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Change in the Third Party Liability (TPL) Recovery Cycle from Quarterly to Monthly

Effective on or after July 1, 2018, the South Carolina Department of Health and Human Services (SCDHHS) proposes to amend the South Carolina Title XIX State Plan to modify the frequency of the third party liability (TPL) health recovery cycle. The proposed modification will increase the occurrence of the TPL health recovery cycle to afford providers quicker notification of other primary health insurance information. Prompt notification should improve the rate of timely claims filing and allow SCDHHS to recover professional claims from third-party payers in a much more timely manner.

Policy Changes to RBHS, LIP, LEA and CMHC manuals

Effective with dates of service on or after July 1, 2018, the South Carolina Department of Health and Human Services (SCDHHS) will limit the billable units of crisis management to 80 units annually, unless otherwise prior authorized by SCDHHS. The daily limits outlined in the respective manuals will remain in place.

Payment Error Rate Measurement (PERM)

The Improper Payments Information Act of 2002 directs federal agency heads, in accordance with the Office of Management and Budget (OMB) guidance, to review programs on an annual basis that are susceptible to significant erroneous payments and to report the improper payment estimates to Congress. In previous reviews, OMB identified Medicaid and Children's Health Insurance Program (CHIP) as at-risk programs for erroneous payments.

Electronic Funds Transfer (EFT) Compliance

The South Carolina Department of Health and Human Services (SCDHHS) is upgrading its legacy accounting system, providing a modern payment alternative to traditional paper checks. Part of this initiative includes enforcement of the agency's Electronic Funds Transfer (EFT) Policy. EFT allows SCDHHS to make more timely and accurate reimbursements to providers than through paper checks.

Early Intensive Behavioral Intervention Providers and Applied Behavior Analysts

Effective April 1, 2018, the South Carolina Department of Health and Human Services (SCDHHS) will implement the following changes to the policy manual for autism spectrum disorder (ASD) services.

Updates to the Seclusion and Restraint Reporting Form

The South Carolina Department of Health and Human Services (SCDHHS) will update the form for reporting seclusion and restraint. The form will contain an additional field indicating who ordered the restraint. The manual will also be updated to include this additional requirement. The new form must be used for all seclusion and restraint reports beginning Oct. 1, 2017.

The updated form will be available in the Psychiatric Hospital Manual beginning Oct. 1, 2017.

Updates to the Autism Spectrum Disorder (ASD) Transition Plan

The South Carolina Department of Health and Human Services (SCDHHS) updated the autism spectrum disorder (ASD) services transition plan for delivery of ASD services. This plan supersedes the bulletin entitled “Transition Guidelines for Autism Services,” published May 4, 2017. The following outlines the instructions for providers of ASD services for services delivered on or after July 1, 2017.

 

1.      State Plan Beneficiaries with an Existing ASD Prior Authorization (PA)

Updates to Autism Spectrum Disorder (ASD) Provider Manual

The South Carolina Department of Health and Human Services (SCDHHS) is updating the Autism Spectrum Disorder Services (ASD) Provider Manual. The updated ASD Provider Manual will be published on June 9, 2017 and will include three changes relative to the direct provision of services by applied behavior analysis (ABA) providers.

CHANCE Waiver Services

The Children's Health Access in Community Environments (CHANCE) waiver manual will be withdrawn from the South Carolina Department of Health and Human Services (SCDHHS) website effective June 1, 2017. The CHANCE waiver was a Psychiatric Residential Treatment Facilities (PRTF) community alternatives demonstration waiver. This waiver was discontinued in September 2014.

Autism Services

Effective on or after July 1, 2017, Autism Spectrum Disorder (ASD) treatment services will be added to the South Carolina Medicaid State Plan.

ASD treatment services will be available both for fee-for-service (FFS) beneficiaries and for managed care organization (MCO) members.

Medical Necessity

Medically necessary ASD treatment services are available for Medicaid beneficiaries between the ages of 0 to 21 who have an established ASD diagnosis via a comprehensive psychological assessment.

 

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