Managed Care

Managed Care

Incontinence Supplies Updates

Effective July 1, 2014, incontinence supply providers will be responsible for obtaining the Physician Certification of Incontinence SCDHHS Form 168IS prior to delivering Incontinence supplies.  This policy replaces the June 18, 2013, memo titled Changes in Incontinence Supplies Authorizations, section 2 Physician’s Orders.

Payment of LARCs through the Pharmacy Benefit

 

Beginning with dates of service on or after March 17, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will reimburse for outpatient utilization of long acting reversible contraceptives (LARC) through the pharmacy program. Any LARC billed to SCDHHS by a pharmacy will be shipped directly to the provider's office for insertion. Providers should take extra care to ensure that they bill Medicaid only for reimbursement of the insertion of the device, and not the device itself, when it is obtained and billed through the pharmacy benefit.

2014 Medicare Deductible, Coinsurance and Medicaid Blood Deductible Rates for Dually Eligible Medicaid Members

 The South Carolina Department of Health and Human Services (SCDHHS) has updated its reimbursement calculations for Medicare Deductible, Coinsurance, and Blood Deductibles to reflect the new 2014 Medicare Rates for Dually Eligible Medicaid members.

Vision Care Services Policy Update

 

Effective for dates of services on or after January 1, 2014, Robertson Optical will no longer be the contracted provider of eye wear for South Carolina Medicaid fee for service (FFS) participants.  The South Carolina Department of Health and Human Services (SCDHHS) will no longer be acquiring this service through an exclusive contract.  Beginning with dates of service on or after January 1, 2014, any enrolled and qualified provider producing eye wear may bill for this service.  

Preferred Drug List Update, Exceptions to Prescription Limit, Update to Synagis® (palivizumab) Reimbursement, Preferred Brand Medications and Certificate of Medical Necessity for Home Infusion Pharmacies

I. Preferred Drug List Update

The following revisions to the South Carolina Department of Health and Human Services (SCDHHS) Preferred Drug List (PDL) are effective with dates of service on or after January 1, 2014:

 

ANTIPARASITICS, TOPICAL

Preferred

Non-Preferred

PERMETHRIN, OTC†

Behavioral Health Screening Tools Clarification

 

The South Carolina Department of Health and Human Services (SCDHHS) expanded the availability of behavioral health pediatric screening tools in a Medicaid Bulletin, dated May 17, 2013.

Behavioral Health is revising the description of Group Psychotherapy and adding Multiple Family Group Psychotherapy to the Behavioral Health Manual

 

The South Carolina Department of Health and Human Services (SCDHHS) is implementing the following changes and clarifications effective December 1, 2013 to the Group Psychotherapy code and adding Multiple Family Group Psychotherapy code as outlined below:

Procedure code 90853 – Group Psychotherapy

Synagis

 

Effective for dates of service on or after October 15, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will increase the rate for Synagis® to the current Average Wholesale Price (AWP) minus 18%. The new rate for the 100mg vial will be $2,429.18.  The 50mg vial will be reimbursed at $1,286.44.

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