Medical Clinics

Medical Clinics

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:

I. Enhanced Physician Payments for RHC and FQHC Individual Providers II. Enhanced Physician Payments for all Providers

 

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

 

Long Acting Reversible Contraceptive

The South Carolina Department of Health and Human Services (SCDHHS) has updated the fee schedule for long acting reversible contraceptive drug codes A4264, J7302, and J7307. Please refer to the Injectable Drug Fee schedule located at www.scdhhs.gov; this fee schedule is updated quarterly.

Modification to Federally Qualified Healthcare Center (FQHC) and Rural Health Center (RHC) enrollment and claims submission criteria.

 

Effective February 1, 2013 the South Carolina Department of Health and Human Services (SCDHHS) will implement the following changes to the Federally Qualified Healthcare Center (FQHC) and Rural Health Center (RHC) enrollment and claims submission criteria. These changes are being made in accordance with the implementation of new Medicaid provider enrollment and screening regulations, as published by the Centers for Medicare and Medicaid Services (CMS).  These regulations have been developed under standards established by the Affordable Care Act.

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.

Referrals to Community Long Term Care (CLTC)

 

ffective January 7, 2013, the Division of Community Long Term Care (CLTC) will centralize intake activities for all programs operated by CLTC.  This includes referrals for nursing home placement, nursing home conversion, Pre-Admission Screening Resident Review (PASRR), home and community based waiver services, children’s personal care and nursing services, and Katie Beckett Medicaid Program (TEFRA).  When intake activities are centralized, referrals will no longer be accepted at the CLTC Regional Offices.  Referrals will only be accepted by one of the methods below.

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.

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.

 

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