Comprehensive Preconception Care Model Waiver

PUBLIC NOTICE: 
SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES

The South Carolina Department of Health and Human Services (SCDHHS) will submit a Section 1115 Demonstration Waiver application to the Centers for Medicare and Medicaid Services (CMS) to adopt a Preconception Care (PCC) Model for family planning, pursuant to Title XIX of the Social Security Act Medical Assistance Program (Medicaid). The waiver application is available for public review and comment at https://msp.scdhhs.gov/pcc.

To continue efforts to improve the health and well-being of mothers, infants and children enrolled in the Medicaid program, SCDHHS intends to amend and enhance its family planning benefit to encompass a broader scope of preconceptive care in a manner that aligns with clinical evidence and nationally accepted treatment guidelines. This effort represents a shift from the traditional model of focus on contraception and care during the prenatal period to a model that includes and ensures the delivery of high quality care during the preconceptive period.

The primary focus of this demonstration waiver is to offer more comprehensive coordination of preconceptive care coverage to existing Medicaid beneficiaries, creating a more complete and coordinated healthcare delivery model. The proposed demonstration waiver employs a more robust and focused care model (e.g., the PCC model) to ensure the coordination of family planning and reproductive health care with primary care services and chronic disease management for both full- and limited-benefit Medicaid beneficiaries. To achieve this enhanced level of coordination, SCDHHS intends to implement a series of policies to ensure the delivery of integrated care that addresses overall healthcare needs, focusing on the early identification and treatment of chronic disease.

To adopt a comprehensive PCC model, SCDHHS proposes the following:

  • The enhancement of the benefit available to individuals enrolled in the optional family planning eligibility group to include: (1) additional primary care outpatient services; (2) a limited pharmacy benefit, focused on drugs that treat chronic disease known to affect reproductive health and birth outcomes; and (3) substance use disorder (SUD) treatment services.

Note: SCDHHS anticipates the adoption of these enhancements through the family planning-related service option of the state's standard State Plan authority, and does not intend to seek waiver authority for this component.

  • Leveraging a focused network of providers for the provision of family planning benefits. Specific requirements for providers who participate in this network will include the ability to screen for and treat the entire scope of PCC, including regularly managing diabetes, hypertension, heart disease, depression, and substance use disorder. To effectively ensure that qualified providers participate in the delivery of preconception care, this application requests waiver of Section 1902(a)(23) of Title XIX of the Act.

SCDHHS anticipates that adopting the PCC model and steering utilization of family planning and related services toward providers who routinely and expertly provide the full spectrum of care inherent to that model will improve the health outcomes of the population using family planning and related services. To evaluate the degree to which this transition in health care delivery models improves outcomes, SCDHHS anticipates the use of the following evaluation parameters:

  • NICU admission rates

  • Mean gestational age

  • Mean birth weight

  • Incidence of neonatal abstinence syndrome (NAS)

  • Maternal morbidity and mortality

  • Initiation of medically necessary caesarian

  • Diabetes

  • Hypertension

  • Depression

  • Maternal substance use

SCDHHS expects no change in enrollment and no significant change in short term care expenditures as a result of this waiver.

Communication
A copy of this notice and the Transitioning to Preconception Care draft waiver application are available at the following locations:

  1. Electronic Access: www.scdhhs.gov (under "PCC Waiver" section)

  2. Hardcopies:
    a) All Healthy Connections County Offices (See Attachment A)
    b) SCDHHS lobby at 1801 Main Street, Columbia, S.C.

Additionally, information on the proposed waiver will be discussed during three public meetings. See details below:

Date: Tuesday, May 22, 2018

Time: 10 a.m.-noon

Location:
Greenville County Public Library
25 Heritage Green Place
Greenville, SC 29601

 

Date: Friday, June 1, 2018

Time: 10 a.m.-noon

Location:
BlueCross BlueShield of South Carolina
8901 Farrow Road, Building 200
Columbia, SC 29203

 

Date: Monday, June 4, 2018

Time: 10 a.m.-noon

Location:
Charleston County Public Library - Main Branch
68 Calhoun Street
Charleston, SC 29401

Additionally, a live webinar will take place Thursday, May 24, 2018, at 1 p.m. Information on registering for the webinar will be available at https://msp.scdhhs.gov/pcc/.

Public Comments and Responses
SCDHHS wants to hear from the public about the proposed PCC waiver program to serve Medicaid beneficiaries during their reproductive years. If you have a question or comment, please submit it by June 6, 2018:

  1. Online: https://msp.scdhhs.gov/pcc/

  2. Email PCCWaiver@scdhhs.gov

  3. Mail: South Carolina Department of Health and Human Services

                    ATTN: PCC Waiver
                    Post Office Box 8206
                    Columbia, SC  29202-8206

Attachment A: Healthy Connections County Offices
SCDHHS COUNTY OFFICE ADDRESS
Abbeville 909 W. Greenwood Street, Suite 1, Abbeville, SC 29620
Aiken 1410 Park Ave, Aiken, SC 29801
Allendale 521 Barnwell Road, Allendale, SC 29810
Anderson 224 McGee Road, Anderson, SC 29625
Bamberg 374 Log Branch Road, Bamberg, SC 29003
Barnwell 10913 Ellenton Street, Barnwell, SC 29812
Beaufort 1905 Duke Street, Beaufort, SC 29901
Berkeley 2 Belt Drive, Moncks Corner, SC 29461
Calhoun 2831 Old Belleville Road, St. Matthews, SC 29135
Charleston 3366 Rivers Avenue, North Charleston, SC 29405
Cherokee 1231 N. Limestone Street, Suite C, Gaffney, SC 29340
Chester 115 Reedy Street, Chester, SC 29706
Chesterfield 203 Commerce Avenue, Chesterfield, SC 29709
Clarendon 236 Commerce St., Manning, SC 29102
Colleton 215 South Lemacks Street, Walterboro, SC 29488
Darlington 300 Russell Street, Room 145, Darlington, SC 29532
  404 S. Fourth Street, Suite 301, Hartsville, SC
Dillon 1213 Highway 34 West, Dillon, SC 29536
Dorchester 216 Orangeburg Road, Summerville, SC 29483
Edgefield 120 W.A. Reel Drive, Edgefield, SC 29824
Fairfield 1136 Kincaid Bridge Road, Winnsboro, SC 29180
Florence 2685 South Irby Street, Box I, Florence, SC 29505
  345 South Ron McNair Blvd., Lake City, SC 29560
Georgetown 330 Dozier Street, Georgetown, SC 29440
Greenville 301 University Ridge, Suite 6700, Greenville, SC 29601
Greenwood 1118 Phoenix Street, Greenwood, SC 29646
Hampton 102 Ginn Altman Avenue, Hampton, SC 29924
Horry 1201 Creel Street, Conway, SC 29526
Jasper 10908 North Jacob Smart Blvd., Ridgeland, SC 29936
Kershaw 110 East Dekalb Street, Camden, SC 29020
Lancaster 1599 Pageland Hwy, Lancaster, SC 29720
Laurens 93 Human Services Drive, Clinton, SC 29325
Lee 820 Brown Street, Bishopville, SC 29010
Lexington 605 West Main Street, Lexington, SC 29072
Marion 137 Airport Court, Suite J, Mullins, SC 29574
Marlboro 1 Ag Street, Bennettsville, SC 29512
McCormick 215 North Mine St/Hwy 28 North, McCormick, SC 29835
Newberry 2107 Wilson Road, Newberry, SC 29108
Oconee 223 B Kenneth Street, Walhalla, SC 29691
Orangeburg 2570 St Matthews Road, Orangeburg, SC 29116
Pickens 212 McDaniel Avenue, Pickens, SC 29671
Richland 3220 Two Notch Road, Columbia, SC 29204
Saluda 613 Newberry Highway, Saluda, SC 29138
Spartanburg 1000 N. Pine Street, #23, Spartanburg, SC 29303
Sumter 105 N. Magnolia Street, 3rd Floor, Sumter SC
Union 200 South Mountain Street, Union, SC 29379
Williamsburg 121 Hampton Avenue, Kingstree, SC 29556
York 454 S. Anderson Road, Suite 11, Rock Hill, SC 29730
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