Proposed Pre-Eligibility Medical Expenses

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 proposed actions regarding the eligibility changes implemented under Social Security Act §1902(r)(1)(A), Social Security Act §1924(d)(1)(D), CFR Title 42 §435.725(c)(4) and CFR Title 42 §435.832(c)(4).

Effective on or after October 1, 2015, SCDHHS proposes to amend the South Carolina Title XIX State Plan to limit allowable pre-eligibility medical expenses applied to reduce recurring income for long term care services to expenses incurred in the retro period which is three calendar months prior to the Medicaid date of application.

After in-depth conversations with federal officials, it is necessary to revise state policy, requiring Medicaid to allow the deduction of pre-eligibility medical expenses from calculated, post-eligibility recurring income for long term care beneficiaries. Recurring income is the calculated dollar amount a beneficiary is required to pay for long term care services. Policy is being revised to allow the deduction. However, the current State Plan does not limit the time period from which these expenses can be applied. It is proposed that this time period be limited to expenses incurred in the three calendar months prior to the month of application (the retro period). This change will limit the application of expenses to those related to the current episode of care.

While the proposed change is expected to minimally increase agency costs, the data needed to determine the financial impact is not readily available at this time.

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 regarding this proposed action is available upon request at the address cited below.

Written comments may be sent to the SCDHHS, Office of Eligibility, Enrollment, and Member Services, Post Office Box 8206, Columbia, South Carolina 29202-8206. Comments may also be submitted to comments@scdhhs.gov. Written and e-mailed comments must be received by close of business September 15, 2015.

Any written comments submitted may be reviewed by the public at the SCDHHS, Office of Eligibility, Enrollment, and Member Services, Jefferson Square Building, 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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