Physicians

Effective for dates of services on or after April 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will cover CPT codes:

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:

In §6407 of the Affordable Care Act (Pub.L. 111-148) Congress added some conditions on the coverage of Durable Medical Equipment (DME).  The Centers for Medicare and Medicaid Services (CMS) has proposed implementing changes to the DME regulations which also clarify the federal agency’s position as to the availability of incontinence and other supplies and equipment under the Medicaid State Plan Home Health benefit.  See 76 FR 41032–41039 (July 12, 2011).

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

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.

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented the Affordable Care Act (ACA) 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.

The South Carolina Department of Health and Human Services (SCDHHS) has updated its reimbursement calculations for Medicare Deductible, Coinsurance, and Blood Deductibles to reflect the new 2013 Medicare Rates for Dually Eligible Medicaid members.

Increased Medicaid Payments for Primary Care

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.

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.