Managed Care

Managed Care

Enhanced Physician Payment Reminder

 

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented the Affordable Care Act (ACA) 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.

2013 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 2013 Medicare Rates for Dually Eligible Medicaid members.

Community Health Worker in Primary Care Practices

The South Carolina Department of Health and Human Services (SCDHHS) is announcing the statewide integration of the Community Health Worker (CHW) into eligible primary care practices under the Department’s Health Access at the Right Time (HeART) initiative. The objective of the CHW program is to improve patient care and health outcomes with the aid of individuals who interface between the clinical practice and the community where patients reside.

Barbiturate and Benzodiazepine Coverage Changes for Dual Eligibles under Medicare Part D Plans

 

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will exclude coverage for barbiturates “used in the treatment of epilepsy, cancer, or a chronic mental health disorder” and benzodiazepines for dual eligible individuals (Medicare/Medicaid).  This exclusion of coverage applies only to dual eligible individuals.

Non Payment Policy for Deliveries Prior to 39 weeks: Birth Outcomes Initiative

Medicaid Agency to Stop Payment for Elective Early Deliveries

Aims to Improve Health of Newborns, Reduce Preterm Births in South Carolina

 

South Carolina Medicaid Preferred Drug List

 

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after January 1, 2013.

 

ANTIDEPRESSANTS, OTHER

Preferred

Non-Preferred

Synagis®

 

Effective for dates of service on or after October 15, 2012, 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 $2,339.98 up from $2,192.89.  The 50mg vial will be reimbursed at $1,239.20 up from $1,161.31.

 

South Carolina Medicaid Preferred Drug List

 

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after October 15, 2012.

 

ANTIHYPERURICEMICS

Preferred

Non-Preferred

ADDITIONAL SERVICES PERFORMED BY KEPRO

 

Effective with dates of service on or after October 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will require prior authorization (PA) for the following services and medical record pre-payment review from our Quality Improvement Organization (QIO), KePRO.

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