Managed Care Organizations, Nursing Facilities, and Swing-Bed Hospitals

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Effective with dates of service on or after April 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will expand coverage of nursing home admission or swing-bed placement from the initial thirty (30) days of continuous confinement to ninety (90) days of continuous confinement as part of the Managed Care Organization (MCO) covered responsibilities.  Providers will be required to file claims to the MCOs for MCO enrolled beneficiaries. 

 

Providers will continue to follow the screening and level of care determination process as used in fee-for-service (FFS) Medicaid.  MCOs will not authorize services.  Upon admission, copies of the level of care certification (DHHS Form 185) and the Notice of Admission, Authorization and Change of Status for Long Term Care (DHHS Form 181) are to be forwarded to the MCO in lieu of a request for authorization and in support of claims adjudication. 

 

Medicaid MCO members should be disenrolled and returned to FFS following ninety (90) days of continuous confinement.  Following admission, providers should notify the Department of Managed Care (SCDHHS) of nursing home placement using the web-based notification process located under ‘Reference Tools’ in the Managed Care section of the Department’s website – www.scdhhs.gov.  MCO members will be disenrolled and returned to FFS according to the enrollment cut-off schedule for the month in which the ninetieth (90th) day of continuous confinement occurs.  

 

Your continued support of the South Carolina Medicaid Program is appreciated.  Please refer any questions or concerns regarding this bulletin to the Managed Care staff at (803) 898-4614. 

 

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