Medical Clinics

Medical Clinics

Meaningful Use Modifications Webinar

The South Carolina Department of Health and Human Services (SCDHHS) will host a live webinar Thursday, Feb. 11, from 2-3 p.m. on the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs' meaningful use modifications for program years 2015 and 2016.

Rescind Physical Medicine and Therapy Policy Update; Medicaid Bulletin #14-001 Released Feb. 6, 2014

Effective immediately the South Carolina Department of Health and Human Services (SCDHHS) is rescinding the policy, bulletin 14-001 released Feb. 6, 2014, that allowed services delivered to recipients 21 years and over in place of service (62) Outpatient Rehabilitation Facility. Beneficiaries will continue to receive outpatient physical, occupational and speech therapies (PT/OT/SP) services in an outpatient hospital, clinic or office setting.

Provider Revalidation Group 5

In the bulletin dated April 20, 2015, providers were informed their enrollment information must be revalidated, per the Centers for Medicare and Medicaid Service (CMS). To avoid risk of termination in the South Carolina Department of Health Human Services (SCDHHS) Healthy Connections Medicaid program, you must complete and submit an enrollment application 30 days from the date of your official revalidation notification letter. DO NOT begin the revalidation process until you receive notification.

Physician Assistant Enrollment

All licensed Physician Assistants (PAs) providing services to Healthy Connections beneficiaries must be enrolled as providers with the South Carolina Department of Health and Human Services (SCDHHS). PAs providing services to Medicaid Managed Care enrolled members must also be enrolled and credentialed with the member's Managed Care Organization (MCO).

Pursuant to 42 CFR Part 455, Subpart E, all providers who refer or order items or services covered by the Medicaid program must be enrolled as described above.

Pharmacy Co-Payments Waiver

In an effort to improve beneficiary adherence to prescribed courses of medication, the South Carolina Department of Health and Human Services (SCDHHS) will waive the copayment for specified classes of medications effective July 1, 2015. Initially, this copayment waiver will apply to medications for the treatment of diabetes and behavioral health disorders. However, SCDHHS may modify the medications subject to the copayment waiver without further notice. Information regarding which medications are exempt from copayments will be made available on the SCDHHS Preferred Drug List (PDL).

Hepatitis C Virus (HCV) Pharmacy Benefit Carve Out

Effective with dates of service on or after July 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will carve out coverage for medications used to treat Hepatitis C Virus (HCV) from the Managed Care Organization (MCO) benefit. Pharmacy claims for these medications for Medicaid members enrolled in a Medicaid Managed Care Organization (MCO) will be covered through the Fee-For-Service (FFS) pharmacy program. All FFS coverage rules, prior authorization requirements and preferred drug classifications will apply.

EPSDT Pediatric Screening Tools

The South Carolina Department of Health and Human Services (SCDHHS) is clarifying the use of developmental and behavioral health pediatric screening tools and providing guidance on the utilization of these tools.  Best practice indicates that standardized screenings of this type are recommended to be done during the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) visits or as dictated by clinical need.  This  is in alignment with the American Academy of Pediatrics (AAP) recommendations regarding screening and age appropriate development and mental health of children and adolescen

Modification to Federally Qualified Healthcare Center (FQHC) Claims Submission Criteria

Effective March 15, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will implement changes to Federally Qualified Healthcare Centers (FQHCs) enrollment and claims submission criteria. FQHC’s will be required to enroll all individual chiropractors, podiatrists, dietitians, ophthalmologists, and optometrists that are providing/rendering service to Healthy Connections Medicaid members through the FQHC.

South Carolina Medicaid Preferred Drug List

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after August 1, 2014. 

ANTIHISTAMINES, MINIMALLY SEDATING

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