Managed Care

 I.        Prior Authorization (PA) for Physician Administered Drugs

South Carolina Department of Health and Human Services (SCDHHS) is implementing a new provider-administered injectable drug program in conjunction with ICORE Healthcare, LLC (ICORE), a specialty pharmaceutical management company.  The program affects certain drugs requiring administration by health care professionals and will ensure quality care and affordability for our members.

The South Carolina Department of Health and Human Services (SCDHHS) has revised reimbursement rates for the following codes:

The South Carolina Department of Health and Human Services (SCDHHS) recently received final CMS approval for its proposed payment methodology for the Affordable Care Act (ACA) Primary Care Physician rate increase for both the Fee for Service (FFS) and Managed Care Organizations (MCOs).  SCDHHS continues its work on this project to ensure that it is implemented accurately, quickly and within the CMS mandates for these enhanced payments.  

The South Carolina Department of Health and Human Services (SCDHHS) is issuing this bulletin for guidance on the application of MHPAEA in Medicaid.

History and Background

Starting in 1996, Congress enacted several laws designed to improve access to mental health and substance use disorder services under health insurance or benefit plans that provide medical/surgical benefits.

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after July 22, 2013. 

The South Carolina Department of Health and Human Services will host an open forum to receive input on the administration and management of the Medicaid Pharmacy program.  The current Administrative Services contract with Magellan Health will expire on March 18, 2014.

This meeting will be held Monday, May 20, 2013 from 10:00 a.m. to 12:00 p.m. at the following address: 

The South Carolina Department of Health and Human Services will host an open forum to receive input on the administration and management of the Medicaid Vision program.  The current Administrative Services contract with Robertson Optical will expire on January 1, 2014.

This meeting will be held Monday, May 13, 2013 from 10:00 a.m. to 12:00 p.m. at the following address:

Blue Cross Blue Shield of South Carolina
8901 Farrow Road
Building 200
Columbia, South Carolina 29203

Effective for dates of services on or after April 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will cover CPT codes:

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented the Affordable Care Act (ACA) final rule, increasing Medicaid reimbursements for evaluation and management and immunization services to 100 percent of Medicare reimbursement in 2013 and 2014.  The increase applies to both fee-for-service (FFS) and managed care organization (MCO) plans.

I. Enhanced Physician Payments for RHC and FQHC Individual Providers