Actions Regarding Changes In Accordance With The Patient Protection and Affordable Care Act of 2010 (ACA)

PUBLIC NOTICE: 
SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions pursuant to the requirements of Title 42 CFR § 435.1110 regarding eligibility changes implemented in accordance with The Patient Protection and Affordable Care Act of 2010 (ACA) under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective for services provided on or after January 1, 2014, SCDHHS will amend the South Carolina Title XIX eligibility methodology to include Presumptive Eligibility in Hospitals as required by the Affordable Care Act. Through the Presumptive Eligibility Program, hospitals that participate in the Medicaid program and have not been disqualified can make presumptive Medicaid eligibility determinations for individuals who attest to a simplified set of eligibility requirements for the following SCDHHS categories:  Pregnant Women, Family Planning, Former Foster Care Children to Age 26, Breast and Cervical Cancer Treatment, Infants and Children under Age 19, Parents and Caretaker Relatives. SCDHHS will communicate the program requirements and provide training to these hospitals. Individuals who are determined presumptively eligible will be enrolled in a fee-for-service payment category based on the hospital’s assessment of categorical eligibility, household income, state residency and citizenship, status as a national or satisfactory immigration status as attested by the applicant. The agency will provide all services covered under the plan, including EPSDT, during this Presumptive Eligibility Period. An exception to this is individuals enrolled in the presumptively eligible category for pregnant women will only be covered for ambulatory prenatal care. Presumptive Eligibility Periods are limited to no more than one period within two calendar years. The Presumptive Eligibility Period begins on the date the determination is made.  The Presumptive Eligibility Period ends with the earlier of:

  • The date the eligibility determination for regular Medicaid is made, if an application for Medicaid is filed by the last day of the month following the month in which the determination of presumptive eligibility is made; or
  • The last day of the month following the month in which the determination of presumptive eligibility is made, if no application for Medicaid is filed by that date.

SCDHHS will require hospitals to meet performance standards that relate to the proportion of individuals determined presumptively eligible who submit a full application before the end of the Presumptive Eligibility Period and the proportion of individuals who are determined eligible for Medicaid based on the submission of an application before the end of the Presumptive Eligibility Period.

Hospitals that want to participate in the January 1, 2014 implementation must attend training.  Training sessions will occur December 9th-12th 2013.  Registration is required and can be accessed at http://medicaidelearning.com/ under Upcoming Events. Participating hospitals must agree to make determinations according to state policy.  Email collaboration@scdhhs.gov, to contact a program representative.

Copies of this notice are available at each County Department of Health and Human Services Office and at www.scdhhs.gov for public review.  Additional information concerning the proposed action is available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at the SCDHHS, Eligibility, Enrollment, and Member Services, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9:00 A.M. and 5:00 P.M.

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