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Medicaid State Plan Amendment (SPA) Related to Targeted Case Management

The South Carolina Department of Health and Human Services (SCDHHS) is in the process of submitting a State Plan Amendment (SPA) for Targeted Case Management (TCM) to the Centers for Medicare and Medicaid Services (CMS). SCDHHS is providing the following updates to the public:

TCM SPA Key Proposals
DRAFT TCM SPA

South Carolina Non-Emergency Medical Transportation

 

Effective February 21, 2012, LogistiCare Solutions, LLC will begin covering the two (2) regions currently operated by Access2Care.  At that time LogistiCare will be responsible for all three (3) South Carolina Non-Emergency Medical Transportation (NEMT) regions in the state.

 

Updates to the SCDHHS Dental Services Program

FREQUENCY LIMITATION APPLICATION
With the transition to DentaQuest (DQ), the South Carolina Department of Health and
Human Services (SCDHHS) made changes to the frequencies allowed for certain dental
services. These changes were communicated in a Provider Bulletin dated October 15,
2010. Providers should review the latest version of the Dental Office Reference Manual
(ORM) to verify frequency limits and to check the web portal to determine if the
beneficiary has received the service within the frequency time period. Failure to follow

Spacers for Metered Dose Inhalers

 

 

I.              Spacers for Metered Dose Inhalers

Retirement of Toll Free Eligibility Verification Line

Effective December 31, 2011, the South Carolina Department of Health and Human Services’ (SCDHHS) toll free eligibility verification line (1-888-809-3040) will no longer be available. This system is currently used by a small number of providers to validate member eligibility and/or to check the status of the most recent payment from SCDHHS. Providers may access this same information via the free SCDHHS Web Tool.

New SCDHHS Website

The South Carolina Department of Health and Human Services (SCDHHS) is excited to announce the launch of its newly designed public website on Monday, Nov. 7, 2011.

Alcohol and Drug Testing Policy

 

Effective with dates of service on or after December 1, 2011, the South Carolina Department of Health and Human Services (SCDHHS) will implement limitations on Alcohol and Drug Screens.  For the complete policy and billing instructions, please see the Physician, Laboratories and Other Medical Professionals manual located at www.scdhhs.gov.

 

Revised Administrative Day Policy

Effective for claims with discharge dates on or after November 1, 2011, the South Carolina Department of Health and Human Services (SCDHHS) has revised the policy for patients eligible for Administrative Days. This revision removes all references to the 50-mile limit for Nursing Home placements. The revised policy will read:

Price Increase For Synagis Injectable

 

Effective for dates of service on or after October 15, 2011, 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 rates for 100mg vial will increase from $1,995.36 to $2,192.89.  The 50mg vial will increase from $1,056.71 to $1,161.31.

 

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