http://www.scdhhs.gov/ en Updated Prior Authorization Expansion on Physician-administered Drugs http://www.scdhhs.gov/communications/updated-prior-authorization-expansion-physician-administered-drugs-1 <span>Updated Prior Authorization Expansion on Physician-administered Drugs</span> <span><span>bradley.harris</span></span> <span><time datetime="2024-04-15T14:32:49-04:00" title="Monday, April 15, 2024 - 14:32">Mon, 04/15/2024 - 14:32</time> </span> <div class="field-type"> <a href="/taxonomy/term/1" hreflang="en">Bulletins</a> </div> <div class="field-topics"> <a href="/taxonomy/term/71" hreflang="en">Providers</a> </div> <div class="field-date"> <time datetime="2024-04-16T12:00:00Z">Tuesday, April 16, 2024</time> </div> <div class="field-mb-"> <div class="field-label">MB# </div> 24-013 </div> <div class="body"> <p>Effective for dates of service on or after May 1, 2024, the South Carolina Department of Health and Human Services (SCDHHS) will require prior authorization (PA) for the physician-administered drugs in the document linked below to ensure use is consistent with the medication’s indication(s) and appropriate clinical guidelines. <strong>This change only applies to medications administered to Healthy Connections Medicaid members enrolled in the fee-for-service (FFS) Medicaid program.</strong></p><p>The list of physician-administered drugs for which a PA is required when administered to a FFS Medicaid member is available in the Procedure Codes section of the <a href="/providers/manuals/physicians-services-provider-manual" data-entity-type="node" data-entity-uuid="996b6773-5ef7-459d-8342-94d553958ea9" data-entity-substitution="canonical">Physicians Services provider manual</a> on the SCDHHS website. The list in the manual will be updated with the additional physician-administered drugs requiring a PA beginning May 1, 2024. The list of additional drugs is available <a href="https://image.messages.scdhhs.gov/lib/fe2911747364047d7d1279/m/1/89c993bc-13a6-45ea-8758-353ecac9fe2e.pdf">here</a>.</p><p>Requests for PA and questions about this bulletin should be submitted to Magellan Rx Management at <a href="https://mrxgateway.com/">https://MRxGateway.com</a> or by calling 1-800-424-8219 between 8 a.m.-5 p.m. Monday-Friday.  </p><p>Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.</p><p><a href="/sites/default/files/documents/(2024-4-16)%20PA%20Expansion%20Bulletin.pdf">Print Version</a></p> </div> Mon, 15 Apr 2024 18:32:49 +0000 bradley.harris 1177 at http://www.scdhhs.gov Mild Obstructive Sleep Apnea (OSA) Treatment http://www.scdhhs.gov/communications/mild-obstructive-sleep-apnea-osa-treatment <span>Mild Obstructive Sleep Apnea (OSA) Treatment</span> <span><span>bradley.harris</span></span> <span><time datetime="2024-04-01T16:30:25-04:00" title="Monday, April 1, 2024 - 16:30">Mon, 04/01/2024 - 16:30</time> </span> <div class="field-type"> <a href="/taxonomy/term/1" hreflang="en">Bulletins</a> </div> <div class="field-topics"> <a href="/taxonomy/term/94" hreflang="en">Durable Medical Equipment</a> <a href="/taxonomy/term/83" hreflang="en">Physicians</a> <a href="/taxonomy/term/77" hreflang="en">Managed Care</a> </div> <div class="field-date"> <time datetime="2024-04-01T12:00:00Z">Monday, April 1, 2024</time> </div> <div class="field-mb-"> <div class="field-label">MB# </div> 24-012 </div> <div class="body"> <p>Effective April 1, 2024, the South Carolina Department of Health and Human Services (SCDHHS) is expanding its coverage for treatment of OSA to include treatment for mild OSA with a Food and Drug Administration (FDA)-approved prescription device. This FDA-approved device is eXciteOSA and will be covered under the agency’s DME benefit.   The device will be covered without prior authorization for full-benefit Healthy Connections Medicaid members aged 18 years or older. Eligible members must have a diagnosis of mild OSA, indicated by a sleep study, with a score of apnea-hypopnea index of more than five and less than 15. Medical providers must follow the FDA guidelines for use, indications and contraindications when prescribing the device.  The device has the following two units: </p><p><strong>Power Source (Control) Unit</strong></p><p>One prescription per lifetime is allowed for the power source and control unit.</p><ul><li>During the first two years, repairs or replacement covered under the product manufacturer’s warranty are not billable to SCDHHS. If the power source (control) unit is damaged or lost after two years of usage or ownership, SCDHHS may allow a replacement power source unit with prior authorization. Providers must file the prior authorization request to the SCDHHS Quality Improvement Organization (QIO).</li></ul><p><strong>Oral Appliance Unit</strong></p><p>The prescription for the oral appliance unit must be renewed annually.   </p><ul><li>During the first two years, repairs or replacement covered under the product manufacturer’s warranty are not billable to SCDHHS. If additional units of oral appliance are needed during a 12-month period, the provider must file a prior authorization request to the SCDHHS QIO justifying the need for the additional unit. Only one additional unit may be allowed. </li></ul><p>To be eligible for reimbursement for eXciteOSA, South Carolina Healthy Connections Medicaid-enrolled DME providers must maintain a copy of the Medicaid certificate of medical necessity in the patient’s record. DME providers must utilize the following procedure codes, criteria and limitations when billing for the prescription of eXciteOSA:</p><table><thead><tr><th>Procedure Code</th><th>Description</th><th>Limitations and Billing</th><th>Reimbursement</th></tr></thead><tbody><tr><th>E0490</th><td>Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by hardware remote</td><td><p>Allowed one power source and control unit per patient per lifetime; This is a capped rental device. Procedure code may be billed monthly for up to13 months using the following modifiers:</p><ul><li><strong>KH</strong> – DMEPOS item, initial claim, purchase of first month rental</li><li><strong>KI</strong> – DMEPOS item, the second or third month of the capped rental period</li><li><strong>KJ</strong> – DMEPOS item, month four to 13 of the capped rental period</li></ul></td><td><p>Months 1-3: Rate is $87.28/month</p><p>Months 4-13: Rate is  $ 65.52/month After 13 months: Device is considered purchased</p></td></tr><tr><th>E0491</th><td>Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by hardware remote, 90-day supply</td><td>Supply purchase; Oral device allowed one per day, per patient and up to four per 12 months. No modifier is required.</td><td>90-day supply: $78.69</td></tr></tbody></table><p>South Carolina Healthy Connections Medicaid managed care organizations (MCOs) are responsible for the coverage and reimbursement of services described in this bulletin for members enrolled in an MCO.</p><p>Providers should direct any 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: <a href="/providers/contact-provider-representative" data-entity-type="node" data-entity-uuid="45e1f318-b52c-4932-ae9d-dc7a67e95ed6" data-entity-substitution="canonical">https://www.scdhhs.gov/providers/contact-provider-representative</a>.</p><p>Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.</p><p><a href="/sites/default/files/documents/(2024-4-1)%20Mild%20Obstructive%20Sleep%20Apnea.pdf">Print Version</a></p> </div> Mon, 01 Apr 2024 20:30:25 +0000 bradley.harris 1168 at http://www.scdhhs.gov Healthy Connections Medicaid Provider Training Opportunities April-June 2024 http://www.scdhhs.gov/communications/healthy-connections-medicaid-provider-training-opportunities-april-june-2024 <span>Healthy Connections Medicaid Provider Training Opportunities April-June 2024</span> <span><span>bradley.harris</span></span> <span><time datetime="2024-03-27T10:23:08-04:00" title="Wednesday, March 27, 2024 - 10:23">Wed, 03/27/2024 - 10:23</time> </span> <div class="field-type"> <a href="/taxonomy/term/1" hreflang="en">Bulletins</a> </div> <div class="field-topics"> <a href="/taxonomy/term/71" hreflang="en">Providers</a> </div> <div class="field-date"> <time datetime="2024-03-27T12:00:00Z">Wednesday, March 27, 2024</time> </div> <div class="field-mb-"> <div class="field-label">MB# </div> 24-011 </div> <div class="body"> <p>The South Carolina Department of Health and Human Services (SCDHHS) regularly offers free Healthy Connections Medicaid training to enrolled Healthy Connections Medicaid providers and their billing agents. These recurring trainings are conducted by SCDHHS’ contracted vendors. Information about the upcoming April-June 2024 training is listed below.</p><p><strong>Medicaid eLearning Provider Workshops</strong></p><p>SCDHHS’ contracted vendor provides web-based training presentations and other materials on a variety of topics to ensure enrolled providers have an understanding of processes and programs.</p><p><strong>To register for a workshop or find additional training resources</strong>, please visit <a href="https://medicaidelearning.remote-learner.net/">www.medicaidelearning.com</a> or call the Provider Service Center (PSC) at (888) 289-0709. The PSC’s hours of operation are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday.</p><p>Below is a schedule of the provider workshops.</p><p><u>Medicaid Basics</u></p><p>This workshop will provide a basic overview of the South Carolina Healthy Connections Medicaid program. The training will address general policies and topics such as eligibility, claim filing options, the remittance package, third party liability (TPL) and claim-level adjustments.</p><p>April 9, 2024, 10 a.m-4 p.m.</p><p>May 8, 2024, 10 a.m-4 p.m.</p><p>June 6, 2024, 10 a.m-4 p.m.</p><p><u>Comprehensive Web Tool</u></p><p>This workshop will explore all the available features on the South Carolina Healthy Connections Medicaid web-based claims submission tool. The training will navigate claim entry and submission as well as how to check eligibility, claim status and e-remits through the online tool.</p><p>April 18, 2024, 10 a.m.-3 p.m.</p><p>May 14, 2024, 10 a.m.-3 p.m.</p><p>June 12, 2024, 10 a.m.-3 p.m.</p><p><u>Overview of Claim-level Adjustments and TPL</u></p><p>This workshop will examine TPL reporting responsibilities, refund processes, claim adjudication, edit resolutions and information on other resources. Providers will also learn the detail-leveled process that gives professional providers the ability to submit claim-level adjustments directly to South Carolina Healthy Connections Medicaid.</p><p>April 24, 2024, 10 a.m.-4 p.m.</p><p>May 23, 2024, 10 a.m.-4 p.m.</p><p>June 18, 2024, 10 a.m.-4 p.m.</p><p><strong>Maximus Managed Care Enrollment Trainings</strong></p><p>The training will inform providers about the Medicaid managed care enrollment process for South Carolina Healthy Connections Medicaid and Healthy Connections Prime. The training will also inform providers on how to use the enrollment broker website, <a href="https://scchoices.com/Member/MemberHome.aspx">scchoices.com</a>, and how to support Medicaid members in choosing their provider medical home and health plan.</p><p>The training is beneficial for any provider or provider office staff interested in understanding member enrollment, learning tips on how to retain Healthy Connections Medicaid members and finding out more about Healthy Connections Prime. For offices assisting patients with Medicaid applications, this training provides information useful in ensuring patients understand the full application process and next steps after their application is accepted.</p><p>Managed care enrollment training is available via webinar or telephone and will take place April-June 2024. The specific dates and times the training is offered are:</p><p>April 12, 2024, 2-3:30 p.m.</p><p>April 26, 2024, 10-11:30 a.m.</p><p>May 17, 2024, 2-3:30 p.m.</p><p>May 31, 2024, 10-11:30 a.m.</p><p>June 14, 2024, 2-3:30 p.m.</p><p>June 28, 2024, 10-11:30 a.m.</p><p>To schedule a training, please email <a href="mailto:providertrainings@maximus.com">providertrainings@maximus.com</a>. If you have questions, please contact Michelle LeMoine at (803) 834-9956 or <a href="mailto:MichelleWLeMoine@maximus.com">MichelleWLeMoine@maximus.com</a>.</p><p>Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.</p><p><a href="/sites/default/files/documents/(2024-3-27)%20Healthy%20Connections%20Provider%20Training%20Opportunities%20April%20-%20June%202024.pdf">Print Version</a></p> </div> Wed, 27 Mar 2024 14:23:08 +0000 bradley.harris 1159 at http://www.scdhhs.gov Extension of Telehealth Flexibilities Issued During the COVID-19 Federal Public Health Emergency http://www.scdhhs.gov/communications/extension-telehealth-flexibilities-issued-during-covid-19-federal-public-health <span>Extension of Telehealth Flexibilities Issued During the COVID-19 Federal Public Health Emergency</span> <span><span>bradley.harris</span></span> <span><time datetime="2024-03-21T14:42:12-04:00" title="Thursday, March 21, 2024 - 14:42">Thu, 03/21/2024 - 14:42</time> </span> <div class="field-type"> <a href="/taxonomy/term/1" hreflang="en">Bulletins</a> </div> <div class="field-topics"> <a href="/taxonomy/term/71" hreflang="en">Providers</a> </div> <div class="field-date"> <time datetime="2024-03-21T12:00:00Z">Thursday, March 21, 2024</time> </div> <div class="field-mb-"> <div class="field-label">MB# </div> 24-010 </div> <div class="body"> <p>The South Carolina Department of Health and Human Services (SCDHHS) is announcing a further extension of telehealth flexibilities issued during the COVID-19 federal public health emergency (PHE).</p><p>SCDHHS previously issued guidance via Medicaid bulletins announcing the status of telehealth flexibilities upon the expiration of the federal PHE (<a href="https://www.scdhhs.gov/communications/policy-clarifications-and-reminders-related-end-covid-19-federal-phe">Medicaid bulletin MB# 23-018</a>). Generally, flexibilities were grouped as those that were made permanent, continued for one year after the expiration of the federal PHE or expired upon the end of the federal PHE May 11, 2023.</p><p>Flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through Dec. 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through Dec. 31, 2024.</p><p>As a reminder, these extended flexibilities, including telehealth flexibilities, were included in the applicable Medicaid provider manuals prior to the end of the federal PHE. Provider manuals can be found on the SCDHHS website <a href="https://www.scdhhs.gov/provider-manual-list">here</a>.</p><p>South Carolina Healthy Connections Medicaid managed care organizations (MCOs) are responsible for the coverage and reimbursement of services described in this bulletin for members enrolled in an MCO.</p><p>Providers may direct any 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 <a href="/providers/contact-provider-representative" data-entity-type="node" data-entity-uuid="45e1f318-b52c-4932-ae9d-dc7a67e95ed6" data-entity-substitution="canonical">https://www.scdhhs.gov/providers/contact-provider-representative</a>.</p><p>Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.</p><p><a href="/sites/default/files/documents/(2024-3-21)%20Telehealth%20Flexibilities%20Extension%20per%20PFS%20final%20rule.pdf">Print Version</a></p> </div> Thu, 21 Mar 2024 18:42:12 +0000 bradley.harris 1156 at http://www.scdhhs.gov Healthy Connections Medicaid Provider Training Opportunities March-May 2024 http://www.scdhhs.gov/communications/healthy-connections-medicaid-provider-training-opportunities-march-may-2024 <span>Healthy Connections Medicaid Provider Training Opportunities March-May 2024</span> <span><span>bradley.harris</span></span> <span><time datetime="2024-02-21T12:50:58-05:00" title="Wednesday, February 21, 2024 - 12:50">Wed, 02/21/2024 - 12:50</time> </span> <div class="field-type"> <a href="/taxonomy/term/1" hreflang="en">Bulletins</a> </div> <div class="field-topics"> <a href="/taxonomy/term/71" hreflang="en">Providers</a> </div> <div class="field-date"> <time datetime="2024-02-21T12:00:00Z">Wednesday, February 21, 2024</time> </div> <div class="field-mb-"> <div class="field-label">MB# </div> 24-009 </div> <div class="body"> <p>The South Carolina Department of Health and Human Services (SCDHHS) regularly offers free Healthy Connections Medicaid training to enrolled Healthy Connections Medicaid providers and their billing agents. These recurring trainings are conducted by SCDHHS’ contracted vendors. Information about the upcoming March-May 2024 training is listed below.</p><p><strong>Medicaid eLearning Provider Workshops</strong></p><p>SCDHHS’ contracted vendor provides web-based training presentations and other materials on a variety of topics to ensure enrolled providers have an understanding of processes and programs.</p><p><strong>To register for a workshop or find additional training resources</strong>, please visit <a href="https://medicaidelearning.remote-learner.net/">www.medicaidelearning.com</a> or call the Provider Service Center (PSC) at (888) 289-0709. The PSC’s hours of operation are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday.</p><p>Below is a schedule of the provider workshops.</p><p><u>Medicaid Basics</u></p><p>This workshop will provide a basic overview of the South Carolina Healthy Connections Medicaid program. The training will address general policies and topics such as eligibility, claim filing options, the remittance package, third party liability (TPL) and claim-level adjustments.</p><p>March 7, 2024, 10 a.m.-4 p.m.</p><p>April 9, 2024, 10 a.m-4 p.m.</p><p>May 8, 2024, 10 a.m-4 p.m.</p><p> <u>Comprehensive Web Tool</u></p><p>This workshop will explore all the available features on the South Carolina Healthy Connections Medicaid web-based claims submission tool. The training will navigate claim entry and submission as well as how to check eligibility, claim status and e-remits through the online tool.</p><p>March 13, 2024, 10 a.m.-3 p.m.</p><p>April 18, 2024, 10 a.m.-3 p.m.</p><p>May 14, 2024, 10 a.m.-3 p.m.</p><p> <u>Overview of Claim-level Adjustments and TPL</u></p><p>This workshop will examine TPL reporting responsibilities, refund processes, claim adjudication, edit resolutions and information on other resources. Providers will also learn the detail-leveled process that gives professional providers the ability to submit claim-level adjustments directly to South Carolina Healthy Connections Medicaid.</p><p>March 19, 2024, 10 a.m.-4 p.m.</p><p>April 24, 2024, 10 a.m.-4 p.m.</p><p>May 23, 2024, 10 a.m.-4 p.m.</p><p> <strong>Maximus Managed Care Enrollment Trainings</strong></p><p>The training will inform providers about the Medicaid managed care enrollment process for South Carolina Healthy Connections Medicaid and Healthy Connections Prime. The training will also inform providers on how to use the enrollment broker website, <a href="https://scchoices.com/Member/MemberHome.aspx">scchoices.com</a>, and how to support Medicaid members in choosing their provider medical home and health plan.</p><p>The training is beneficial for any provider or provider office staff interested in understanding member enrollment, learning tips on how to retain Healthy Connections Medicaid members and finding out more about Healthy Connections Prime. For offices assisting patients with Medicaid applications, this training provides information useful in ensuring patients understand the full application process and next steps after their application is accepted.</p><p>Managed care enrollment training is available via webinar or telephone and will take place March-May 2024. The specific dates and times the training is offered are:</p><p>March 8, 2024, 2-3:30 p.m.</p><p>March 22, 2024, 10-11:30 a.m.</p><p>April 12, 2024, 2-3:30 p.m.</p><p>April 26, 2024, 10-11:30 a.m.</p><p>May 17, 2024, 2-3:30 p.m.</p><p>May 31, 2024, 10-11:30 a.m.</p><p>To schedule a training, please email <a href="mailto:providertrainings@maximus.com">providertrainings@maximus.com</a>. If you have questions, please contact Michelle LeMoine at (803) 834-9956 or <a href="mailto:MichelleWLeMoine@maximus.com">MichelleWLeMoine@maximus.com</a>.</p><p>Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.</p><p><a href="/sites/default/files/documents/(2024-2-21)%20Healthy%20Connections%20Provider%20Training%20Opportunities%20March-May%202024.pdf">Print Version</a></p> </div> Wed, 21 Feb 2024 17:50:58 +0000 bradley.harris 1140 at http://www.scdhhs.gov Physician Services Provider Manual Updates http://www.scdhhs.gov/communications/physician-services-provider-manual-updates <span>Physician Services Provider Manual Updates</span> <span><span>bradley.harris</span></span> <span><time datetime="2024-02-12T11:01:27-05:00" title="Monday, February 12, 2024 - 11:01">Mon, 02/12/2024 - 11:01</time> </span> <div class="field-type"> <a href="/taxonomy/term/1" hreflang="en">Bulletins</a> </div> <div class="field-topics"> <a href="/taxonomy/term/76" hreflang="en">Hospitals</a> <a href="/taxonomy/term/86" hreflang="en">Laboratories</a> <a href="/taxonomy/term/77" hreflang="en">Managed Care</a> <a href="/taxonomy/term/82" hreflang="en">Medical Clinics</a> <a href="/taxonomy/term/87" hreflang="en">Mental Health and Rehabilitation Clinics</a> <a href="/taxonomy/term/83" hreflang="en">Physicians</a> </div> <div class="field-date"> <time datetime="2024-02-12T12:00:00Z">Monday, February 12, 2024</time> </div> <div class="field-mb-"> <div class="field-label">MB# </div> 24-008 </div> <div class="body"> <p>Effective for dates of service on or after March 1, 2024, the South Carolina Department of Health and Human Services will reimburse for the following laboratory services:</p><ul><li>Oncotype DX® Breast Cancer Assay</li><li>Neuropharmagen Genomic Test</li></ul><p>Updated policy language on the coverage of both of these laboratory tests will be available in the <a href="/providers/manuals/physicians-services-provider-manual" data-entity-type="node" data-entity-uuid="996b6773-5ef7-459d-8342-94d553958ea9" data-entity-substitution="canonical">Physicians Services provider manual</a> by March 1, 2024. The <a href="/providers/manuals/community-mental-health-cmh-services-manual" data-entity-type="node" data-entity-uuid="57ac054c-b38c-43c7-a798-babd86912fe8" data-entity-substitution="canonical">Community Mental Health Services provider manual</a> will also include updated policy language on the coverage of the Neuropharmagen Genomic Test. Providers must utilize the following procedure codes, criteria and limitations when billing for these tests.</p><table border="2px" cellspacing="2px" cellpadding="2px"><thead><tr valign="top"><th><strong>Procedure Code</strong></th><th><strong>Description</strong></th><th><strong>Eligible Members</strong></th><th><strong>Benefit Criteria and Limitations</strong></th><th><strong>Fee</strong></th></tr></thead><tbody><tr valign="top"><td><strong>81519</strong></td><td>Oncology (Breast), MRNA, Gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence score.</td><td>Adults enrolled in full-benefit Medicaid coverage. This includes members who are enrolled in the breast and cervical cancer program.</td><td><p>One test per lifetime is covered. Medicaid members must have the following findings and diagnosis:</p><ul><li>recently been diagnosed with stage I, stage II or stage III invasive breast cancer;</li><li>the cancer is estrogen receptor-positive;</li><li>the cancer is HER2-negative; and,</li><li>the cancer is lymph node-positive or lymph node-negative.</li></ul><p>No prior authorization is required. Providers must file claims with primary diagnosis of the conditions listed above.</p></td><td><strong>$3,020.94</strong></td></tr><tr valign="top"><td><strong>81418</strong></td><td>Drug metabolism (e.g., pharmacogenomics) genomic sequence analysis panel, must include testing of at least six genes, including CYP2C19, CYP2D6 and CYP2D6 duplication/deletion analysis.</td><td>Medicaid members enrolled in full-benefit Medicaid coverage.</td><td><p><strong>Prior authorization must be obtained for this genomic test.</strong></p><p>Prior authorization requests must meet the following criteria:</p><ol><li>The test must be ordered by a board-certified psychiatrist or by a psychiatrist extender (psychiatric physician assistant or psychiatric nurse practitioner) under the supervision of a board-certified psychiatrist; and,</li><li>The Medicaid member must have one of the following mental health conditions: general anxiety disorder, major depressive disorder, obsessive compulsive disorder, bipolar or schizophrenia; and,</li><li>The Medicaid member must meet at least one of the following:<ol><li>The Medicaid member has experienced a trial and failure of two previous psychoactive drugs for the mental health condition being treated. <strong>OR</strong></li><li>The Medicaid member is currently taking more than two medications to treat the mental health condition.</li></ol></li></ol></td><td><strong>$715.32</strong></td></tr></tbody></table><p>South Carolina’s Healthy Connections Medicaid managed care organizations (MCOs) are responsible for the coverage and reimbursement of services described in this bulletin for members enrolled in an MCO.</p><p>Providers should direct any 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 <a href="https://www.scdhhs.gov/providers/contact-provider-representative.">https://www.scdhhs.gov/providers/contact-provider-representative</a>.</p><p>Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.</p><p><a href="/sites/default/files/documents/(2024-2-12)%20Physician%20Manual%20updates%203.1.24%20.pdf">Print Version</a></p> </div> Mon, 12 Feb 2024 16:01:27 +0000 bradley.harris 1131 at http://www.scdhhs.gov Updated Rehabilitative Therapy and Audiological Services Provider Manual Published, Provider Webinars Announced http://www.scdhhs.gov/communications/updated-rehabilitative-therapy-and-audiological-services-provider-manual-published <span>Updated Rehabilitative Therapy and Audiological Services Provider Manual Published, Provider Webinars Announced</span> <span><span>bradley.harris</span></span> <span><time datetime="2024-02-01T14:27:48-05:00" title="Thursday, February 1, 2024 - 14:27">Thu, 02/01/2024 - 14:27</time> </span> <div class="field-type"> <a href="/taxonomy/term/1" hreflang="en">Bulletins</a> </div> <div class="field-topics"> <a href="/taxonomy/term/73" hreflang="en">BabyNet</a> <a href="/taxonomy/term/85" hreflang="en">Disabilities and Special Needs</a> <a href="/taxonomy/term/98" hreflang="en">EPSDT</a> <a href="/taxonomy/term/77" hreflang="en">Managed Care</a> <a href="/taxonomy/term/82" hreflang="en">Medical Clinics</a> <a href="/taxonomy/term/95" hreflang="en">Other Medical Professionals</a> </div> <div class="field-date"> <time datetime="2024-02-01T12:00:00Z">Thursday, February 1, 2024</time> </div> <div class="field-mb-"> <div class="field-label">MB# </div> 24-007 </div> <div class="body"> <p>The South Carolina Department of Health and Human Services (SCDHHS) has published its updated <a href="https://www.scdhhs.gov/providers/manuals/rehabilitative-therapy-and-audiological-services-manual">Rehabilitative Therapy and Audiological Services provider manual</a>. The manual’s former name was the Private Rehabilitative Therapy Audiological Services provider manual. As announced in <a href="https://www.scdhhs.gov/communications/rehabilitative-therapy-and-audiological-services-provider-manual-updates-coming-2024">Medicaid bulletin 24-001</a>, <strong>the program information and requirements described in the Rehabilitative Therapy and Audiological Services provider manual are effective for dates of service on or after Feb. 1, 2024</strong>. The manual is available on the <a href="https://www.scdhhs.gov/provider-manual-list">provider manual page of the SCDHHS</a> website. SCDHHS appreciates providers taking time to submit feedback on the draft of the manual distributed Jan. 2, 2024.</p><p>SCDHHS will conduct two live webinars to address the updates to the manual. A recorded webinar will also be made available for viewing on the SCDHHS website. The dates, times and links to register for the live webinars are below:</p><ul><li>Feb. 12, 2024, from 12-2 p.m.<ul><li><a href="https://bit.ly/4b4MUKP">Register with this link</a></li></ul></li><li>Feb. 23, 2024, from 12-2 p.m. <ul><li><a href="https://bit.ly/3NWoV6q">Register with this link</a></li></ul></li></ul><p>The webinars will cover the following program information and requirements in each section of the updated manual. Updates include:</p><ul><li>Categorizing eligible Medicaid members in groups to align with the Medicaid State Plan authority;</li><li>Changes to the qualified providers section to align with state and federal regulations and the Medicaid State Plan authority;</li><li>Changes to covered services definitions to align with federal regulations;</li><li>Adding definitions of the Early Periodic Screening, Diagnostic and Treatment benefit and telehealth services;</li><li>Clarifying reimbursement and charge limits policies; and utilization management policies and processes;</li><li>Updating the Reporting and Documenting section with information about health record retention and maintenance and signature requirements;</li><li>Adding a new Billing Guidance section, which includes information about claims filing and modifiers; and,</li><li>Adding a Benefit Criteria and Limitations section, which includes frequency limits and criteria for each covered procedure code.</li></ul><p>South Carolina’s Healthy Connections Medicaid managed care organizations (MCOs) are responsible for the coverage and reimbursement of services described in this bulletin for members who are enrolled in an MCO.</p><p>Providers serving Healthy Connections Medicaid-enrolled children who are also enrolled in South Carolina’s Individuals with Disabilities Education Act Part C program, which is commonly known as BabyNet, must follow BabyNet’s rules regarding delivering services via telehealth.</p><p>Providers may 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: <a href="https://www.scdhhs.gov/providers/contact-provider-representative">http://www.scdhhs.gov/contact-us</a>.</p><p>Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.</p><p><a href="/sites/default/files/documents/(2024-2-1)%20Rehabilitative%20Therapy%20and%20Audiological%20Services%20Manual%20Published%20-FINAL.pdf">Print Version</a></p> </div> Thu, 01 Feb 2024 19:27:48 +0000 bradley.harris 1129 at http://www.scdhhs.gov Healthy Connections Medicaid Provider Training Opportunities February-April 2024 http://www.scdhhs.gov/communications/healthy-connections-medicaid-provider-training-opportunities-february-april-2024 <span>Healthy Connections Medicaid Provider Training Opportunities February-April 2024</span> <span><span>bradley.harris</span></span> <span><time datetime="2024-01-23T11:20:42-05:00" title="Tuesday, January 23, 2024 - 11:20">Tue, 01/23/2024 - 11:20</time> </span> <div class="field-type"> <a href="/taxonomy/term/1" hreflang="en">Bulletins</a> </div> <div class="field-topics"> <a href="/taxonomy/term/71" hreflang="en">Providers</a> </div> <div class="field-date"> <time datetime="2024-01-23T12:00:00Z">Tuesday, January 23, 2024</time> </div> <div class="field-mb-"> <div class="field-label">MB# </div> 24-006 </div> <div class="body"> <p>The South Carolina Department of Health and Human Services (SCDHHS) regularly offers free Healthy Connections Medicaid training to enrolled Healthy Connections Medicaid providers and their billing agents. These recurring trainings are conducted by SCDHHS’ contracted vendors. Information about the upcoming February-April 2024 training is listed below.</p><p><strong>Medicaid eLearning Provider Workshops</strong></p><p>SCDHHS’ contracted vendor provides web-based training presentations and other materials on a variety of topics to ensure enrolled providers have an understanding of processes and programs.</p><p><strong>To register for a workshop or find additional training resources</strong>, please visit <a href="https://medicaidelearning.remote-learner.net/">www.medicaidelearning.com</a> or call the Provider Service Center (PSC) at (888) 289-0709. The PSC’s hours of operation are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday.</p><p>Below is a schedule of the provider workshops.</p><p><u>Medicaid Basics</u></p><p>This workshop will provide a basic overview of the South Carolina Healthy Connections Medicaid program. The training will address general policies and topics such as eligibility, claim filing options, the remittance package, third party liability (TPL) and claim-level adjustments.</p><p>Feb. 7, 2024, 10 a.m.-4 p.m.</p><p>March 7, 2024, 10 a.m.-4 p.m.</p><p>April 9, 2024, 10 a.m-4 p.m.</p><p><u>Comprehensive Web Tool</u></p><p>This workshop will explore all the available features on the South Carolina Healthy Connections Medicaid web-based claims submission tool. The training will navigate claim entry and submission as well as how to check eligibility, claim status and e-remits through the online tool.</p><p>Feb. 13, 2024, 10 a.m.-3 p.m.</p><p>March 13, 2024, 10 a.m.-3 p.m.</p><p>April 18, 2024, 10 a.m.-3 p.m.</p><p><u>Overview of Claim-level Adjustments and TPL</u></p><p>This workshop will examine TPL reporting responsibilities, refund processes, claim adjudication, edit resolutions and information on other resources. Providers will also learn the detail-leveled process that gives professional providers the ability to submit claim-level adjustments directly to South Carolina Healthy Connections Medicaid.</p><p>Feb. 22, 2024, 10 a.m.-4 p.m.</p><p>March 19, 2024, 10 a.m.-4 p.m.</p><p>April 24, 2024, 10 a.m.-4 p.m.</p><p><strong>Maximus Managed Care Enrollment Trainings</strong></p><p>The training will inform providers about the Medicaid managed care enrollment process for South Carolina Healthy Connections Medicaid and Healthy Connections Prime. The training will also inform providers on how to use the enrollment broker website, <a href="https://scchoices.com/Member/MemberHome.aspx">scchoices.com</a>, and how to support Medicaid members in choosing their provider medical home and health plan.</p><p>The training is beneficial for any provider or provider office staff interested in understanding member enrollment, learning tips on how to retain Healthy Connections Medicaid members and finding out more about Healthy Connections Prime. For offices assisting patients with Medicaid applications, this training provides information useful in ensuring patients understand the full application process and next steps after their application is accepted.</p><p>Managed care enrollment training is available via webinar or telephone and will take place February-April 2024. The specific dates and times the training is offered are:</p><p>Feb. 9, 2024, 2-3:30 p.m.</p><p>Feb. 23, 2024, 10-11:30 a.m.</p><p>March 8, 2024, 2-3:30 p.m.</p><p>March 22, 2024, 10-11:30 a.m.</p><p>April 12, 2024, 2-3:30 p.m.</p><p>April 26, 2024, 10-11:30 a.m.</p><p>To schedule a training, please email <a href="mailto:providertrainings@maximus.com">providertrainings@maximus.com</a>. If you have questions, please contact Michelle LeMoine at (803) 834-9956 or <a href="mailto:MichelleWLeMoine@maximus.com">MichelleWLeMoine@maximus.com</a>.</p><p>Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.</p><p><a href="/sites/default/files/documents/(2024-1-23)%20Healthy%20Connections%20Provider%20Training%20Opportunities%20February-April%202024.pdf">Print Version</a></p> </div> Tue, 23 Jan 2024 16:20:42 +0000 bradley.harris 1115 at http://www.scdhhs.gov IRS 1099-MISC Forms for 2023 http://www.scdhhs.gov/communications/irs-1099-misc-forms-2023 <span>IRS 1099-MISC Forms for 2023</span> <span><span>bradley.harris</span></span> <span><time datetime="2024-01-22T16:43:27-05:00" title="Monday, January 22, 2024 - 16:43">Mon, 01/22/2024 - 16:43</time> </span> <div class="field-type"> <a href="/taxonomy/term/1" hreflang="en">Bulletins</a> </div> <div class="field-topics"> <a href="/taxonomy/term/71" hreflang="en">Providers</a> </div> <div class="field-date"> <time datetime="2024-01-22T12:00:00Z">Monday, January 22, 2024</time> </div> <div class="field-mb-"> <div class="field-label">MB# </div> 24-005 </div> <div class="body"> <p>Some Healthy Connections Medicaid-enrolled providers were mailed an IRS 1099-MISC form from the South Carolina Department of Health and Human Services (SCDHHS). The IRS 1099-MISC form providers received in the mail in January 2024 from SCDHHS contains an error. While the dollar amount of “Medical and health care payments” listed in block six of the IRS 1099-MISC form is correct for calendar year 2023, the form indicates it is for calendar year 2022.</p><p>Corrected forms are currently being printed and will be mailed in the next two business days. Providers should receive the replacement IRS 1099-MISC forms for 2023 within the next three to seven business days.</p><p>The incorrect form showing the 2022 date should be disregarded and not used to file taxes for the 2022 or 2023 calendar years. The error occurred during the process of printing the forms that were mailed to providers. The forms with the correct calendar year were submitted to the IRS.</p><p>If you have any questions, please contact the Provider Service Center at (888) 289-0709, extension four, option one. The Provider Service Center is open Monday through Thursday from 7:30 a.m. to 5 p.m. and Friday from 8:30 a.m. to 5 p.m.</p><p>Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.</p><p><a href="/sites/default/files/documents/(2024-1-22)%201099%20Form%20for%20Tax%20Year%202023%20FINAL.pdf">Print Version</a></p> </div> Mon, 22 Jan 2024 21:43:27 +0000 bradley.harris 1114 at http://www.scdhhs.gov Updated Guidance Regarding Certification of Temporary Nurse Aides http://www.scdhhs.gov/communications/updated-guidance-regarding-certification-temporary-nurse-aides-0 <span>Updated Guidance Regarding Certification of Temporary Nurse Aides</span> <span><span>hopkinsj</span></span> <span><time datetime="2024-01-19T16:28:02-05:00" title="Friday, January 19, 2024 - 16:28">Fri, 01/19/2024 - 16:28</time> </span> <div class="field-type"> <a href="/taxonomy/term/1" hreflang="en">Bulletins</a> </div> <div class="field-date"> <time datetime="2023-04-25T12:00:00Z">Tuesday, April 25, 2023</time> </div> <div class="field-mb-"> <div class="field-label">MB# </div> 23-017 </div> <div class="body"> <p>The South Carolina Department of Health and Human Services (SCDHHS) is issuing updated guidance regarding the certification of temporary nurse aides (TNAs). This updates the guidance in <a href="https://www.scdhhs.gov/press-release/updated-guidance-regarding-certification-temporary-nurse-aides"><strong>Medicaid bulletin 22-017 </strong></a>. The Centers for Medicare and Medicaid Services (CMS) approved South Carolina’s request for an extension of the 1135 waiver of the requirements contained in 42CFR§483.35(d) Training and Certification of Nurse Aides for Skilled Nursing Facilities/Nursing Facilities. This waiver allowed TNAs to continue working while they were actively working toward completion of testing and certification requirements. <strong>This waiver will expire on the last day of the COVID-19 federal public health emergency (PHE), May 11, 2023 </strong>.</p><p>Nursing facilities will have four months (through Sept. 10, 2023) to ensure all nurse aides who are hired prior to the end of the PHE have completed a state-approved Nurse Aide Training and Competency Evaluation Program (NATCEP/CEP). Nurse aides hired after the end of the PHE will have up to four months from their date of hire to complete a state-approved NATCEP/CEP.</p><p>Additional information detailing steps for a TNA to become a nurse aide is available in the SCDHHS guidance dated <a href="https://www.scdhhs.gov/pro-alert/additional-guidance-regarding-certification-temporary-nurse-aides"><strong>Aug. 19, 2022 </strong></a><strong>. </strong></p><p>Providers with questions about the policy changes announced in this bulletin should submit their questions to <a href="mailto:SCNAR@scdhhs.gov"><strong>SCNAR@scdhhs.gov </strong></a>.</p><p>Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.</p><p><a href="https://www.scdhhs.gov/sites/default/files/%282023-04-16%29%20TNA%20Updated%20Guidance%20.pdf">Print Version</a></p> </div> Fri, 19 Jan 2024 21:28:02 +0000 hopkinsj 1095 at http://www.scdhhs.gov