Other Medical Professionals

Other Medical Professionals

Provider Updates on ABA for Autism Spectrum Disorder (ASD) Services

Effective with dates of service on and after July 1, 2018, the South Carolina Department of Health and Human Services (SCDHHS) will implement the following changes to the applied behavior analysis (ABA) fee schedule and the policy manual for autism spectrum disorder (ASD) services.

The rate for codes 0364T and 0365T will increase to $15.50 per unit. Providers will no longer utilize procedure codes 0360T, 0361T, 0362T and 0363T for billing and reimbursement of ABA services.

SCDHHS will continue to utilize the following procedure codes for ABA reimbursement:

May SC Pharmacy and Therapeutics Committee Meeting

The South Carolina Department of Health and Human Services (SCDHHS) Pharmacy and Therapeutics (P&T) Committee meeting scheduled for Wednesday, May 2, 2018, is cancelled.

The committee's next meeting is scheduled for Wednesday, June 6, 2018. 

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

Over-The-Counter Aspirin Coverage

The American College of Obstetricians and Gynecologists (ACOG) has issued updated recommendations regarding low-dose aspirin and the prevention of preeclampsia. The South Carolina Department of Health and Human Services (SCDHHS) issues this alert to remind providers that over-the-counter (OTC) aspirin is covered by the agency when a valid prescription is authorized by a licensed practitioner. Providers are advised to follow the ACOG recommendations only if this therapy is appropriate for their patient.
 

August SC Pharmacy and Therapeutics Committee Meeting

The South Carolina Department of Health and Human Services (SCDHHS) Pharmacy and Therapeutics

(P&T) Committee meeting scheduled for Wednesday, Aug. 2, 2017, is cancelled.

The committee’s next meeting is scheduled for Wednesday, Sept. 6, 2017.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

Monthly Prescription Limit

Effective with dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will no longer limit the number of prescriptions available to Medicaid beneficiaries.

If you have any questions regarding this policy, please contact the Provider Service Center at (888) 289-0709.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

Changes to the Psychiatric Hospital Services Provider Manual Regarding Psychiatric Residential Treatment Facilities (PRTFs)

Effective with dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will include psychiatric residential treatment facility (PRTF) services and providers in the coordinated care benefit provided by SCDHHS-contracted managed care organizations (MCOs). MCO members will access PRTF services through the MCO they have chosen or to which they have been assigned. Individuals not choosing or not mandatorily assigned to an MCO will continue to access PRTF services through the SCDHHS Medicaid fee-for-service (FFS) benefit.

Modification to Codes that require Filing to TPL

Effective for dates of service on or after July 1, 2017, and as required by 1902(a) (25) of the Social Security Act, the South Carolina Department of Health and Human Services (SCDHHS) will implement cost avoidance rules for the procedure codes reflected below. Service providers will be required to file claims to any liable third-party insurer before submitting a claim to SCDHHS for payment.

Tobacco Cessation Coverage

Effective with dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) is enhancing tobacco cessation coverage for full-benefit Medicaid beneficiaries to align with recommendations from the Centers for Disease Control and Prevention (CDC) and the American Lung Association (ALA). This update applies to both the fee-for-service and managed care Medicaid benefits.

The following medications will be available without prior authorization or co-payment when prescribed by a Medicaid provider:

CHANCE Waiver Services

The Children's Health Access in Community Environments (CHANCE) waiver manual will be withdrawn from the South Carolina Department of Health and Human Services (SCDHHS) website effective June 1, 2017. The CHANCE waiver was a Psychiatric Residential Treatment Facilities (PRTF) community alternatives demonstration waiver. This waiver was discontinued in September 2014.

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