Medical Clinics

Medical Clinics

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.

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.

Prior Authorization (PA) for Physician Administered Drugs and Training Schedule with ICORE for Physician Administered Drugs

 

 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.

Enhanced Physician Payment Reimbursement

 

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.  

South Carolina Medicaid Preferred Drug List

 

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

LAXATIVES & CATHARTICS

Preferred

Non-Preferred

South Carolina Department of Health and Human Services Hosts Vision Services Open Forum

 

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

Adjusting Your Enhanced Physicians ACA Attestation Period

 

The South Carolina Department of Health and Human Services (SCDHHS) has implemented policy to assist providers who have attested for the Affordable Care Act (ACA) Enhanced Physician Program.  Some providers may need to terminate the effective dates of inclusion into this program, effective January 1, 2013 through December 31, 2014.  The following are two instances where a provider may need to end his/her enrollment.

Examples:

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