April 2011 Bulletin Archive

New MCO Contract Language
Description: The South Carolina Department of Health and Human Services (SCDHHS) Has Developed a Standardized Subcontract Boilerplate for All Providers Who Contract with Medicaid Managed Care Organizations (MCOs).
The new subcontract boilerplate is a result of a collaborative effort between representatives of SCDHHS, the Medicaid Managed Care Organizations (MCOs), and South Carolina Medical Association Society of Managed Care Contractors and will be replacing existing subcontracts utilized by the MCOs over the next four years.
Posted: 4/28/2011 11:54:10 AM

Management Of Mental Health, HIV/AIDS And Oncology Medications
Description: On April 6, 2011, The General Assembly Approved Joint Resolution S.434 Which Now Allows The South Carolina Department Of Health And Human Services (Scdhhs) To Require Prior Authorization (Pa) On Medications Used To Treat Major Depression, Schizophrenia, Bipolar Disorder, Hiv/Aids And Cancer.
Posted: 04/26/2011

All Patient Refined Diagnosis Related Grouper (APR – DRG) Training
Description: The South Carolina Department Of Health And Human Services (Scdhhs) Will Offer 4 Regional Trainings On The New Apr-Drg Grouper. Effective With Discharges On Or After October 1, 2011, Apr-Drg Version 28 Will Replace The Current 3m Grouper Version 24 With Crosswalk.

Providers Indicated
Description: Eligibility Verification Problem
Providers may have been given inaccurate information concerning participation in a managed care plan (Managed Care Organization (MCO) or Medical Homes Network (MHN)) when checking eligibility from Saturday, March 26, 2011 through Thursday, March 31, 2011. Enrollment in an MCO or MHN was not reflected. Beneficiaries enrolled in an MCO or MHN appeared, in error, as being enrolled in fee-for-service Medicaid. We apologize for any inconvenience and have corrected the problem; however, it is possible claims will reject with a 965 or 989 edit, requiring action on the part of the provider.
Posted:4/18/2011 10:18:14 AM

Providers Indicated
Description: Policy Statement - Outpatient Therapy Services
As a reminder to all hospital providers, the South Carolina Department of Health and Human Services (SCDHHS) will reimburse physical, occupational, and speech therapy services in an outpatient hospital only under the following conditions:
Posted: 4/12/2011 7:31:14 AM

All Providers
Description: Rehabilitative Therapy
This is an update to the January 31, 2011, Medicaid bulletin which addresses the requirements for additional units request for Private Rehabilitative Therapy Services (speech-language pathology, occupational, and/or physical therapy). Individuals under age 21 will require prior approval once they have reached a combined total of 75 hours (300 units) per fiscal year. The hours used as of April 1st will count toward this checkpoint for the fiscal year ending June 30. The state fiscal year begins July 1st and ends June 30th of each year.
Posted: 4/11/2011 7:54:55

Medicaid Rate Reduction
Description: Reimbursement for South Carolina Medicaid providers will be reduced by 3% effective for dates of service beginning on Friday, April 8, 2011.
Posted: 4/7/2011 9:49:07 AM

Providers Indicated
Description: Managed Care Organizations (MCOs) Contract Changes
I. Prior Authorization for Acute Inpatient Psychiatric Services
Effective on or after May 1, 2011, the South Carolina Department of Health and Human Services (SCDHHS) will be including Medicaid covered inpatient Behavioral Health Services (DRGs 424-433 and 521-523) in a general acute care hospital as a part of the Managed Care Organization (MCO) covered responsibilities.

II. Co-Payments
Beginning April 1, 2011, SCDHHS will increase the amount of adult beneficiary co-payments as reflected in the Medicaid Bulletin dated March 16, 2011.
Posted:4/4/2011 7:56:05 AM

Report Fraud