Physicians

Physicians

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.

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

 

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

Discount for NCQA's PCMH Recognition Program

 

The South Carolina Department of Health and Human Services (SCDHHS) is a 2013 National Committee for Quality Assurance (NCQA) Recognition Program Sponsor for Patient Centered Medical Homes (PCMH).

Increase in Hours for Nurse Aide Training & Programs New Timeframe Policy for Nurse Aide Program Testing

 

South Carolina Department of Health and Human Services (SCDHHS) will be making important changes to the South Carolina State-approved Nurse Aide Training Program (NATP) requirements. These changes will be effective as of July 1, 2013.

National Provider Call: Stage 1 of the Medicare & Medicaid EHR Incentive Programs for EPs

 

National Provider Call: Stage 1 of the Medicare & Medicaid EHR Incentive Programs for Eligible Professionals: First in a Series — Registration Now Open

Thursday May 30; 1:30-3 PM ET

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