Revised Guidance Regarding Qualified Providers Eligible for the Enhanced Physician Fee Schedule and Clarification of Fee Schedule for Any Qualified Providers

  1. Providers Eligible For Enhanced Payments Beginning in Calendar Year 2015

The South Carolina Department of Health and Human Services (SCDHHS) issued a bulletin on November 26, 2014, titled Primary Care Fee Schedule Enhancement.  The bulletin listed physicians that would qualify for enhanced payments in the Healthy Connections Medicaid-funded Enhanced Physician Fee Schedule beginning in calendar year 2015.  This bulletin is being issued to remind providers of current policy and that the Medicaid Enhanced Physician Fee Schedule will not be applicable for any physicians participating in the Supplemental Teaching Physician (STP) Payment Program.

  1. Enhanced Fee Schedule For Qualifying Providers

In the bulletin dated November 26, 2014, the fee schedule was labeled as, “Medicaid Fee for Service Fee Schedule January 1, 2015.”  SCDHHS has amended the title and column headers of the attached fee schedule to reflect that the enhanced fee schedule is only for qualifying providers.  None of the rates in the fee schedule have changed since the November 26th bulletin.

Although SCDHHS has provided the Managed Care Organizations (MCOs) a capitation payment increase based upon the enhanced payments set forth in the Qualifying Provider Fee Schedule, MCO payments to qualifying providers are a contractual matter between the MCO and the provider.  SCDHHS is attaching the Qualifying Provider Fee Schedule that will be implemented January 1, 2015.

Please refer any questions or concerns regarding this bulletin to the Provider Service Center at (888) 289-0709.  Thank you for your continued support of the SC Healthy Connections Medicaid Program.

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