Notification to Amend Medicaid Home and Community-Based Waivers

PUBLIC NOTICE: 
SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES

As noted in the Nov. 3, 2014, public notification, the South Carolina Department of Health and Human Services (SCDHHS) intends to file amendments with the Centers for Medicare and Medicaid Services (CMS) to two of its home and community-based waivers operated through the Community Long Term Care (CLTC) program.

Additionally, based on further guidance (since the Nov. 2, 2014, notification) from CMS, drafts of these two amendments have been posted to the SCDHHS website (scdhhs.gov) for public review and comments.

These waivers are:

1. SC.0405 Community Choices Waiver and

2. SC.40181 Mechanical Ventilator Dependent Waiver

The waivers will be amended to address the following topics.

1. Changes to the Community Choices Waiver

The number of participants served in this waiver has grown faster than was projected when the five-year estimates were made (this waiver began its fourth year of the current approval July 1, 2014). In order to be in compliance with federal requirements, an amendment must be requested which will increase the number of people allowed to be served in the waiver program. The census accounts for the entire waiver year, allowing the agency to continue to add participants at all points during the year and will have a proposed effective date of July 1, 2014. NOTE: This waiver amendment is not posted on the website, as it is does not affect participant services or substantive aspects of the waiver.

The Community Choices waiver will also be amended to add Adult Day Health Care Nursing as a waiver service. Persons attending adult day health care centers often have skilled medical needs. This service reimburses the facility for providing certain skilled nursing services (e.g. ostomy care, urinary catheter care, wound care, tracheostomy care, tube feedings and nebulizer treatments that require medication). This service was a part of the waiver program for a number of years but was removed as a cost saving measure during 2011.

Finally, during the amendment process, SCDHHS will review current language and make necessary modifications to reflect technical changes to the flow of billing and filing of claims, organizational structure changes, and other minor language clarifications that may be necessary. Examples include: updating previous references to Care Call and Phoenix, changing the name of internal SCDHHS bureaus and divisions and similar items. These language updates, do not affect participant services or substantive aspects of the waiver.

 

2. Changes to the Mechanical Ventilator Dependent Waiver

Presently, case management for Mechanical Ventilator Dependent waiver participants is performed as an administrative service by nurse consultants who are SCDHHS employees. This was done due to the extensive medical needs of this population. However, these nurses have many other duties and can better utilize their medical training. This amendment will make case management a new waiver service that will be provided by provider case managers (usually licensed social workers). Waiver providers will be reimbursed for these services and SCDHHS nurse consultants will be able to commit more time to their many other responsibilities, such as completing initial waiver assessments to determine waiver medical eligibility and enrollment. The SCDHHS nurse consultants will also be available to consult with case managers when necessary.

Another change for this waiver is to add the service of home delivered meals. Many persons on ventilators are able to spend some time during the day off of the ventilator. This service meets the nutritional needs of participants in the Community Choices and HIV/AIDS waivers. This will make the service available for all three waiver programs.

Finally, during the amendment process, SCDHHS will review current language and make necessary modifications to reflect technical changes to the flow of billing and filing of claims, organizational structure changes and other minor language clarifications that may be necessary. Examples include: updating previous references to Care Call and Phoenix, changing the name of internal SCDHHS bureaus and divisions, and similar items. These language updates do not affect participant services or substantive aspects of the waiver.

The Nov. 3, 2014, notification effective date for all changes (except the census increase for the Community Choices waiver) was upon CMS approval and not prior to May 1, 2015. However, due to posting of amendments for 30 days, the effective date for all changes is upon CMS approval but not before Aug. 1, 2015.  

 

Communication:

These amendments were discussed at SCDHHS’ Medical Care Advisory Committee (MCAC) meeting on Nov. 12, 2014 at 10 a.m. at 1801 Main Street, Columbia, S.C.

Additionally, information on these amendments was shared during four regional public meetings and one live online webinar.

The Community Choices and Mechanical Ventilator Dependent Waiver Amendments can be found in the following locations:

Electronic Access: scdhhs.gov

Hardcopies: Community Long Term Care Regional Offices or the SCDHHS:

Greenville

620 North Main Street, Suite 300

Greenville, S.C. 29601

Spartanburg

945 East Main Street, Suite 3

Spartanburg, S.C. 29302

Greenwood

617 South Main Street¸ Suite 301

Greenwood, S.C. 29648

Rock Hill

454 South Anderson, Suite 11

BTC Box 526

Rock Hill, S.C. 29730

Columbia

7499 Parklane Road, Suite 164

Columbia, S.C. 29223

Orangeburg

191 Regional Parkway, Bldg. A

Orangeburg, S.C. 29115

Aiken

6170 Woodside Executive Court

Aiken, S.C. 29803

Sumter

30 Westmark Ct.

Sumter, S.C. 29150

Florence

201 Dozier Boulevard

Florence, S.C. 29501

Conway

1201 Creel Street

Conway, S.C. 29526

Charleston

4130 Faber Place Drive, Suite 303

North Charleston, S.C. 29405

Ridgeland

10175 South Jacob Smart Blvd.

Ridgeland, S.C. 29936

 

Anderson

3215 Martin Luther King Jr. Blvd., Suite H

Anderson, S.C. 29625

SCDHHS (Documents are in Lobby)

1801 Main Street

Columbia, S.C. 29202

Questions and/or comments must be sent to the following before April 20, 2015:

Email:                   Comments@scdhhs.gov

Written:               Community Long Term Care

ATTN:  Belinda Adams

South Carolina Department Health and Human Services

Post Office Box 8206

Columbia, S.C. 29202-8206

Any written comments submitted may be reviewed by the public at SCDHHS, Division of Community Long Term Care, Jefferson Square Building, 1801 Main Street, Columbia, S.C., Monday through Friday between the hours of 9 a.m.-5 p.m.

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