Other Medical Professionals

Other Medical Professionals

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.  

KePRO Outpatient Prior Authorization Fax Form. Changes in LIP Policy effective Jan. 1, 2014

 
The South Carolina Department of Health and Human Services (SCDHHS)
is requesting that LIP providers use KePRO’s Outpatient Prior Authorization
Fax Form along with SCDHHS required documents as outlined in the
Licensed Independent Practitioners Rehabilitative Services manual when
requesting Prior Authorization for services. KePRO has the Outpatient Prior
Authorization Fax Form located under the Forms tab on their website

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.

Behavioral Health is revising the description of Group Psychotherapy and adding Multiple Family Group Psychotherapy to the Behavioral Health Manual

 

The South Carolina Department of Health and Human Services (SCDHHS) is implementing the following changes and clarifications effective December 1, 2013 to the Group Psychotherapy code and adding Multiple Family Group Psychotherapy code as outlined below:

Procedure code 90853 – Group Psychotherapy

Home Health Policy Updates

Face-to-Face Requirements for State Plan Home Health benefit:

Effective October 1, 2013, as mandated by section 6407 (d) of the Affordable Care Act, prior to certifying a beneficiary’s eligibility for the home health benefit, the certifying physician must document that he or she, or an allowed non-physician practitioner (NPP) has had a face-to-face encounter with the beneficiary. The state plan Home Health benefit includes skilled nursing, home health aide and therapeutic services such as physical therapy, occupational therapy and speech therapy.

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.  

CMS National Provider Call July 23: EHR Incentive Program: Overview of EP CQM Beginning 2014

 

 Medicare and Medicaid EHR Incentive Programs for Eligible Professionals: In-depth Overview of Clinical Quality Measures for Reporting Beginning in 2014 - Registration Now Open

Tuesday, July 23; 1:30-3pm ET

 

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