Primary Care Enhanced Payments


The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirement of 42 CFR 447.205, gives notice of the following action regarding payments for services furnished by certain primary care physicians and charges for vaccine administration under the Vaccines for Children Program.

Effective on or after January 1, 2015, SCDHHS will make the following change: SCDHHS will adjust its fee schedule for certain providers that deliver primary care services. This state plan update will adjust rates for evaluation, management and immunization procedure codes. SCDHHS will use the established 2014 ACA enhanced primary care rate schedule and procedural coding. Providers qualifying for the program include physicians in the following disciplines: family practice, general practice, gynecology, internal medicine, obstetrics, obstetrics & gynecology, pediatrics, psychiatry and child psychiatry.

Higher payments are not available for physicians who are identified as teaching physicians under the Supplemental Teaching Physician Payment Program and/or who are reimbursed through a FQHC, RHC, health department/clinic encounter or visit rate. SCDHHS estimates that the implementation of the above policy will result in a total dollar expenditure of $3.5 million for FY15 and $7 million in FY 16 once enhanced ACA primary care physician payments end on December 31, 2014.

Copies of this notice are available at each county Department of Health and Human Services office for public review. Additional information concerning this action is available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at the Department of Health and Human Services, Office of Health 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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