Managed Care

Managed Care

List of School IDs to be Included on School-based Mental Health Claims Published

The South Carolina Department of Health and Human Services (SCDHHS) has published a list of the South Carolina Department of Education’s unique school IDs in support of its school-based mental health services initiative. The unique school ID must be included on claims submitted by providers for school-based mental health services.

Updates to State Plan Emergency Ambulance Service Rates

The South Carolina Department of Health and Human Services (SCDHHS) is increasing reimbursement rates for specific emergency ambulance services included in this bulletin.

Rate Increases for Emergency Ambulance Services

Effective July 1, 2022, reimbursement for the below listed codes will be increased as follows:

Description

Code

Current Rate

Updates to Adult Day Health Care Transportation

The South Carolina Department of Health and Human Services (SCDHHS) is transitioning adult day health care (ADHC) transportation for Healthy Connections Medicaid members within 15 miles of their ADHC to the state’s non-emergency medical transportation (NEMT) broker, Modivcare. Previously, transportation for trips less than 15 miles from the ADHC was provided directly by the ADHC while transportation for trips longer than 15 miles from the ADHC was provided by either the ADHC or the NEMT broker. This change is effective for dates of service on or after July 1, 2022.

SCDHHS School-based Mental Health Policy Updates for July 1, 2022

The South Carolina Department of Health and Human Services (SCDHHS) is formally launching its school-based mental health services initiative effective July 1, 2022. The SCDHHS policy changes announced in this bulletin are consistent with the recommendations made by SCDHHS to improve access to school-based mental health services for children across the state.

Upcoming Healthy Connections Medicaid Provider Trainings – Spring 2022

The South Carolina Department of Health and Human Services (SCDHHS) regularly offers free trainings to prospective and enrolled Healthy Connections providers. Information about an upcoming training opportunity for spring 2022 is listed below.

Maximus Enrollment Training

In partnership with the state's contracted enrollment broker, Maximus, SCDHHS is offering virtual enrollment trainings. The trainings will take place each Friday in May 2022. The dates and times for the trainings are:

Rate Increase for Psychiatric Residential Treatment Facilities (PRTFs)

The South Carolina Department of Health and Human Services (SCDHHS) will increase the reimbursement rate for all contracting Medicaid PRTFs to $500 per patient day for services provided to South Carolina Medicaid-eligible children. The change is being made in order to address the impact of market forces affecting the South Carolina Medicaid PRTF program and will be effective for dates of service on and after April 1, 2022.

Approval of South Carolina’s Appendix K Amendment Request for Temporary Rate Increases

As part of the South Carolina Department of Health and Human Services’ (SCDHHS) ongoing response to the state and federal states of emergency related to coronavirus disease 2019 (COVID-19), SCDHHS submitted a request to the Centers for Medicare and Medicaid Services (CMS) to amend multiple waivers with the Emergency Preparedness and Response Appendix K. The request was approved Jan. 20, 2022, and will temporarily:

Pharmacy Coverage of Over-the-Counter Diagnostic Antigen Tests for COVID-19

The South Carolina Department of Health and Human Services (SCDHHS) will reimburse for Food and Drug Administration-approved coronavirus disease 2019 (COVID-19) over-the-counter (OTC) tests for home use. SCDHHS will reimburse SCDHHS-enrolled pharmacy providers for these tests as authorized within sections 9811 and 9821 of the American Rescue Plan Act, and further delineated within the August 30, 2021, letter from the Centers for Medicare and Medicaid Services (SHO# 21-003).   

Updates to the Quarterly Seclusion and/or Restraint Reporting Form

TO: Providers Indicated
 
SUBJECT: Updates to the Quarterly Seclusion and/or Restraint Reporting Form
 

Patient Centered Medical Home (PCMH) Incentive Update

The South Carolina Department of Health and Human Services (SCDHHS) is informing all practices currently recognized by the National Committee for Quality Assurance (NCQA) as a patient-centered medical home (PCMH) or who have applied or are considering applying for PCMH certification that the following modifications are being made to its PCMH incentive program, effective July 1, 2017.

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