Physicians

Physicians

Barbiturate and Benzodiazepine Coverage Changes for Dual Eligibles under Medicare Part D Plans

 

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will exclude coverage for barbiturates “used in the treatment of epilepsy, cancer, or a chronic mental health disorder” and benzodiazepines for dual eligible individuals (Medicare/Medicaid).  This exclusion of coverage applies only to dual eligible individuals.

Non Payment Policy for Deliveries Prior to 39 weeks: Birth Outcomes Initiative

Medicaid Agency to Stop Payment for Elective Early Deliveries

Aims to Improve Health of Newborns, Reduce Preterm Births in South Carolina

 

South Carolina Medicaid Preferred Drug List

 

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after January 1, 2013.

 

ANTIDEPRESSANTS, OTHER

Preferred

Non-Preferred

Synagis®

 

Effective for dates of service on or after October 15, 2012, 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 $2,339.98 up from $2,192.89.  The 50mg vial will be reimbursed at $1,239.20 up from $1,161.31.

 

National Correct Coding Initiative

 

Effective on or after October 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will implement the National Correct Coding initiative (NCCI) Procedure to Procedure (PTP) edits for Durable Medical Equipment (DME).  This will affect services related to wheelchair bases (WCB), wheelchair options and accessories (WCOA), and wheelchair seating (WSC).

 

South Carolina Medicaid Preferred Drug List

 

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after October 15, 2012.

 

ANTIHYPERURICEMICS

Preferred

Non-Preferred

ADDITIONAL SERVICES PERFORMED BY KEPRO

 

Effective with dates of service on or after October 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will require prior authorization (PA) for the following services and medical record pre-payment review from our Quality Improvement Organization (QIO), KePRO.

Birth Outcomes Initiative Modifiers

 

In July 2011, the South Carolina Department of Health and Human Services (SCDHHS) began partnering with the South Carolina Hospital Association (SCHA), the March of Dimes, other state agencies, public and private providers and payors, consumers and advocacy groups in an effort to reduce the number of low birth weight babies born in South Carolina.  One of the first steps towards this goal was the elimination of non-medically necessary elective inductions and elective cesareans prior to 39 weeks gestation.

 

South Carolina Medicaid Preferred Drug List

 

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after August 1, 2012.

 

ANTICONVULSANTS, RECTAL PREPARATIONS

Preferred

Non-Preferred

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