South Carolina Medicaid Complex Care program is a patient assessment system that targets Medicaid-eligible hospital patients who no longer require hospitalization, but meet the nursing facility level of care. The program is intended to provide financial incentives to enrolled nursing facilities who admit Medicaid beneficiaries with complex care needs.
Beneficiaries who qualify for the Complex Care program must meet the South Carolina Level of Care Criteria (Skilled or Intermediate) for Long Term Care. Beneficiaries must also have multiple needs, which fall within the higher ranges of disabilities in the criteria.
Contact us by email at Complexcare@scdhhs.gov or by fax at (803) 255-8209.
- Complex Care FAQs
What is Complex Care?
Complex Care is a program that targets Medicaid-eligible hospital patients who have complex medical needs who no longer require hospitalization, but require nursing home care. The program is intended to provide financial incentives to enrolled nursing facilities that admit Medicaid beneficiaries with complex medical needs.
What is the level of criteria for Complex Care?
All Complex Care individuals must meet either skilled or intermediate level of care in addition must have at least two Complex Care medical needs.
How can I make a referral for Complex Care?
The Complex Care Supplement Assessment Form, 185S, must be completed and submitted along with plans of care, progress notes and/or history and physical documentation.
Where do I send the completed 185s?
The 185s and documentation can be sent via fax at (803)255-8209 or by email to complexcare@scdhhs.gov.
Who completes the 185s?
The initial referral must be completed and submitted by the hospital staff prior to admission into a nursing facility. After the initial referral has been approved, recertification’s must be submitted by the nursing facility to continue Complex care.
How long does it take for a Complex Care determination?
All Complex Care referrals are reviewed and returned within 5 business days from the date received.
Where is the policy for Complex Care?
The policy for Complex Care can be found in the Nursing Facility Services Manual.
How can I find out which nursing facilities are Complex Care providers?
You can search on the Nursing Facility bed locator www.nfbl.sc.gov or send an email request to complexcare@scdhhs.gov.
Who can I contact if I have questions regarding Complex Care?
All questions on Complex Care including status updates can be sent to complexcare@scdhhs.gov.
Bed Locator - www.nfbl.sc.gov