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Bulletins and Information for All Medicaid Providers

Prior Authorization for Transplant Services

Effective Jan. 1, 2022, the South Carolina Department of Health and Human Services (SCDHHS) will accept prior approval of an organ transplant by the agency’s quality improvement organization (QIO) as approval for a Healthy Connections Medicaid member to be treated out of state, if applicable. The agency’s QIO is Keystone Peer Review Organization (KePRO). Providers must continue to contact KePRO for prior authorization before rendering transplant services.

2022 Provider Enrollment Application Fee

The Centers for Medicare and Medicaid Services (CMS) has announced the enrollment application fee amount for calendar year 2022 will be $631. This fee is required with any applicable Healthy Connections Medicaid provider enrollment application.

November 2021 Payment Schedule

The South Carolina Department of Health and Human Services (SCDHHS) will operate on an updated schedule for Healthy Connections Medicaid claims submission and payments for one week in November 2021 to accommodate the 2021 Thanksgiving holiday.

Rate Increase for Adult Day Health Care Providers (S5102)

The South Carolina Department of Health and Human Services (SCDHHS) has increased the reimbursement rate for adult day health care services provided to Healthy Connections Medicaid members participating in home and community-based waiver programs.

Rate Increase for Respite Services (T1005)

The South Carolina Department of Health and Human Services (SCDHHS) has increased the reimbursement rate for respite care services provided to Healthy Connections Medicaid members participating in waiver programs operated by the South Carolina Department of Disabilities and Special Needs (DDSN).

Coronavirus Disease 2019 (COVID-19) Third Dose of Vaccine Administration Coverage

The South Carolina Department of Health and Human Services (SCDHHS) will reimburse for the administration of additional doses of the COVID-19 vaccine consistent with the updated emergency use authorization issued by the U.S. Food and Drug Administration (FDA) and the recommendations of the Centers for Disease Control and Prevention (CDC).

Vaccines for Children Policy and Coding Update

The South Carolina Department of Health and Human Services (SCDHHS) is issuing a clarification regarding billing for vaccine administration current procedural terminology (CPT) codes 90460 and 90461 for vaccines obtained through the Vaccines for Children (VFC) program to Healthy Connections Medicaid-enrolled children. The guidance included in this bulletin replaces existing SCDHHS guidance on this topic, including the agency’s Oct. 15, 2020, bulletin .

 

Prostate Cancer Screenings Added to Limited Benefit Program

The South Carolina Department of Health and Human Services (SCDHHS) today announced it will add coverage of prostate cancer screenings for members of the Family Planning limited benefit program beginning Aug. 1, 2021. For those who qualify through the limited benefit program, prostate cancer screenings for the following Current Procedural Terminology (CPT) codes will be covered:

Resuming Onsite Visits for Provider Reviews

Effective July 1, 2021, the South Carolina Department of Health and Human Services’ (SCDHHS) Program Integrity Unit (PI) will resume onsite visits for provider reviews.

In accordance with recommendations from the Centers for Disease Control and Prevention (CDC) and the South Carolina Department of Health and Environmental Control (DHEC), PI is adopting new protocols to conduct onsite reviews. These protocols will support the health and safety of the provider, their staff and the PI team.

Payment Error Rate Measurement (PERM) Program

The Centers for Medicare and Medicaid Services (CMS) has informed the South Carolina Department of Health and Human Services (SCDHHS) that the South Carolina Healthy Connections Medicaid program will participate in the Payment Error Rate Measurement (PERM) program for State Fiscal Year 2022. CMS' PERM program was developed to measure the accuracy of Medicaid and Children's Health Insurance Program (CHIP) payments made by states. Each state is reviewed once every three years. Samples of claims with paid dates of July 1, 2021, through June 30, 2022, will be subject to review.

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