Nutritional Counseling Bulletin.
Tagged:
I.Nutritional Counseling
Effective Aug. 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will implement a policy for nutritional counseling. This policy specifically targets those individuals with a Body Mass Index (BMI) of 30 and greater who are currently not seeking gastric bypass surgery or related services.
The nutritional counseling program will exclude the following categories of Healthy Connections members:
- Pregnant women
- Members who have had bariatric surgery, gastric banding or other related procedures
- Members receiving active treatment with Gastric Bypass Surgery/Vertical-Banded Gastroplasty
- Members for whom medication use has significantly contributed to the member's obesity as determined by the treating physician
Examples of medications that may cause weight gain include but are not limited to:
- Atypical antipsychotics (aripiprazone, olanzapine, quetiapine, risperidone, ziprasidone)
- Long-term use of oral corticosteroids (prednisone, prednisolone)
- Certain anticonvulsant medications (valproic acid, carbamazepine)
- Tricyclic antidepressants (amitriptyline)
Adult members with a BMI of 30 or greater who are committed to losing weight through diet and exercise will be eligible for this program. The program includes an initial screening, five additional face to face behavioral counseling visits/encounters with a physician, physician assistant, and/or a nurse practitioner, an initial dietitian visit for nutritional counseling and five follow up visits with a dietician. Obesity-management related treatment for children will continue to be covered as a part of the Medicaid Early Periodic Screening Diagnosis and Testing (EPSDT) Program.
Please note, for Healthy Connections Medicaid members also receiving Medicare benefits, SCDHHS will only pay as a secondary payor to Medicare.
II.Dietitian Enrollment
SCDHHS is currently enrolling Licensed Dietitians (LDs) and these providers will be able to provide nutritional counseling services for obesity, effective with dates of service on or after August 1, 2015. In order for LDs to be reimbursed directly for services rendered on or after August 1, 2015, LDs must enroll with SCDHHS. Additionally, SCDHHS contracts with Managed Care Organizations (MCOs) for these services and LD's must be enrolled and contracted with the members MCO in order to receive reimbursement from the MCO.
A LD must meet the South Carolina licensure and educational requirements. LDs practicing within 25 miles of the South Carolina border in Georgia or North Carolina must meet the licensure and educational requirements of the State in which the LD practices.
All services must be rendered within the South Carolina Medicaid Service Area (SCMSA). SCMSA is defined as South Carolina and adjacent areas within 25 miles of its borders.
Hospitals employing LDs will be reimbursed for nutritional counseling services for obesity by enrolling the LDs directly with SCDHHS and linking the LDs to the hospital's professional clinical groups. LDs may enroll utilizing the provider enrollment online application tool located at scdhhs.gov. For MCO dietitian enrollment and credentialing questions, MCO contact information is available at https://msp.scdhhs.gov/managedcare//resource/managed-care-health-plan-contact-information. Contact each MCO directly for questions and timelines regarding their dietitian enrollment and credentialing processes.
To review the entire policy, policy limitations, billing procedures and codes please refer to the Physicians, Laboratories and Other Medical Professionals Provider Manual located online at scdhhs.gov.
Please refer any questions or concerns regarding this bulletin to either Obesity@scdhhs.gov or the Provider Service Center at (888) 289-0709. For MCO-related questions and concerns contact information is available at https://msp.scdhhs.gov/managedcare//resource/managed-care-health-plan-contact-information. Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.
