

Third Party Liability:
See the TPL Supplement in the Nursing Facility Services Provider manual

Words to Remember


Activities of Daily Living (ADLs):
Personal functions performed by an individual in the course of a day, such as walking, bathing, shaving, dressing, eating, toileting, etc.

Certified Nursing Assistant (CNA):
Trained and certified staff that provides non-medical assistance to residents, such as help with walking, bathing, shaving, dressing, eating, etc. A nurse aide is certified if he/she is listed on the South Carolina Nurse Aide Registry as current and in good standing.

Community Residential Care Facility (CRCF):
A facility that offers room and board and provides a degree of personal care. Licensed by SCDHEC.

Long-Term Care
Ombudsman:
An independent advocate (supporter) for nursing home and assisted living facility residents who works to solve problems between residents and the nursing home or assisted living facilities.

Medicaid:
A joint Federal and State governmental program that pays for health care services for some low income people. Each state has a separate Medicaid program with different eligibility requirements and services.

Medicare:
The Federal health insurance program for: people 65 years of age and older, certain younger people with disabilities, and people with End-Stage Renal Disease.

Skilled Nursing Facility (SNF):
A nursing facility with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services and other related health services 24 hours a day.

Helpful Numbers and Web Info


To report abuse, neglect or misappropriation of funds for a Skilled Nursing Facility or Community Residential Care Facilities resident call: The DHHS Bureau of Senior Services, Long Term Care Ombudsman at 1-800-868-9095 and/or call the DHEC Complaint Hotline at 1-800-922-6735.

To apply for Medicaid call: 1-888-549-0820 or go to
Eligibility Menu .

To learn more about other non-Medicaid aging services call: 803-734-9900 or toll free 1-800-868-9095 or see the Lt. Governor's Office Division on Aging website.

To compare nursing homes call: 1-800-633-4227 or log on to: www.Medicare.gov

To compare Home Health agencies log on to: www.Medicare.gov

To search the South Carolina Nurse Aide Registry to confirm the certification status of a CNA call: 1-800-475-8290 or log on to: Search the Nurse Aide Registry.

To update your address at the South Carolina Nurse Aide Registry call: 1-800-475-8290.

To obtain a duplicate nurse aide certification renewal form call the South Carolina Nurse Aide Registry: 1-800-475-8290 or print the verification of certification from the registry web site see Search the Nurse Aide Registry

To become certified in South Carolina if you are on the registry in another state call: 1-800-475-8290 or log on to: SCNAR

To determine whether a nursing facility or community residential care facility is licensed call: 1-803-545-4370 or log on to: www.SCDHEC.net .

To discuss Medicaid services that are available for persons who meet medical criteria for institutional care but choose to reside in their homes: visit the Division of Community Long Term.

To learn more about Medicare call: 1-800-633-4227 or log on to: www.Medicare.gov.

To learn more about other non-Medicaid aging services call: 803-734-9900 or toll free 1-800-868-9095.