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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.

Medical Assessment of all OSS Residents

 

 

Effective October 1, 2014, SCDHHS will begin to conduct medical assessments of Optional State Supplementation (OSS) residents.  These medical assessments will be required of all residents within the program.  The assessments will be in the form of a survey.  Please note that the new medical assessment policy will not affect any resident’s standing within the program.  To learn more about the new assessment policy please review the OSS Provider Manual on the South Carolina Department of Health and Human Serviceswebsite.

Correction Regarding The Medicaid Targeted Case Management Providers Notice Posted June 26, 2014

The notice that was posted regarding Medicaid Targeted Case Management (MTCM) providers on June 26, 2014, pertaining to Medicaid Targeted Case Management was intended only for  newly enrolled private providers of MTCM. The intent was to advise newly enrolled private providers of MTCM of potential policy changes reflecting “conflict free” care management. Below is the updated correspondence distributed to newly enrolled private providers of MTCM. We apologize for any inconvenience. 

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, 2014. 

ANTIHISTAMINES, MINIMALLY SEDATING

Quality Improvement Organization (QIO) Updates

 

KEPRO's, the QIO, primary role is to prior authorize (PA) select Medicaid services including, but not limited to inpatient admissions, therapy services for adults and children and Durable Medical Equipment (DME).  Effective April 1, 2014, the number of days required for providers to submit requests to the QIO as well as response times for the QIO to render determinations have been changed or revised as indicated below.

Referrals for Medicaid Targeted Case Management

 

Medicaid Targeted Case Management (MTCM) is an available Medicaid covered service that helps individuals in gaining access to doctors, social services, educational resources, jobs and other services.  Anyone who is Medicaid eligible and meets one of the following categories may qualify for MTCM:

Medicaid cards now have a new design

Medicaid cards have been updated to reflect the new Healthy Connections logo, as pictured at right.

Cards with the previous design (below) are still in use and valid too, so please accept either version from your Medicaid beneficiaries.

Medicaid Targeted Case Management (MTCM) services

 

South Carolina Department of Health and Human Services (SCDHHS) is accepting applications from entities interested in providing Medicaid Targeted Case Management (MTCM) services.  Prospective South Carolina Healthy Connections Medicaid providers may apply through an online application. This new process will ensure the security of providers’ information and is accessible from any computer that has internet access. Provider enrollment requirements include: 

State Medicaid Agency Releases Report Identifying Regulations Causing Burdens on South Carolina Businesses

 

The South Carolina Department of Health and Human Services (SCDHHS) releases its findings on current regulatory burdens on businesses. The report was developed in response to Governor Nikki Haley’s Executive Order, 2013-02, to establish a Regulatory Review Task Force to reduce government involvement in businesses and encourage entrepreneurial activities and economic growth. The SCDHHS-generated report was submitted to the task force in May.

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