Other Medical Professionals

Other Medical Professionals

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.

Rehabilitative Behavioral Health Services Changes Updates

The South Carolina Department of Health and Human Services (SCDHHS) released a Medicaid Bulletin April 13, 2015, outlining new Rehabilitative Behavioral Health Services (RBHS) policy changes effective May 1, 2015. There are two updates to this bulletin.

Rehabilitative Behavioral Health Services Changes

The South Carolina Department of Health and Human Services (SCDHHS) will implement the following changes to the Rehabilitative Behavioral Health Services (RBHS) policy. These changes apply to fee for service RBHS only and are effective May 1, 2015, unless otherwise specified in this bulletin.

  1. Prior Authorizations

 

Change in SC P&T Committee Meeting Date

The South Carolina Healthy Connections Medicaid Pharmacy and Therapeutics Committee meeting scheduled for Wednesday, May 6, 2015, has been changed to Wednesday, May 20, 2015. The meeting location and time will remain the same:

South Carolina Medicaid Pharmacy and Therapeutics Committee
Location: South Carolina Pharmacy Association (SCPhA) Office
1350 Browning Road, Columbia, SC 29210

Wednesday, May 20, 2015, 4 p.m.

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

Change in SC P&T Committee Meeting Date

The South Carolina Healthy Connections Medicaid Pharmacy and Therapeutics Committee meeting scheduled for Wednesday, Feb. 4, 2015, has been changed to Wednesday, April 1, 2015. The meeting location and time will remain the same:
 
South Carolina Medicaid Pharmacy and Therapeutics Committee
Location: South Carolina Pharmacy Association (SCPhA) Office
1350 Browning Road, Columbia, SC 29210
Wednesday, April 1, 2015, 4 p.m.
 

Rehabilitative Behavioral Health Services Changes

 

Effective March 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will implement the following changes to the Rehabilitative Behavioral Health Services (RBHS) policy. These changes apply to fee for service RBHS only.

  1. Medical Necessity and Prior Authorizations

Behavioral Health Providers

Effective with dates of service on or after February 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will reimburse for conducting and scoring the Child and Adolescent Level of Care Utilization System (CALOCUS) using procedure code H2000 with the appropriate billing modifier.  This code is billed per encounter (one per date of service) per Healthy Connections member requiring the service with a maximum of two encounters per month per member. The completed assessment, scoring sheet and supporting documentation must be maintained in the member’s clinical record.

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